Evaluation and Continuous Quality Improvement in Prescribing Proton Pump Inhibitors

Bárbara Duarte Ferreira, Carolina Pais Neto, Marta Valente Mendes, Cátia Almeida, Carla Almeida

Keywords: Proton Pump Inhibitors; Deprescription;

Background:

Proton Pump Inhibitors (PPIs) are one of the most prescribed and used classes of medications worldwide. In Portugal, an increase in PPI sales was observed every year, with an estimated annual growth of 30%. PPIs began to be widely used, exceeding clinical indications. This is due, not only to its efficacy, safety and good tolerability, but also to the low cost of treatment. This inadequate prescription can occur in 25-70% of the cases.

Research questions:

The decision whether or not to deprescribe PPIs must be user-centered and doctors must review the indications for all medications used chronically in every consultation with the patient. PPI deprescription involves dose reduction, interruption or change to “on demand” dosing, following the guiding principle of using PPIs at the lowest effective dose for the shortest possible time. Therefore, the purpose is to evaluate and improve the profile of PPI use (and, therefore, their deprescription when not recommended), in a portuguese family health unit.

Method:

The aim is, therefore, to carry out a quasi-experimental study, with pre- and post-intervention evaluation, in a family health unit in Portugal. The target population was defined as the adult population chronically taking PPI, without indication. Patients who take PPIs for a period of ≤ 8 weeks are excluded, as well as patients who need to take PPI chronically due to health problems. Doctors from the family health unit are the peers for the internal assessment in question. The dimension being studied corresponds to the technical-scientific quality in the appropriate prescription of PPI. The quality indicator corresponding to the percentage of patients with adequate PPI prescription presents the following quality standards: insufficient (0 to 29%), sufficient (30 to 49%), good (50 to 69%), very good (70 to 89 %) or excellent (90 to 100%). Defined assessment periods include diagnostic assessment, first and second reassessment.

Results:

Conclusions:

Points for discussion:

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