Patient and physician predictors of inappropriate acid-suppressive therapy (AST) use in hospitalized patients.

BACKGROUND: The use of acid suppressive therapy (AST) in prevention of stress ulcers has been well defined in critical care patients, though its use has become increasingly common in general medicine patients, with little to no supportive evidence. None of the previous studies has examined the patient and physician characteristics of inappropriate AST initiation and use in hospitalized patients. The aim of our study was to identify: (1) the appropriateness of AST in hospitalized patients and the cost associated with inappropriate use; and (2) patient and physician characteristics predicting inappropriate initiation and use of AST.
METHODS: All discharges over a period of 8 consecutive days were selected.
RESULTS: There were 207 patients discharged over a period of 8 days. AST was inappropriately initiated in 92 of 133 (69.2%) patients included in our study. On univariate analysis, higher hemoglobin value, postgraduate year 1 (PGY-1) residents, physicians with an MD degree, international medical graduates (IMGs), and internal medicine physicians were more likely to prescribe AST inappropriately. On multivariate analysis, a higher hemoglobin value, PGY-1 residents, and MD physicians were factors associated with inappropriate AST use. The total direct patient cost for this inappropriate use was $8026, with an estimated annual cost of approximately $366,000.
CONCLUSIONS: AST was inappropriately initiated in 69.2% of patients with increased direct costs of $8026. Residents in their first year of training as well physicians with a MD degree are more likely to initiate AST inappropriately. Curtailing the inappropriate use of AST therapy may reduce overall costs for the patient and institution. Copyright 2009 Society of Hospital Medicine