Initial proton pump inhibitor characteristics associated with long-term prescriptions in US veterans diagnosed with gastro-oesophageal reflux disease

Objectives: The objectives were to (1) determine initial proton pump inhibitor (PPI) prescriptions in US veterans diagnosed with gastro-oesophageal reflux disease (GERD); (2) assess initial PPI prescription factors associated with long-term PPI prescriptions at the national level; (3) determine healthcare use in patients with short- and long-term PPI prescriptions. Methods: US veterans aged 18-90 years with a clinical outpatient diagnosis of GERD from 2003 to 2007 were eligible for the study. Analyses assessed differences in prescribing patterns and healthcare use by PPI prescription duration (short term (<6 months) versus long term (≥6 months to 2 years)). Multivariable logistic regression was used to determine the initial prescription factors associated with long-term PPI prescriptions adjusted for demographic and clinical characteristics. Key findings: A majority of patients with GERD and initial PPI prescriptions (n=177394) were classified as having long-term PPI prescriptions (77.5%). A minority of patients received initial high daily dose prescriptions, and this differed slightly between short (18.3%) and long (16.2%) prescriptions (P<0.0001). More patients received ≥90-day initial supply of medication in those patients classified with long-term prescriptions (71.4% versus 58.7%, P<0.0001). Patients who provided a ≥90-day total supply of the initial prescription were more likely to be dispensed PPIs long term (odds ratio 1.71; 95% CI, 1.67 to 1.76) when adjusted for patient demographic and clinical characteristics. Patients with long-term PPI prescriptions had more overall healthcare encounters, predominantly of primary care origin. Conclusions: The quantity of initial PPI prescriptions provided to Veterans does not reflect the guideline recommendations for GERD management and could affect long-term use of these pervasive medications.