Intervention works to reduce PPI overuse in hospital setting

PPI proton pump inhibitor Intervention works to reduce PPI overuse in hospital settingInvestigators have just published in JAMA Internal Medicine the results of an intervention that was launched in 2015 by fellows and residents at University of Chicago. Their goal was to address and reduce in the hospital setting unnecessary proton pump inhibitor infusions in patients with upper GI bleeding, lowering the cost of the care the patient receives, said Healio.

“Unfortunately, PPI infusions may be continued for 72 hours without indication,” investigators wrote. “Reducing the overuse of these infusions is important because, in addition to increasing the length of stay and cost, PPI overuse is associated with various complications.”

Some of the complications that have been linked to PPIs include side effects such as kidney disease, stomach infections, heart disease, pneumonia, bone fractures, dementia and even death.

The intervention was successful in improving evidenced-based care. Data showed that there was an overall reduction of inappropriate PPI infusions of 35 percent. The estimated pharmacy savings over nine months was a least $121,000.

There were multiple layers to the intervention, and all were important to its success. The intervention included changing the electronic health record so that physicians were prompted to choose an appropriate indication for PPI infusions. In the scenario where that was the only change implemented there was no significant change observed.

The other aspects of the intervention included staff training and support of the initiative and the accountability of pharmacists monthly tracking PPI infusions. When all aspects were included they were able to make a practical difference in PPI overuse.

There are many who are concerned with PPI overuse and looking for ways to assist health care professionals in making sure that they are only prescribing these drugs when medically necessary and for the shortest amount of time possible. Studies have shown that PPIs are overprescribed, as much as two-thirds of the time in unnecessary situations.

“Proton pump inhibitors (PPIs) were selected in a national modified Delphi consensus process as an important medication class for developing deprescribing guidelines, given their high prevalence of use and overuse,” wrote the authors of recent guidelines for desprescribing these drugs. “Concern about overuse of PPIs has been growing.”

JAMA Internal Medicine
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