Larsen, Michael Due4; Schou, Mette6; Kristiansen, Anja Sparre5; Hallas, Jesper7
1 Institute of Forensic Medicine, Det Sundhedsvidenskabelige Fakultet, SDU2 Clinical Pharmacology and Pharmacy, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU3 Phase IV Unit, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU4 Faculty of Health Sciences, Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, J. B. Winsløwsvej 19, 2. sal, Odense M, 5000, Denmark, firstname.lastname@example.org unknown6 Institute of Forensic Medicine, Det Sundhedsvidenskabelige Fakultet, SDU7 Clinical Pharmacology and Pharmacy, Department of Public Health, Det Sundhedsvidenskabelige Fakultet, SDU
AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing patterns after discharge. METHODS: This register study was conducted at Odense University Hospital, Denmark, and by use of pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the medication regimens of patients were followed across hospitalisation. The influence of hospital drug policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge decreased from 33.5 to 9.4 %, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4 % of esomeprazole use was initiated in the hospital, and this was 8.4 % for PPIs in general. After the change of hospital drug policy, this decreased to 6.5 % for esomeprazole and increased for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1 %, respectively. The effect of a large discount on expensive PPI to hospital was 14.7 %, and this decreased to 2.6 % when coordinating drug policy in hospital and primary care. CONCLUSION: The likelihood of having an expensive PPI prescribed after hospital stay decreased when coordinating drug policy and the influence of a large discount to hospital could be minimised.
European Journal of Clinical Pharmacology, 2014, Vol 70, Issue 7, p. 859-865