Patterns of proton pump inhibitor prescription: a retrospective study from a tertiary hospital in Saudi Arabia

Abstract

Background and Objective Proton pump inhibitors (PPIs) are overprescribed extensively. This presents a significant clinical challenge, leading to unnecessary polypharmacy and increased risk of adverse events. Overuse in the hospital settings is well documented. However, there is limited evidence on prescribing patterns for outpatients in Saudi Arabia. This study investigated PPI prescription frequency among outpatients and assessed demographics, specialty-group, and diagnosis associations with prescription rates after accounting for observable time. Materials and Methods A retrospective cohort analysis was conducted using electronic health records from the calendar year of 2023. Adult outpatients who received at least one PPI prescription were included. The outcome was the number of PPI prescriptions per patient. Descriptive statistics, univariate analyses, and Poisson regression with robust standard errors were used to identify the primary demographic and clinical predictors of prescription frequency. Results A cohort of 5586 patients was analysed, accounting for 30,748 discrete prescription events. Females constituted 55.2% of the cohort, and the mean age was 52.4 years. Pantoprazole accounted for 73.5% of all cases, dominating the volume of prescription. Although 46.8% of patients required only one prescription, the median number of PPI prescriptions was two per patient and 299 patients (5.4%) received five or more prescriptions. In adjusted analyses of patients with complete covariate data (n = 5,482), prescription rates increased with age (Model A IRR 1.005 per year, 95% CI, 1.004–1.006; p < 0.001) and were higher among Non-Saudi Arab patients than Saudi patients (IRR, 1.085; 95% CI, 1.035–1.137; p < 0.001). In the diagnosis model, systemic lupus erythematosus (IRR, 1.249), type 2 diabetes mellitus without complications (IRR, 1.137), and essential hypertension (IRR, 1.176) were associated with higher prescription rates. Conclusion Outpatients being managed for complex cardiovascular and metabolic conditions demonstrated elevated and sustained PPI prescriptions. These findings support the need for improved medication review and rational prescribing strategies. Pharmacist-led stewardship and indication-based review within electronic health records may be appropriate areas for future intervention. Future studies should assess indication, dose, treatment duration and guidelines compliance.