P3946 - Reducing Proton Pump Inhibitor Overuse Through PPI De-Prescription: A Primary Care Quality Improvement Project

Duha Zaffar, MD, Mohammad Hossain, MD, Jeffrey Gerbino, MD, Bruce D.. Greenwald, MD
University of Maryland Medical Center, Baltimore, MD

Introduction: Proton pump inhibitor (PPI) use is extremely common. Developed for the treatment and prevention of acid-mediated upper GI conditions, these agents are used increasingly for indications where benefit is less certain. PPI over-prescription imposes an economic cost and contributes to polypharmacy. In addition, PPI use has been increasingly linked to a number of adverse events. Therefore, de-prescribing of PPIs is an important strategy to lower pill burden while reducing real costs and theoretical risks.

Methods: All patients followed at the University of Maryland Midtown Campus Primary Care Resident Clinic between March 15 - April 30, 2024 were included. Baseline prevalence of PPI use was determined through the Slicer-Dicer feature in our electronic health record (EHR) system (Epic). A fishbone diagram for root-cause analysis (RCA) revealed key causes of inappropriate PPI use: insufficient resident knowledge of PPI overuse and associated harm and lack of EMR notification of inappropriate PPI usage. Our first PDSA (Plan-Do-Study-Act) cycle involved educating residents on assessing PPI appropriateness. A second PDSA cycle involved pasting self-generated QR code (printed in bright red) at each clinic workstation to assist residents in de-prescribing. The QR code led to a short questionnaire based on a clinical practice update issued by the American Gastroenterology Association (1). This provided guidance to residents on safely de-prescribing PPI.

Results: 80 patients on PPI were identified. Inappropriate use was identified in 17 (21%) based on AGA guidelines. All 17 were successfully de-prescribed. Most common indication for PPI was GERD (76.9%) followed by "no apparent indication" (15.4%) and gastritis (7.7%). Only 7.7% had absolute indications including active peptic ulcer disease, Barrett’s esophagus, esophageal stricture, erosive esophagitis, eosinophilic esophagitis, idiopathic pulmonary fibrosis, or use of anticoagulants and/or NSAIDs. Ongoing PDSA cycles include pharmacists and EMR reminders to assess PPI appropriateness for those on PPI longer than 6 months.

Discussion: Using EHR analytic tools, RCA, and PDSA cycles, inappropriate PPI use was identified in over 21% of patients seen in a resident primary care clinic. De-prescribing was successful in all patients.
(1) Targownik L, et al. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology 2022; 12(4): 1334 - 1342


Disclosures:


Duha Zaffar, MD, Mohammad Hossain, MD, Jeffrey Gerbino, MD, Bruce D.. Greenwald, MD. P3946 - Reducing Proton Pump Inhibitor Overuse Through PPI De-Prescription: A Primary Care Quality Improvement Project, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.