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Physician and Patient Education Can Lead to Reduction in Inappropriate PPI Use

Prateek Sharma, MD, FASGE, reviewing Lin D, et al. Clin Gastroenterol Hepatol 2019 Dec 27.

The use of proton pump inhibitors (PPIs) for the treatment of upper gastrointestinal disorders has been increasing over the years, leading to concerns over their appropriateness of indications, duration of use, risk of side effects, and costs to patients and the health care system. This study evaluated the impact of an educational program to assist in tapering total and inappropriate uses of PPIs. 

In this study conducted within the Harris Health System and the resident’s clinic at Baylor College of Medicine, primary care physicians and internal medicine residents were provided with a series of Grand Rounds, noon conferences, clinic flyers, and emails focusing on PPI reduction interventions that included information about appropriate indications, duration of therapy, and adverse effects. Pharmacy staff provided in-person patient education regarding potential adverse effects of PPIs, along with a handout with instructions to discuss appropriateness of PPI discontinuation with their provider. Furthermore, a PPI-tapering algorithm was developed to reduce the risk of rebound acid hypersecretion and help improve patient compliance with discontinuing PPI therapy. Overall, prescription data from 16 pharmacies were collected, and a retrospective chart review was conducted to assess the appropriateness of PPI de-escalating efforts. The average numbers of PPI prescriptions per month and the number of inappropriate PPI prescriptions were compared preintervention and postintervention. 

There were significant decreases in the total prescription number and the number of PPI pills dispensed before and after intervention: 66,261 versus 55,322 prescriptions (16.5% decrease, P<0.0001) and 3,990,790 versus 3,194,651 pills dispensed (19.9% decrease, P<0.0001). Similarly, the number of inappropriately prescribed PPIs showed a significant reduction from 70% to 52% postintervention (P=0.005).

COMMENT

A multifaceted approach that includes physician and patient education can result in a significant decrease in overall and inappropriate uses of PPI within a health care system.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Prateek Sharma, MD, FASGE

CITATION(S)

Lin D, Eke C, Cai C, Thrift AP, Shukla R. Decreasing overall and inappropriate proton pump inhibitor use: perspective from a large safety-net healthcare system. Clin Gastroenterol Hepatol 2019 Dec 27. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2019.12.015)

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