P2225 - Reducing Inappropriate Use of Proton Pump Inhibitors in Outpatient Settings: A Quality Improvement Project

Saqr Alsakarneh, MD¹, Vinay Jahagirdar, MD², Noor Hassan, MD², Ahmed Husain, MD³, Parth Sharma, MBBS⁴, Roshni Thomas, MD¹, Zainab Humayan, MD¹, Kevin Varghese, MD⁵, Julie Banderas, PharmD², David Wooldridge, MD^6
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; ²University of Missouri Kansas City School of Medicine, Kansas City, MO; ³University of Missouri Kansas City, Kansas City, MO; ⁴University of Missouri, Kansas City, MO; ⁵University of Missouri - Kansas City School of Medicine, Kansas City, KS; ⁶University of Missouri, Overland Park, KS

Introduction: Proton pump inhibitors (PPIs) are among the most commonly used medications worldwide. PPI overuse is not only linked to severe adverse effects like pneumonia and Clostridioides difficile infections, but also imposes economic costs and contributes to polypharmacy. The rate of inappropriately prescribed PPIs for patients at University Health (UH) internal medicine (IM) resident clinics between July and December 2023 was 66%. We aimed to reduce the rate of inappropriate PPI prescriptions among UH adult patients in resident clinics by 20% in three months.

Methods: A quality improvement team conducted a root cause analysis (RCA) to identify barriers to inappropriate use of PPIs in UH clinics. Interventions were designed based on the RCA findings, which included the creation and implementation of customized educational curricula for IM residents. Educational efforts included in-person presentations and dissemination of infographics and handouts via email to IM residents. Additionally, pre- and post-intervention surveys were used to test the residents’ knowledge regarding the appropriate use of PPIs. The outcome measures were the percentage of patients inappropriately prescribed PPIs and resident knowledge of appropriate indications of PPIs. The interventions were complemented by Plan-Do-Study-Act (PDSA) cycles to ensure a comprehensive approach. A run chart was used for the analysis.

Results: Educational sessions for residents were conducted in December 2023, and materials were disseminated throughout the intervention period. The mean rate of inappropriate PPI prescriptions in the post-intervention period decreased significantly from 66% (456/689) at baseline to 32% (108/340) (p < 0.01) [Figure]. Moreover, knowledge assessments demonstrated a notable improvement, with correct answers increasing from 68% to 89% post-intervention (p < 0.01). However, residents reported an increase in the time of clinic visit encounters (balancing measure).

Discussion: The interventions effectively reduced inappropriate PPI use and improved resident knowledge. Long-term implementation of this educational curriculum will ultimately improve patient care quality. Plans for sustainability include integrating the educational curriculum into ongoing training and institutional practices. This low-resource intervention could be replicated in other settings. A limitation of this project was the short post-intervention follow-up, limiting the observation time.


Disclosures:


Saqr Alsakarneh, MD¹, Vinay Jahagirdar, MD², Noor Hassan, MD², Ahmed Husain, MD³, Parth Sharma, MBBS⁴, Roshni Thomas, MD¹, Zainab Humayan, MD¹, Kevin Varghese, MD⁵, Julie Banderas, PharmD², David Wooldridge, MD⁶. P2225 - Reducing Inappropriate Use of Proton Pump Inhibitors in Outpatient Settings: A Quality Improvement Project, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.