S1496 Addressing over Prescription of PPI in an Outpatient Underserved Population

Abstract

Introduction: Long term use of PPIs has been associated with increased risk of mineral and vitamin deficiencies and in some studies with C. Difficile Colitis. It is estimated that 25%-70% of PPI prescriptions are without an appropriate indication. The aim of this study was to discontinue at least 10% of the patients on PPIs who do not have an appropriate indication for therapy over the course of a 6-week period. Methods: This study took place at a medically underserved resident clinic in Hartford Connecticut. Patients scheduled between 09/16/21 and 10/01/21 were pre-screened using EMR review. Any patient with a PPI on their medication list was included in the data set. Patients were stratified based on clinical need for PPI and potential for tapering using ACG Clinical Guidelines. Providers were educated on the clinical guidelines for PPI therapy. Patients on standard dosing were reduced to 50% dosing for 2 weeks and then discontinued. Patients were provided with as needed H2 Blocker for possible rebound symptoms. A total of 114 patients on PPI with appointments during the time window were identified. On the date of their visit, providers assessed individual patient PPI usage and discontinuation eligibility. Patients eligible for discontinuation of PPI were advised to dose reduce by 50% for 2 weeks and prescribed as needed H2 blocker. Providers also provided education on how to take PPI appropriately. Patients were called 2 weeks later for follow up. At that time if symptoms tolerated, PPI was discontinued. Results: Of the total population, 28% (32/114) were on long term PPI appropriately. Seventy-two percent (82/114) of the patients prescribed PPI lacked a true medical indication. Of these, 44 patients were seen and provided a taper plan. PPI was discontinued successfully in 22% (18/82) of the population of inappropriately prescribed PPI within the 6-week window. Conclusion: The aim of this study to achieve 10% population reduction in inappropriate PPI use was exceeded with roughly 22% discontinuation. Frequent medication reconciliation, patient education on proper PPI use and physician education with ACG Clinical Guidelines were simple changes to successfully improve clinically indicated PPI therapy. Many patients are aware of their triggers and use PPIs as a means of avoiding lifestyle and dietary change. When prescribing PPI, placing a “stop” time on the prescription may further reduce PPI burden.