Amy Scholl, MD1, Ifeanyichukwu Onwe, MD2, Andrew Lee, MD2, Edgar Chou, MD3
1Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA; 2Hahnemann University Hospital, Philadelphia, PA; 3Drexel University College of Medicine, Philadelphia, PA
Proton pump inhibitors (PPIs) are widely prescribed medications for the treatment of acid suppression for a variety of conditions. The American College of Gastroenterology recommends that the continued use of PPIs be re-assessed 8-12 weeks after the initial start of treatment, but unfortunately, PPIs tend to be prescribed for much longer than this. Our Quality Improvement project investigates the over-prescription of PPIs in an Internal Medicine Residency outpatient clinic. We created an intervention to decrease the inappropriate prescription of PPIs.
This is a prospective study of 150 patients in an outpatient setting and their use of PPIs over the course of a year. Patients had an active diagnosis of either gastroesophageal reflux disease or functional dyspepsia. We performed an educational session as well as an electronic-medical record reminder to tell residents to re-assess the continued use of PPI. Patients were re-assessed 5 months after the intervention. Primary endpoints were the overall number of patients prescribed PPIs, if they were being prescribed PPIs appropriately, and if residents were re-assessing patients’ symptoms and continued need for PPI.
The final sample size was 133 patients. The average duration that patients were prescribed PPIs was 73.4 weeks, and there were 7.5% associated adverse complications noted. After the intervention, there was a 12.1% decrease in the number of patients prescribed a PPI. Before the intervention 30% (n=40) of patients were appropriately prescribed a PPI, and this number increased to 39.1% (n=52) after the intervention (p=0.023). Before the intervention, 34.58% (n=46) of patients had their symptoms re-assessed by residents, and this number increased to 47.3% (n=63) after the intervention (p=0.001).
Discussion: By educating residents on the proper use of PPIs and by placing alert reminders in patients’ charts, we observed a decrease in the overall number of prescriptions of PPIs in the outpatient clinic. After the intervention, the frequency of residents re-assessing patients’ symptoms and need for continued use of PPI as well as the overall number of patients appropriately prescribed PPIs increased. We were unable to determine which intervention had the greatest impact (educational session versus alerts) as both interventions were looked at at the same time. Future studies could expand on this by just studying one intervention to see what has the greatest effect on the prescription of PPIs.
Citation: Amy Scholl, MD; Ifeanyichukwu Onwe, MD; Andrew Lee, MD; Edgar Chou, MD. P0261 - REDUCING OVER-PRESCRIPTION OF PROTON PUMP INHIBITORS AT AN INTERNAL MEDICINE RESIDENCY CLINIC. Program No. P0261. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.