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Original research
Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study
  1. Yujuan Liu1,
  2. Xian Zhu2,
  3. Rongxin Li2,
  4. Jun Zhang1,
  5. Feng Zhang2
  1. 1Clinical Pharmacy Department, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
  2. 2Emergency Department, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
  1. Correspondence to Dr Feng Zhang; jgyyzf{at}


Objectives This study aimed to characterise the prescribing patterns and evaluate the appropriateness of the prescribed proton pump inhibitors (PPIs) in adult patients via a review of electronic medical records in a single-centred hospital.

Design All patients admitted to the outpatient department of Jinshan Hospital, Fudan University, Shanghai, between 1 January 2018 and 31 December 2018 were evaluated. Individuals aged 18 years or above and with at least one dispensing for PPIs were identified as PPI users. New PPI users were defined as a subject who did not receive any dispensing for PPIs in the year prior to the index date. Baseline characteristics of PPI users and their therapies were described by treatment indication, economic indicators and co-prescription, overall and separately.

Setting The prescription database was retrieved from the hospital information system of Jinshan Hospital, Fudan University.

Results Among 18 435 identified PPI users in 2018, 14 219 patients (aged 18 years or above) who had at least one dispensing PPIs were new users (77%), and among them, men accounted for 47%. The mean treatment duration was 23 days. Omeprazole was the most commonly prescribed drug. PPIs are inappropriately prescribed in 50% (13 589/25 850) of prescriptions. Prescription appropriateness analysis indicated that the unapproved indications for PPI new users accounted for 47%; among them, the proportion of gastritis diagnosis was 34%. The proportion of PPI new users with co-prescription of glucocorticosteroids (GCs) who have risk factors accounted for 24% and lower than other co-prescription. A majority of PPI users (73%) reported high-dose PPI prescription. The defined daily dose of oral pantoprazole was the highest, and injectable omeprazole had the highest defined daily cost. In contrast, only the drug utilisation index value of oral esomeprazole was less than 1.0.

Conclusion The results indicate the challenge of PPI use was accompanied by unapproved indications, frequent inappropriate co-prescription with GCs and excessive dosages. Efforts should be paid to promote rational use and ensure the choice of suitable PPI therapy in the future.

  • epidemiology
  • adult gastroenterology
  • preventive medicine
  • health informatics
  • information management
  • health economics

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  • Contributors YL and JZ conceived and designed the study. YL, XZ and RL analysed the data and drafted the manuscript. YL and JZ collected and organised the patient data. FZ critically revised the manuscript. All authors read and approved the final manuscript.

  • Funding The work was funded by the Key Construction Project on Clinical Pharmacy (1229).

  • Disclaimer The funding sources had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was not required for this study. The present study retrospectively analysed data abstracted from the hospital information system of Jinshan Hospital without interventions or disruptions to patients’ lives, and no direct human participants were involved, thus informed consent was not required and waived by the Ethics Committee of Jinshan Hospital Affiliated to Fudan University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.