WHY ARE PATIENTS PRESCRIBED PROTON PUMP INHIBITORS - RETROSPECTIVE ANALYSIS OF LINK BETWEEN MORBIDITY AND PRESCRIBING IN THE GENERAL-PRACTICE RESEARCH DATABASE

Objectives: To establish the relation between new prescriptions for pr oton pump inhibitors and recorded upper gastrointestinal morbidity wit hin a large computerised general practitioner database. Design: Retros pective survey of morbidity and prescribing data linked to new prescri ptions for proton pump inhibitors and comparison with licensed indicat ions between 1991 and 1995. Setting: General Practice Research Databas e and prescribing analysis and cost (PACT) data for the former West Mi dlands region. Subjects: Information for 612 700 patients in the Gener al Practice Research Database. Anonymous PACT data for all general pra ctitioners in West Midlands region. Main outcome measures: Diagnostic codes linked to the first prescriptions issued for proton pump inhibit ors; relation between new prescriptions and licensed indications; year ly change in ratio of new to repeat prescriptions and prescribing volu mes measured as defined daily doses. Results: Oesophagitis was the com monest recorded indication in 1991, accounting for 31% of new prescrip tions, but was third in 1995 (14%). During the study new prescriptions increased substantially, especially for duodenal disease (780%) and n on-ulcer dyspepsia (690%). In 1995 non-specific morbidity accounted fo r 46% of new prescriptions. The total volume of prescribing rose 10-fo ld between 1991 and 1995, when repeat prescribing accounted for 77% of the total. Conclusions: Changes in recorded morbidity associated with new prescriptions of proton pump inhibitors did not necessarily refle ct changes in licensed indications. Although general practitioners see med to respond to changes in licensing, particularly for duodenal and gastric disease, prescribing for unlicensed indications non-ulcer dysp epsia and non-specific abdominal pain increased.