Strategies to Foster Appropriate Proton Pump Inhibitor Use

Abstract

This thesis examines strategies to address the inappropriate proton pump inhibitor (PPI) use. A scoping review was conducted to examine patient preferences and values towards PPI initiation and continued treatment, as well as their attitudes towards reducing PPI use (deprescribing). Symptom control (reflux, heartburn) was a driver for patients to seek treatment. Patients were concerned about symptoms returning if they reduced their PPI use but were interested in using less medication if possible. Patients were open to discussing PPI reduction and valued clear communication about rationale and potential benefits/harms. As such, shared and informed decision-making (including eliciting patient values) is important in the choice to continue a PPI or try deprescribing. A decision-support tool for clinicians, aimed at the decision to continue a PPI versus try deprescribing, was implemented over 12 months in one long-term care home in Ottawa. The tool led to a non-statistically significant decrease in PPI use after it was implemented, but PPI usage began to gradually increase after six months. Strategies to sustain use of deprescribing initiatives are needed. Finally, a consult patient decision aid (PtDA) was developed and piloted in three Ottawa area clinics, and aimed to facilitate shared decision-making surrounding the decision to continue or try to reduce a PPI during a healthcare visit. Based on a sample of 12 patients, the consult PtDA increased knowledge about the decision and increased decisional confidence. After receiving the consult PtDA, 8/12 (75%) patients chose to reduce their PPI use and 4/12 (25%) chose to continue their PPI.