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Reducing overuse of proton pump inhibitors (PPIs) is a significant challenge in healthcare. In the Veterans Affairs Healthcare System, a large-scale initiative aimed to tackle this issue. This program sought to reduce unnecessary PPI prescriptions, which are commonly given to patients without clear indications for long-term use.
Jacob E. Kurlander and his colleagues conducted a comprehensive study across the US Veterans Affairs Healthcare System. This effort was focused on implementing a multicomponent intervention, targeting both patients and healthcare providers. The intervention, which spanned nearly a decade, involved restricting PPI prescriptions, facilitating the use of H2 receptor antagonists, and providing targeted education.
“We designed this program to not only reduce PPI overuse but also ensure that patients who needed gastroprotection continued to receive it,” Kurlander explained. The results were promising. The intervention led to a 7.3% absolute reduction in patients filling PPI prescriptions. This figure represented a significant drop compared to control sites.
One key finding was the reduction in unnecessary prescriptions without increasing hospital visits for acid peptic diseases or other gastrointestinal conditions. “We found no significant uptick in healthcare utilization or adverse clinical outcomes,” said one of the lead researchers. This is important because concerns about potential risks often hinder such de-implementation efforts.
The initiative’s impact was not limited to reducing overall PPI use. It also cut the percentage of patients at high risk of gastrointestinal bleeding who filled PPI prescriptions. Although there was some reduction in PPI use among patients who needed gastroprotection, the authors noted that the intervention did not lead to an increase in serious clinical harms.
“While reducing PPI overuse was our primary goal, we ensured the safety of patients with high gastrointestinal bleeding risk by encouraging alternatives like H2 receptor antagonists,” added another researcher. The findings are relevant to any healthcare system dealing with medication overuse.
The researchers highlighted the importance of using a combination of approaches, including restricting refills and providing education, to change prescribing habits. “We believe that the success of this program was due to the comprehensive nature of the intervention, which addressed multiple facets of PPI overuse,” said Kurlander.
The study demonstrated how pharmacy-based interventions could be effective in large, integrated healthcare systems. By implementing similar strategies, other systems may see similar reductions in unnecessary PPI prescriptions. This could contribute to both reduced healthcare costs and improved patient outcomes.
Although the study did not find a strong clinical benefit from reducing PPI use, it underscored the value of focusing on de-implementation strategies that prioritize patient safety. “It’s crucial to balance reducing unnecessary treatments with ensuring that patients who truly need these medications continue to receive them,” the researchers concluded.
Citation:
Kurlander JE, Laine L, Kim HM, et al. Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study. BMJ. 2024;385. doi:10.1136/bmj-2023-076484.
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