Do Intervention Programs Reduce Unnecessary PPI Use?

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A December 2019 study published in Clinical Gastroenterology and Hepatology looked at a 2017 intervention program meant to decrease the inappropriate use of proton pump inhibitors (PPIs) in the Harris Health System in Harris County, Texas. Results indicate the intervention program decreased the number of PPI prescriptions by 16.5% in a year, from 66,262 to 55,322. Researchers found that 56 of 80 (70%) new PPI prescriptions made in the quarter year before the intervention were inappropriate either by indication (intended use) or by duration of prescription. After the intervention, that number dropped to 52%.

PPIs, a group of medications used primarily to reduce stomach acid secretion to treat conditions related to damage of the lining of the stomach and esophagus, can pose unnecessary risks to patients if the medication is unwarranted or used excessively. PPIs are associated with an increased risk of gastrointestinal infections.

A recent French study published in the Journal of the American Medical Association found that long-term use of PPIs has a 181% increased risk of viral gastroenteritis, commonly known as the “stomach bug.” PPIs are also associated with problems absorbing important dietary nutrients including magnesium and vitamin B12, according to Gastroenterology.

With as many as 65% of patients using PPIs having no continued justification and 8.8% of ambulatory patients with documented PPI use, these interventions might be important to help reduce excessive or unnecessary PPI prescriptions and over-the-counter use by patients.

By Benjamin Duong

Benjamin Duong is a medical student and freelance writer based in Dothan, Alabama. He has a Masters of Public Health from the George Washington University and majored in microbiology and political science at the University of Florida. He has worked on advocacy for issues ranging from medical education to global maternal and infant mortality.

Footnotes

Bustillos H. et al. “A cross-sectional study of national outpatient gastric acid suppressant prescribing in the United States between 2009 and 2015.” PLOS. 2018 Nov; https://doi.org/10.1371/journal.pone.0208461.

Lin D. et al. “Decreasing Overall and Inappropriate Proton Pump Inhibitor Use: Perspective From a Large Safety-Net Healthcare System.” Clinical Gastroenterology and Hepatology. 2019 Dec; https://doi.org/10.1016/j.cgh.2019.12.015

Nardino RJ, Vender RJ, Herbert PN. “Overuse of acid-suppressive therapy in hospitalized patients.” Am J Gastroenterol. 2000 Nov;95(11):3118–22.

Vaezi, Michael F. et al. “Complications of Proton Pump Inhibitor Therapy.” Gastroenterology, Volume 153, Issue 1, 35–48.

Vilcu A, Sabatte L, Blanchon T, et al. “Association Between Acute Gastroenteritis and Continuous Use of Proton Pump Inhibitors During Winter Periods of Highest Circulation of Enteric Viruses.” JAMA. 2019; 2(11):e1916205. doi:10.1001/jamanetworkopen.2019.16205

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