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.