Table 4.

The 10 Most Frequently Observed PPOs

PPO Description		Percentage of Total PPOs (N = 55,578)a
1.	Start laxatives in patients receiving opioids regularly	14.7
2.	Start ACE inhibitor with systolic heart failure and/or documented coronary artery disease	7.9
3.	Start statin therapy with a documented history of coronary, cerebral, or peripheral vascular disease, unless patient has end-of-life status or is >85 years old	7.4
4.	Start ACE inhibitor or ARB (if intolerant of ACE inhibitor) in diabetes with evidence of renal disease, that is, dipstick proteinuria or microalbuminuria (>30 mg/24 hours) with or without serum biochemical renal impairment	7.1
5.	Start metformin twice a day with diabetes mellitus type 2 if eGFR is 30-50 mL/min/1.73m2, not if < 30 mL/min/1.73m2	6.5
6.	Start antiplatelet therapy (aspirin, clopidogrel, prasugrel, or ticagrelor) with a documented history of coronary, cerebral, or peripheral vascular disease	5.9
7.	Start aspirin (75-160 mg once daily) in the presence of chronic atrial fibrillation, where vitamin K antagonists or direct thrombin inhibitors or factor Xa inhibitors are contraindicated	5.6
8.	Start β-blocker with ischemic heart disease	5.1
9.	Start vitamin D supplement in older adults who are housebound, are experiencing falls, or have osteopenia (bone mineral density T-score is greater than −2.5 but less than −1.0 in multiple sites)	4.9
10.	Start regular inhaled β2 agonist or antimuscarinic bronchodilator (eg, ipratropium, tiotropium) for mild to moderate asthma or COPD	4.8

ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; COPD = chronic obstructive pulmonary disease; eGFR = estimated glomerular filtration rate; PPO = potential prescribing omission.

Note: PPOs provide information on correct prescribing according to the Screening Tool to Alert doctors to Right Treatment (START) criteria.

^aUnique PPOs per patient over 6 years.