Perceptions and Practices of Primary Care Physicians Regarding Proton Pump Inhibitors

Abstract

Introduction: Adverse effects associated with proton pump inhibitor (PPI) use are well-documented in medical literature and have become a subject of great interest. Although highly efficacious, the indiscriminant use of PPIs has led to a concern about risks related with over prescription and indefinite usage. Primary care physicians (PCPs) are largely responsible for medically managing the population at risk for excessive PPI use. We studied the knowledge, perceptions, and practices of residents and attending physicians in primary care specialties at a tertiary care university hospital. Methods: We conducted a cross sectional study utilizing survey methods at West Virginia University School of Medicine from March to April, 2018. The study was approved by our Institutional Review Board. Resident and attending physicians in the departments of Internal Medicine and Family Medicine were recruited, and completed the study questionnaire. Data was analyzed using RedCap Software. Results: In a sample of 59 participants comprising 15 attending physicians and 45 residents, 85% reported that greater than 20 patients under their care were using PPIs. However, upon prescribing PPIs, 37% reported that they were either unlikely, or not at all likely to discuss adverse events. Although Clostridium Difficile infection, bone fractures, and kidney disease were correctly identified as adverse effects of PPI's by (74.6%), (86.4%), and (45.8%) of participants respectively, no participant was able to correctly identify all adverse effects associated with PPIs. 78% of participants reported that less than 10% of their patients had inquired about adverse effects of PPIs, word of mouth was the most common medium of learning the potential adverse effects reported by patients, n=24 (40.7%). 31 participants (52%) reported that changing prescribing practices due to the adverse effect profile of PPI's; 80% of the sample reported having discontinued PPIs in 10 patients or less, and 76.3% reported deescalating the doses in 10 patients or less in their practice. Conclusion: Our study explores the perceptions and practices of PCPs regarding to PPI prescription patterns. The knowledge level of participants in our study regarding PPI adverse effects was moderate at best, and although a majority of participants reported concern for PPI adverse effects, this was not translated into a change in practice. Knowing these discrepancies, it is imperative to devise and investigate interventions to improve prescribing behaviors of PCPs.