Multifaceted strategy succeeds in deprescribing PPI in adult patients

An academic, primary care clinic has significantly and sustainably reduced the inappropriate use of proton pump inhibitors (PPI) to 30 percent from the baseline rates of 80 percent, surpassing its goal within 12 months, a recent study has shown.

“This quality improvement was unique as no pharmacy personnel was utilized in this process,” the authors said. “The multifaceted strategies in a safety-net internal medicine clinic resulted in successful deprescribing of PPI and can be replicated in other setting.”

This study sought to reduce the percentage of inappropriately prescribed PPIs in patients aged ≥50 years from 80 percent (baseline) to 60 percent within 12 months in an academic, internal medicine clinic. A multidisciplinary quality improvement team identified barriers to inappropriate PPI use by performing a root cause analysis and by using the Plan-Do-Study-Act Model of healthcare improvement.

The outcome measure was the percentage of patients inappropriately prescribed PPI, while process measures included completion rates of PPI risk assessment and esophagogastroduodenoscopy. The multidisciplinary team carried out interventions, such as the creation of customized electronic health record templates and education to both providers and patients. They performed analysis using monthly statistical process control charts.

PPI discontinuation had an average rate of 51.1 percent (92/180), corresponding to 30.0 percent of inappropriate PPI use within 12 months. The mean rate of PPI discontinuation was 2.0 percent, 32.0 percent, and 49.7 percent in the 1-year prestudy, study, and 6 months poststudy period, respectively.

The mean esophagogastroduodenoscopy completion rate stood at 49.8 percent from the baseline of <30 percent.

“The use of PPIs has increased drastically worldwide,” the authors said. “Internal medicine clinic patients had inappropriate use of PPIs for an average of 4 to 5 years.”