Predictors of inappropriate prescribing of acid suppressive medications among medical inpatients in a referral hospital in Kenya

Abstract

Objective: To characterize the patterns and determinants of acid suppressive medications use among adult medical inpatients of Kenyatta National Hospital.
Design: Cross-sectional study.
Setting: Medical wards in the hospital.
Participants: Inpatients aged ≥18 years.
Interventions: Demographic, clinical characteristics and details of acid suppressant use were examined both by records review and patient interview
Main outcome measures: Demographic characteristics: age, gender; Acid suppressant use: prevalence, types, indication; Factors associated with inappropriate prescribing of acid suppressants.
Results: 272 patients were included in the study. The mean age was 45.4 ± 16.6 years. 55.9% of the participants were on acid suppressive medications, majority (57.0%) being females. Proton pump inhibitors were the most frequently (95.2%) used acid suppressants. Acid suppressive medications were inappropriately prescribed in 178 (65.4%) patients. Internationally recognized indications of acid suppressive therapies accounted for 27 (28.7%) while stress ulcer prophylaxis was indicated in 55 (58.5%) of the patient in whom it was justified. Logistic regression revealed that use of cardiovascular drugs (P = 0.020), corticosteroids (P = 0.001) and anti-cancers (P = 0.012) as well as a diagnosis of pneumonia (P = 0.016) were significantly associated with inappropriate prescription of acid suppressive therapies.
Conclusion: Acid suppressive medication use is high and generally unjustified among the medical inpatients of the Kenyatta National Hospital. Measures aimed at controlling their use by intensifying the evaluation of patients’ in need for appropriate prescribing should be encouraged. Future studies should assess prescribers and hospital contextual factors associated with appropriate use of acid suppressive medications.