Deprescription of proton pump inhibitors in the primary care setting in the Canary Islands. A randomized massive educational intervention.

Abstract

Background: It is estimated that between 20% and 80% of Proton Pump Inhibitor (PPI) prescriptions worldwide lack an appropriate clinical indication. Since their introduction in 1989, PPIs have proven highly effective for treating acid-related digestive disorders. However, over three decades of global use have revealed notable side effects, notwithstanding their overall safety profile. The chronic and indiscriminate use of PPIs by millions of people without proper indications represents a substantial public health issue and threatens the sustainability of health services worldwide.

Objective: To evaluate the clinical and economic outcomes of deprescribing PPIs that are indefinitely and incorrectly prescribed in primary care centres across the Canary Islands after an educational intervention.

Method: An online training course was developed to educate family physicians on deprescribing PPIs in accordance with internationally recognized guidelines. Indications for PPI prescriptions were assessed and compared among an intervention group and two control cohorts: physicians interested in but not participating in the training, and those who did not express any interest on it. Following an initial assessment at twelve weeks, the second interested group received the same training. Chronic prescribing practices were then evaluated for all three groups at twelve and twenty-four weeks post-study initiation.

Results: Before the intervention the 8% of indefinite PPI prescriptions in the primary care setting met the appropriate criteria according to the guideline used. This percentage did not increase in the groups of trained physicians. However, PPI-related expenditures were significantly lower in the intervention group compared to both control groups at 24 weeks, with the intervention group showing a median reduction of €82 per physician, while the control and anonymous groups showed increases of €15 and €160 respectively (p = 0.020 for the initial to 12-week comparison).

Conclusions: Given the high volume of use of these medicines, any strategy aimed at improving their management by physicians can have a significant beneficial effect on the health of the population, and an exponential impact on the consumption of public resources. Longer-term follow-up, improved documentation of indications, and increased longitudinal patient care may play a critical role in the impact of educational interventions.