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

Abstract

Introduction: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications, and are often prescribed for unnecessarily extended courses. A variety of adverse outcomes have been attributed to prolonged PPI use. Outpatient deprescribing strategies aimed at decreasing the burden of these adverse effects have been infrequently described. Materials and Methods: This was a retrospective before-after observational cohort study of a quality improvement program conducted at an internal medicine residency continuity clinic. The intervention was two-tiered. The first part of our intervention was a 15-minute presentation explaining the indications for discontinuing PPI therapy and the methods by which to do so (tapering versus on-demand). Secondly, an alert prompting the consideration of a PPI Discontinuation Protocol was attached to electronic medical record (EMR) patient records with ICD 10 codes commonly associated with PPI prescriptions. Appropriate PPI indication was based on published guidelines, and patients without an appropriate indication or exceeding the recommended course were targeted for discontinuation. Data collected one year prior to and six months after intervention implementation were compared. All data included patients' demographics, ICD 10 diagnoses which indicated PPI therapy, whether or not the patient was on a PPI, have they ever attempted discontinuation, as well as other data regarding type of PPI with dosages, adverse effects, duration of therapy and whether or not the PPI was ultimately discontinued. Results: Of the 210 patient records reviewed, 115 patients were prescribed PPIs. Comparing pre intervention to post intervention data, a Pearson Chi Square analysis was performed which did not reveal a statistical difference between the rate of PPI discontinuation attempts pre and post intervention (p-value > 0.05). Conclusions: Education and raising awareness in the outpatient setting of the adverse effects resulting from prolonged use of and over prescription of PPIs could possibly increase the rate of reevaluation for continued use and de-prescription as seen in our study.