S0385 Implementation of a Deprescribing Tool to Reduce Inappropriate Proton Pump Inhibitor Use

Abstract

INTRODUCTION: Recent perceptions of inappropriate PPI use have led to an increased interest in deprescribing; however, evaluation of different PPI deprescribing methods have been inconsistent. Inappropriate use of a PPI usually occurs either in the absence of an absolute indication or for non-absolute indications without considering or attempting PPI cessation. The purpose of this project was to study the effectiveness of a deprescribing algorithm to reduce inappropriate use of PPIs in an outpatient gastroenterology clinic. METHODS: This project recruited adult patients seen in the outpatient gastroenterology clinic that were on PPI therapy for more than 8 weeks. Patient’s eligible for study completed an initial GerdQ and were contacted at 2-week and 4-week post intervention for follow up. The primary outcome measure was symptom control, defined as a change in positive predictor GerdQ difference of ≤ 2 at 4 weeks. Baseline variables were assessed with descriptive statistics for analysis and project evaluation. RESULTS: The baseline (week 0) mean GerdQ (1.6 ± 2.09762) was marginally increased at week 2 (1.6667 ± 2.19306) and remained stable at week 4 (1.6667 ± 2.25726). A paired-samples t tests was calculated to compare the mean GerdQ score at baseline to the mean change in GerdQ score at 4 weeks. A significant change from baseline to week 4 was found (t(14) = 2.860, P < 0.05). Of the 15 participants, 13 (87%) had a score change ≤2. CONCLUSION: Overall, most participants (87%) had a statistically significant stability in their GerdQ scores at 4 weeks after having their PPIs deprescribed. These results are considerably higher than the predetermined goal of at least 25% participants with symptom control used to evaluate project effectiveness. It has been widely accepted in the medical community that PPIs are often prescribed inappropriately. The appeal for evidence-based guidelines has been expressed among many medical practitioners to improve their deprescribing capabilities. The potential reduction in health care expenditures, adverse effects, and pill burden strengthens the need to deprescribe PPIs used inappropriately. Results from this study will hopefully encourage clinicians to routinely evaluate use of ongoing medications and deprescribe where appropriate.Figure 1.: PPI deprescribing algorithm. Please note that participants were monitored at 2 and 4 weeks rather than 4 and 12 weeks. Reprinted with permission.Table 1.: GerdQ tool used to measure clinical data at baseline (Week 0), Week 2, and Week 4Table 2.: Comparison of outcome measures assessed by GerdQ score at baseline (week 0), week 2, and week 4. (a) Total of difference in GerdQ scores. Negative values indicate increase in positive predictors in GERD symptoms while positive values indicate decrease in positive predictors in GERD symptoms