“Get Me Off This Medication!”: A Comparison Between Gastroenterology and Primary Care Regarding Patient’s Perceptions of Proton Pump Inhibitor Therapy

Abstract

Background Not much is known about patient perceptions regarding proton pump inhibitor (PPI) de-escalation. We sought to determine the knowledge of adverse effects (AEs) and willingness to de-escalate therapy among patients presenting to primary care and subspecialty clinics. Methods We conducted an anonymous survey of patients presenting to family medicine, internal medicine, and gastroenterology clinics who use PPIs. Survey topics included awareness of and concern for AEs of PPIs, and willingness to de-escalate PPI therapy. Results The sample comprised 206 participants presenting to the gastroenterology (29.8%), internal medicine (32.2%), and family medicine clinics (38%). Of the participants, 16% were "extremely concerned" about AEs and 28.2% reported attempting to stop PPIs by themselves in the past. Many patients (54.9%) reported that providers had not discussed AEs before initiation. Patients visiting digestive disease clinics were no more likely to report discussions on AEs and de-escalation or discontinuation attempts compared to primary care patients (p-values > 0.05). On logistic regression analysis, concern for AEs and counseling regarding PPI discontinuation were found to be significantly associated with attempts to discontinue PPI. Conclusions Although many patients on PPIs are concerned about AEs, a low number of patients reported providerinitiated discussions on AEs of PPI at initiation.

Outcomes of de‐prescribing proton pump inhibitors during acute admissions in a general medical unit: a pilot study

“…The literature suggests that most patients harbour a level of concern regarding PPI use and its side effects in community-based studies. 18,19 Patients' perceptions in our study, however, were inconsistent with this finding. The reason for this is unclear, but patients reprioritising their clinical concerns while acutely unwell is a possibility.…”

“…The literature suggests that most patients harbour a level of concern regarding PPI use and its side effects in community‐based studies 18,19 . Patients' perceptions in our study, however, were inconsistent with this finding.…”

Symptom Profile, Proton Pump Inhibitor Therapy, and Diagnostic Testing in Patients With Persistent Reflux-Like Symptoms: Results From a Population-Based Survey

“…Surveys have found that patients often report that their healthcare providers had not discussed the potential risk of adverse events of PPIs before initiation of therapy. 18,19 This survey confirms the ongoing dissatisfaction with PPIs and GERD therapies, dissatisfaction being reported by 70% of patients who had a self-reported formal diagnosis of GERD or rGERD and were taking a PPI. Patients continued to report troublesome reflux symptoms (70%) and concerns around long-term PPI use (69%) and side effects (77%).…”

“…17 This is important because concerns about PPIs have been associated with attempts at discontinuation without a physician's recommendation, and discontinuations increased in association with increasing levels of patient concern. 17,18 In one survey, patients with concerns about long-term side effects were more than twice as likely to make changes to their PPI use, often without physician input, compared to patients who did not express concerns. 19 This survey found that respondents with GERD/rGERD using PPIs had frequently tried other medications, including antacid/alginates (73%), histamine H 2 -receptor antagonists (36%), mucosal protectants (26%), and prokinetics (20%).…”

The Inappropriate Use of Proton Pump Inhibitors: An Internal Medicine Residency Clinics Effort to Deprescribe

“…Literature reports an abundance of adverse effects from PPI use, including those mentioned above in addition to gastric neoplasia, liver disease and even dementia [6][7][8]. Although relatively rare when compared to the widespread use of PPIs, considerations should be made on the necessity of unnecessary treatments when no longer warranted.…”