Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study
In study conducted in network of Veterans Affairs medical centres in US, a large scale, pharmacy based PPI overuse intervention reduced use overall (7.3% absolute reduction) & also in patients appropriate for gastroprotection, with minimal evidence of clinical benefits/harms.
Source:
British Medical Journal
SPS commentary:
In the study, the number of patients analysed per interval ranged from 192,607 to 250,349 in intervention sites and from 3,775,953 to 4,360,868 in control sites, with 26% of patients receiving PPIs before the intervention.
The intervention also resulted in an 11.3% absolute reduction in percentage of time patients at high risk for upper GI bleeding had appropriate PPI gastroprotection, but there was no increased hospital admissions for peptic ulcer disease in older patients at high risk. There was no increase in healthcare resource utilisation related to upper GI symptoms as assessed by primary care visits with GI diagnoses and upper GI endoscopies
The VISN 17 PPI overuse initiative had five components:
(1) Targeted restrictions on PPI refills: if clinician failed to document appropriate indication for chronic use in prescription, it was limited to 90 days without refills or 30 days with up to two refills but allowed to order de novo (or renew) for patients whose refills had been restricted.
(2) Voiding inactive prescriptions: prescriptions not filled within six months were discontinued.
(3) Facilitated prescribing of H2 receptor antagonists: a quick order option was added to the medication order menu to help with tapering of PPIs.
(4) Education for clinicians and patients:
(5) Data resources: VISN 17 pharmacists created a reporting tool to capture prescriptions for high dose PPIs for tracking purposes.