Improving the Use of Proton Pump Inhibitors

When used correctly, proton pump inhibitors (PPIs) can be effective in treating patients with acid reflux, ulcers, and other digestive issues. However, there is evidence that they have been overprescribed in recent years, leading to inappropriate usage. This is unnecessary and can be unsafe, leading researchers to examine ways by which inappropriate PPI use could be reduced.

To improve upon the proper prescription of PPIs, the root cause of inappropriate use needed to be identified. This led researchers on a quest to uncover the root cause of the problem, as well as to discover a solution to the issue at hand.

The Study

Worldwide, PPI use has increased dramatically. So much so that internal medicine clinic patients averaged inappropriate use for four to five years. To identify the underlying issues and correct them, a team of researchers utilized a health care improvement strategy known as Plan-Do-Study-Act Model and analyzed the potential root causes of this misuse.

Several factors were measured, including the rates of PPI risk assessment and esophagogastroduodenoscopy completion, as well as the percentage of patients prescribed PPI inappropriately.

Interventions were also implemented, including customized health record templates and improved PPI education for both patients and providers.

Findings

The goals of this study included the identification of root causes of over-prescription, reduction of the number of new inappropriate uses, and the active decreasing the number of current misuses.

All three of these goals were achieved, as PPI use was discontinued by 51.1% in correspondence to 30% inappropriate usage of PPI within 12 months. The discontinuation rate was further analyzed by examining it one year prior to the study, during the study, and six months after the study. These rates were 2%, 32%, and 49.7%, respectively.

What it Means

This trial demonstrated that there are ways in which to produce statistically significant reductions in inappropriate PPI use. Not only is this reduction possible, but it is also sustainable using simple methods. Notably, these results were also accomplished without the inclusion of pharmacy personnel.

Because of the impressive achievements of this study and the fact they can be replicated, similar strategies can be implemented in other settings. In turn, this could lead to even more widespread deprescribing of PPIs, helping massively reduce the inappropriate use of the drugs in question.