IJPP 2009, 17: 73–75 ß 2009 The Authors Received August 21, 2008 Accepted October 15, 2008 DOI 10.1211/ijpp.17.1.0011 ISSN 0961-7671 Correspondence: Lindsay B. Palkovic, Assistant Professor of Clinical Pharmacy, Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia–Philadelphia College of Pharmacy, 600 S. 43rd St., Philadelphia, PA 19104, USA. E-mail: l.palkovic@usp.edu Short Communication Factors associated with inappropriate inpatient prescribing of acid-suppressive therapy Lindsay B. Palkovic a,b , Kim C. Coley c and Denise R. Sokos c a Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia–Philadelphia College of Pharmacy, Philadelphia, Pennsylvania, b Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center–Presbyterian Hospital and c Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA Abstract Objectives Acid-suppressive therapy is used for 54–70% of inpatients, and is frequently prescribed for inappropriate indications. The objective of this study was to identify characteristics associated with inappropriate prescribing of acid-suppressive therapy. Methods A random sample of adult internal medicine inpatients admitted between 1 July 2005 and 30 June 2006 was screened for acid-suppressive therapy. Patients receiving such therapy without an accepted indication and those not prescribed acid-suppressive therapy were included in group 1 and group 2, respectively. Significant characteristics from separate univariate regression models were entered into a multivariate logistic regression to determine characteristics associated with inappropriate use. The setting was internal medicine units at a tertiary care academic medical centre. Key findings There were 108 patients in group 1 and 134 patients in group 2. Group 1 patients were older, had a longer median length of stay, a greater number of comorbidities, a greater median number of medications upon admission, and a higher rate of cirrhosis. Factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor (odds ratio, 15.3; 95% confidence interval, 4.1–56.3) or histamine 2 receptor antagonist (14.5; 2.8–74.8) prior to admission, cirrhosis (6.4; 1.02–39.5), use of inpatient anticoagulants (2.7; 1.4–5.2) and length of stay (1.1; 1.1–1.3). Conclusions The strongest factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor or histamine 2 receptor antagonist prior to admission, a diagnosis of cirrhosis and use of inpatient anticoagulants. Keywords acid suppressive therapy; histamine 2 receptor antagonists; medication overuse; proton-pump inhibitors Introduction Recent studies report rates of inpatient acid-suppressive therapy (AST) use of 54–71%, much of which is for inappropriate indications (65–90%). [1,2] Despite relative safety and efficacy, AST overuse can lead to polypharmacy, drug interactions, unjustifiable patient expense and wasted health care resources. Whereas overuse is well documented, risk factors for AST overuse are not clearly defined. [1,2] The objective of this study was to identify clinical characteristics that are associated with AST without an accepted indication in adult internal medicine inpatients. Methods This was a retrospective study of adult internal medicine inpatients at a tertiary care academic centre. Patients were eligible if they were 18 years old and admitted to an internal medicine service between 1 July 2005 and 30 June 2006. Patients in an intensive care unit, transferred from an outside hospital or with incomplete medical records were excluded. A randomized, computerized sampling selected equal numbers of weeks per quarter over the study period, and eligible patients admitted during those weeks were chosen for chart review. De-identified admission and discharge summaries and International Classification of Diseases-9th Revision-Clinical Modification (ICD-9-CM) diagnosis codes were screened by the primary 73