Prescribing variation of proton pump inhibitors and policy implications in a Japanese hospital

Background

While inappropriate proton pump inhibitors PPI use has been extensively documented in Western countries, prescribing behavior and its underlying decision-making patterns are poorly characterized in Japanese hospital settings. We aimed to examine the prescribing behavior of PPIs in a Japanese general hospital and to identify clinical and pharmacological factors associated with prescriptions lacking clear clinical justification.

Methods

This retrospective observational study involved adult inpatients who were prescribed oral PPIs between December 2017 and March 2018. Prescriptions were assessed for justification based on approved indications and commonly accepted off-label use. Patients were classified according to the presence or absence of clear prescribing justification. Multivariable logistic regression analysis was performed to identify factors associated with prescribing behavior lacking justification.

Results

Among 334 patients, 131 (39%) received PPIs without clear clinical justification. Older age and routine selection of esomeprazole were independently associated with prescriptions lacking justification, whereas concomitant antiplatelet therapy and continuation of PPI therapy at discharge were associated with justified prescribing. These findings indicate substantial variations in PPI prescribing behavior and suggest the influence of precautionary and habitual decision-making in routine inpatient care.

Conclusion

There were considerable variations in PPI prescribing behavior in a Japanese general hospital, with distinct decision-making patterns associated with older patient age and preferential selection of esomeprazole. Rather than representing isolated prescribing errors, these patterns reflect systematic tendencies in everyday hospital practice. Structured medication review and pharmacist-led deprescribing strategies may help support more deliberate, transparent, and consistent prescribing decisions.