D Lin et atl. Clin Gastroenterol Hepatol 2020; 18: 763-6. In a retrospective chart review, the authors examined pharmacy data from patients in the Harris Health System (Harris county -Houston, TX) which had more than 1.9 million outpatient clinic visits in 2017.
In January 2018, multiple efforts were made to try to reduce inappropriate proton pump inhibitor (PPI) usage. This included grand rounds and system-wide emails to providers. In addition, a suggested tapering algorithm (order in EPIC) was given to reduce the likelihood of rebound acid hypersecretion which could undermine the goal of stopping PPI.
- Taper: When ready to taper, start with “a PPI every other day for 2 weeks, followed by a PPI every 4 days for 2 additional weeks before discontinuation.”
- De-escalation: Before educational intervention, in 2017, there were 66,261 unique PPI prescriptions. After educational intervention, in 2018, there were 55,322 unique PPI prescriptions (16.5% decrease). This equates to ~800,000 fewer capsules or pills dispensed in 1 calendar year
- The most “important driver” for de-escalation was the initiation of the discussion by the ambulatory primary care provider
- The authors recommend clinic followup within a month after starting de-escalation and gastroenterology evaluation for patients with severe symptoms or those refractory to PPI treatment
My take: This study indicates that 1 in 6 PPI users were able to de-escalate off treatment. Physician initiative is crucial to improve appropriate medication use.
Related blog posts:
- Deconstructing PPI-Associated Risks with Nearly 8 Billion Pieces of Data
- PPIs: Good News on Safety Large randomized double-blind study of pantoprazole: “we found that pantoprazole is not associated with any adverse event when used for 3 years, with the possible exception of an increased risk of enteric infections.”
- PPIs: Good News on Safety (Part 2, 2019)
- Favorable “Break”through Data for PPIs and Bone Density
- Which PPIs are most potent?
- PPIs: Dissecting the Evidence
- The Prosecution Rests…PPIs on Trial
- No Effect of Proton Pump Inhibitors and Irritability on Crying in Infants
- Two for the PPI Team
- Proton Pump Inhibitors Webinar | gutsandgrowth
Recent study from JAMA Pediatrics (5/11/20) -Full text: Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units
Of the 48 children with COVID-19 admitted to participating PICUs (14 hospitals)… Forty patients (83%) had significant preexisting comorbidities; 35 (73%) presented with respiratory symptoms and 18 (38%) required invasive ventilation….At the completion of the follow-up period, 2 patients (4%) had died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation. The median (range) PICU and hospital lengths of stay for those who had been discharged were 5 (3-9) days and 7 (4-13) days, respectively.
NY Times Summary of Study: Details of U.S. Children Severely Affected by Coronavirus
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