DOI: 10.5061/dryad.q2bvq83t4
title: Prescribing variation of proton pump inhibitors and policy implications in a Japanese hospital

description: 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.
description: # Prescribing variation of proton pump inhibitors and policy implications
 in a Japanese hospital
 [https://doi.org/10.5061/dryad.q2bvq83t4](https://doi.org/10.5061/dryad.q2bvq83t4) Author(s) Naoto Nakagawa, Phar.D., Ph.D. School of Pharmaceutical Sciences, Ohu University, Koriyama, Fukushima, Japan 31-1 Misumido, Tomita-machi, Koriyama, Fukushima 963-8611, Japan Email: [n-nakagawa@pha.ohu-u.ac.jp](mailto:n-nakagawa@pha.ohu-u.ac.jp) Keita Odanaka, Ph.D. School of Pharmaceutical Sciences, Ohu University, Koriyama, Fukushima, Japan 31-1 Misumido, Tomita-machi, Koriyama, Fukushima 963-8611, Japan Email: [keita.odanaka@sums.ac.jp](mailto:keita.odanaka@sums.ac.jp) Yoshitaka Okubo, BS, RPh. Department of Pharmacy, Sendai Tokushukai Hospital, Sendai, Miyagi, Japan 9-8 Takadamacho, Izumi-ku, Sendai, Miyagi 981-3116, Japan Email: [hoshi@sendai.tokushukai.or.jp](mailto:hoshi@sendai.tokushukai.or.jp) Tsutomu Ogata, BS, RPh Department of Pharmacy, Sendai Tokushukai Hospital, Sendai, Miyagi, Japan 9-8 Takadamacho, Izumi-ku, Sendai, Miyagi 981-3116, Japan Email: [tsutomu.ogata@tokushukai.jp](mailto:tsutomu.ogata@tokushukai.jp) ### Files and variables #### File: Survey\_data.csv **Description:**  All data ##### Variables * Patient No * Compliant: 0= NO, 1=YES * Age: 0= below 29 yo, 1=30-40 yo, 2=41-50 yo, 3=51-60 yo, 4=61-70 yo, 5=71-80 yo, 6=81-90 yo, 7=over 91 yo * Department: 0= Internal Medicine, 1= Cardiology, 2= Neurology, 3= Surgery, 4= Orthopedic Surgery, 5= Neurological Surgery, 6= Thoracic Surgery, 7= Cardiovascular Surgery, 8= Urology * PPI: 0= Lansoprazole, 1= Esomeprazole, 2= Vonoprazan, 3= Omeprazple * Concomitant medication number * Concomitant use of anticoagulants: 0=No, 1=Yes * Concomitant use of anti-platelet agent: 0=No, 1=Yes * Concomitant use of steroids: 0=No, 1=Yes * Concomitant use of NSAIDs: 0=No, 1=Yes * History of GI bleed: 0=No, 1=Yes * PPI listed on discharge medication list: 0=No, 1=Yes * PPI prophylaxis: 0=No, 1=Yes