Clinical audit to assess whether the current use of proton pump inhibitors in a general practice conforms to standard guidelines

Abstract

Introduction: Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. The present clinical audit identifies the patients who are on Proton Pump Inhibitor (PPI) therapy and assess whether their indication for proton pump indicators is appropriate as per the standard guidelines. The data is collected by the personal interview of patients or their attenders and filled information in the questionnaires and results are analysed. Effective interventions are made and then a second phase audit is conducted. Again data is collected and results are analysed. Proton pump inhibitors (PPIs) are a group of drugs that cause pronounced and long-lasting reduction of gastric acid production. PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Our audit aimed to assess whether the current use of proton pump inhibitors in a general practice conforms to standard guidelines. Results: Out of 205 patients, appropriate use was found in 176 cases, and inappropriate use of PPIs was found in 29 cases in phase I audit. After intervention, Phase II audit is conducted and results are evaluated. Out of 250 patients, appropriate use was found in 248 cases, and inappropriate use of PPIs was found in 2 cases in phase II audit. The inappropriate use of proton pump inhibitors was decreased in the Phase II by around 14.2%, when compared to the Phase I audit. Conclusion: The present clinical audit showed the usage pattern of PPIs in a wide range of indications. PPIs should be used only when there is valid documented evidence and when their use is clinically justified. This clinical audit has strongly highlighted that there is inappropriate use of PPI as add on drug for corticosteroids. Various efforts should be made to reduce the unnecessary use of PPIs to minimize drug interactions, related risks, adverse effects and health care costs.