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Reducing Unnecessary Chronic Use of PPIs in a VA Primary Care Clinic: A QI Project


Buaisha, Haitam MBBCh1; Abuhamidah, Nawras MBBCh2; Emsalem, Rabie MBBCh2; Alshebani, Yazeid MBBCh2; Fordjour, Akua MD, PhD2; Jamieson, Elizabeth PharmD3; Puhl, James PharmD3; Reddymasu, Savio MD2; Cichowski, Erica MD2

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S638
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Introduction: Proton pump inhibitors (PPIs) are a widely used class of medications in the US, with total annual sales exceeding over $10 billion dollars. There has been a recent flurry of studies that associate long term PPI use with increased rate of clostridium difficile colitis, hypomagnesemia, and CKD among others. It is also estimated that up to 60% of patients taking PPIs do not have an appropriate indication for continued use of the medication.

Methods: DEFINING THE PROBLEM: In January 2017, we undertook a chart review of 50-patients in the primary care clinic who were on long term PPI therapy (more than one year). This revealed that 80% of these patients did not need to be on a PPI based on societal recommendations. Moreover, VA pharmacy data from November 2016 showed that of the 1003 patients on long term PPI therapy, only 17.6% had a possible indication to be on this medication.

AIM OF THE PROJECT: To reduce unnecessary long term PPI therapy by at least 5% in 3 months.

PLAN: Educate and encourage Internal Medicine residents to apply an evidence based de-prescribing algorithm to stop unnecessary use of PPIs.

INTERVENTIONS: 1) A 15 minute didactic was provided to all residents who had their continuity clinic at the Omaha VA. 2) Residents were provided with an evidence based de-prescribing algorithm to help taper or discontinue PPI use. 3) Residents were given a list of their patients who are on PPIs for more than one year. 4) A new Pharmacy medical therapy management consult was made available to assist with tapering of PPIs.

Results: Of the 1003 patients on long term PPI therapy, 168 (16.7%) patients were not on a PPI within 2.5 months of starting the above mentioned interventions.

Conclusion: 1) Resident education on: a) Potential side effects of PPIs, b) Appropriate indications of long term PPI use, and c) Application of evidence based de-prescribing algorithm is a very effective tool in reducing unnecessary use of proton pump inhibitors. 2) Educational material including brief lectures, email reminders and/or or handouts should be carried out at least annually for sustained reduction in unnecessary PPI use.

© The American College of Gastroenterology 2017. All Rights Reserved.