Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

Wade Thompson,Dorte Ejg Jarbøl,Carina Lundby,Jesper Bo Nielsen,Peter Haastrup,Jette Videbæk Le,Malene Nissen

doi:10.1186/s12875-020-01227-5

Wade Thompson, Dorte Ejg Jarbøl + Show 5 more

Open Access

https://doi.org/10.1186/s12875-020-01227-5

Copy DOI

Abstract

BackgroundDeprescribing of proton pump inhibitors (PPIs) can be considered in situations where the drug may no longer be necessary; however, this requires a careful discussion between patients and healthcare providers, often general practitioners (GPs). The aim of our study was to explore how GPs discuss PPI deprescribing with patients and compare that to how older patients would like to discuss this decision.MethodsWe conducted a qualitative study using semi-structured interviews with GPs (n = 11) and patients aged ≥65 years who were taking PPIs (n = 4). Analysis of interviews was based on systematic text condensation.ResultsWe identified four main themes: (1) Reasons PPI deprescribing comes up, (2) Considering PPI deprescribing, (3) Discussion topics, and (4) Incorporating patient preferences into PPI deprescribing decisions. We found that PPI deprescribing often comes up during consultations for other problems or due to concern about medication burden in general. GPs discussed topics related to symptom control, such as the possibility of rebound symptoms, the need to taper PPIs, and what to do if symptoms returned. This aligned with what patients felt was important to discuss. Some GPs routinely incorporated patient preferences into decisions, whereas others did not.ConclusionWhen discussing PPI deprescribing, the GPs in our study generally focused on topics related to symptom control. There was variability in how and if patient preferences were discussed. Greater focus may be needed on developing mechanisms to elicit and incorporate patient preferences into PPI deprescribing decisions. Future research could also explore more systematic approaches to reassess ongoing PPI use in an effort to curb unnecessary long-term use of PPIs.

Highlights

Deprescribing of proton pump inhibitors (PPIs) can be considered in situations where the drug may no longer be necessary; this requires a careful discussion between patients and healthcare providers, often general practitioners (GPs)
We identified four main themes: (1) Reasons PPI deprescribing comes up, (2) Considering PPI deprescribing, (3) Discussion topics, and (4) Incorporating patient preferences into PPI deprescribing decisions
Theme 1: Reasons PPI deprescribing comes up Subtheme 1: Concern about medication burden in general GPs noted that deprescribing of PPIs could be discussed as part of a general strategy of reducing medication use in patients taking many medications

Summary

Introduction

Deprescribing of proton pump inhibitors (PPIs) can be considered in situations where the drug may no longer be necessary; this requires a careful discussion between patients and healthcare providers, often general practitioners (GPs). Proton pump inhibitors (PPIs) are common medications, used to treat upper gastrointestinal (GI) problems such as gastroesophageal reflux disease (GERD) and peptic ulcer disease as well as reduce risk of GI bleeding in those at elevated risk [1]. After a treatment course (typically two to 8 weeks), the need to continue the PPI should be reassessed [2, 3]. Many patients eligible for possible discontinuation appear to continue PPIs beyond recommended treatment courses [4]. Consideration of PPI deprescribing may be important in older persons, who are at higher risk of adverse drug events and drug interactions, and tend to use higher numbers of medications [6, 7]

Objectives

Results

Discussion

Conclusion