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The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

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.

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Conflict of interest

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that Jesper Hallas has participated in research projects funded by Nycomed, the manufacturer of pantoprazole, and AstraZeneca, the manufacturer of Nexium (esomeprazole) and, with grants paid to institutions where they have been employed. Jesper Hallas has personally received fees for teaching from Nycomed and consulting from the Danish Association of Pharmaceutical Manufacturers.

Michael Due Larsen, Mette Schou and Anja Sparre Kristiansen declare no conflicts of interest.

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Authors and Affiliations

  1. Faculty of Health Sciences, Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, J. B. Winsløwsvej 19, 2. sal, Odense M, 5000, Denmark

    Michael Due Larsen, Mette Schou, Anja Sparre Kristiansen & Jesper Hallas

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  1. Michael Due Larsen
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  2. Mette Schou
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  3. Anja Sparre Kristiansen
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  4. Jesper Hallas
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Correspondence to Michael Due Larsen.

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Larsen, M.D., Schou, M., Kristiansen, A.S. et al. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol 70, 859–865 (2014). https://doi.org/10.1007/s00228-014-1681-2

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  • DOI: https://doi.org/10.1007/s00228-014-1681-2

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