Improving the Quality of Care: Overutilization of Proton Pump Inhibitors
Improving the Quality of Care: Overutilization of Proton Pump Inhibitors
Learning Objectives:
- Review the appropriate indications for short-term and long-term use of proton pump inhibitors (PPIs)
- Describe potential adverse effects associated with use of PPIs
- Summarize best practices for responsible prescribing of PPIs
Key Points:
- PPIs are one of the most commonly prescribed medications in the United States, but an estimated 25% to 70% of these prescriptions have no appropriate indication for PPIs.
- PPI use may be associated with an increased risk of both acute and chronic kidney disease, hypomagnesemia, Clostridium difficile infection, osteoporotic fractures, and dementia.
- For patients with gastroesophageal reflux disease (GERD) without contraindications to PPIs, an eight-week course of PPIs is the first-line pharmacotherapy of choice for symptom relief.
- Within the Medi-Cal fee-for-service population, 77% of beneficiaries with a paid claim for a PPI between November 1, 2015, and October 31, 2016, had no indication for potentially appropriate use of PPI therapy and 85% of long-term users showed no attempt at tapering off PPIs during a one-year period.
Background
PPIs, typically used to reduce gastric acid, are one of the most commonly prescribed medications in the United States.1-3 However, an estimated 25% to 70% of these prescriptions have no appropriate indication for PPIs (see Table 1). 2-5 Treatment with PPIs often continues well beyond recommended guidelines, and there is increasing data showing that PPIs are associated with a number of adverse effects.1-9 Current evidence now suggests PPI use may be associated with an increased risk of both acute and chronic kidney disease, hypomagnesemia, Clostridium difficile infection, osteoporotic fractures, and dementia.1-9 A recent comparative study found an increased risk of chronic kidney disease specific to long-term use of PPI medications, while finding no increased risk with long-term use of H2-receptor antagonists, which are prescribed for the same indications as PPIs.
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