Internists’ Perceptions of Proton Pump Inhibitor Adverse Effects and Impact on Prescribing Practices: Results of a Nationwide Survey

Kurlander, Jacob E.; Kolbe, Mark; Rubenstein, Joel H.; Richardson, Caroline R.; Heisler, Michele; Weissman, Arlene; Vries, Raymond De; Saini, Sameer D.

doi:10.14740/gr944w

Cited by 12 publications

(14 citation statements)

References 25 publications

(30 reference statements)

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“…It is apparent from our survey that many patients are obtaining their information from non‐physician sources, a finding not captured in the internet survey. The same authors surveyed primary care physicians and reported similar findings to the primary care MDs in our study, however, did not report information on GI MDs perceptions . Our sample of physicians consisted of academic physicians, whose views and knowledge may differ from attending physicians who are not in academic practice, offering opinions from an additional physician population.…”

Section: Discussionmentioning

confidence: 73%

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

Ghosh

Schnoll‐Sussman

Mathews

et al. 2019

Aliment Pharmacol Ther

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Summary Background Proton pump inhibitors (PPI) are among the most commonly prescribed medications and studies are reporting potentially harmful PPI‐related adverse events. While these studies’ findings are controversial, their impact on patients and physicians remains unknown. Aim To determine patient and physician awareness of PPI‐related adverse events, source of information, and subsequent effect on patient behaviour and physician practice. Methods A 20‐item questionnaire was administered to English speaking adult patients and physicians in primary care and specialty clinics about topics including knowledge of PPI‐related adverse events, change in behaviour of patients on PPIs and physician management of patients on PPIs. Results Of 277 patients surveyed, 45% reported knowledge of side effects related to PPIs. Patients were more likely to hear about PPI side effects from non‐physician sources (66%) than physicians (38%). Of patients who had heard about PPI side effects, bone fractures and osteoporosis were the most common concerns, 42% and 44% respectively. Of PPI users, 38% changed their behaviour based upon concerns about PPI‐related adverse events. Change in patient behaviour due to concern about PPI side effects was associated with age ≥ 65 years (odds ratio [OR] 4.07 [1.19‐13.94]; P = 0.03) and concern about long‐term side effects (OR 2.31 [1.03‐5.17]; P = 0.04). Of 83 physicians surveyed, 60% reported concern about PPI‐related adverse events, with bone fractures (46%) and osteoporosis (49%) being the most frequently reported. Overall, 37% of physicians reported changing their practice based upon their concerns. Conclusions Nearly half of patients reported knowledge of PPI‐related adverse events, most often from non‐physician sources, and general concern regarding their impact. PPI users are changing their behaviour based upon these concerns, without physician input, and care providers are changing behaviour based on relatively weak evidence.

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Section: Discussionmentioning

confidence: 73%

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

Ghosh

Schnoll‐Sussman

Mathews

et al. 2019

Aliment Pharmacol Ther

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“…Physician concern about adverse effects of PPI therapy have been suggested, with 52% of internal medicine physicians self-reporting they sometimes or often changed a patient’s prescription from PPI therapy to H2 antagonists. 22 A prior study suggested H2 antagonists were prescribed more frequently than PPIs in patients with uninvestigated dyspepsia (88.1% versus 47.4%, respectively). 13 However, the current study’s findings were consistent with guideline recommendations, and this increased usage of PPIs over H2 antagonists for acid suppression therapy may indicate guideline adherence in this area.…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence in Dyspepsia Investigation and Treatment

Dugan¹,

Ablah²,

Okut³

et al. 2020

kjm

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Introduction: The impact of dyspepsia guidelines on clinical practice may be poor. Provider adherence with dyspepsia guidelines was examined to determine their impact on clinical practice. Methods: Provider adherence with the 2005 American College of Gastroenterology Guidelines for the Management of Dyspepsia and the 2017 American College of Gastroenterology and Canadian Association of Gastroenterology joint Dyspepsia Management Guidelines was assessed on a national level using data from the National Ambulatory Medical Care Survey (NAMCS). Patient visit data, including reason for visit of dyspepsia, diagnosis of dyspepsia, or diagnosis of H. pylori infection from NAMCS years 2012 through 2015, were used. Provider adherence with dyspepsia management guidelines was determined based upon provision of at least one recommended test or treatment for dyspepsia. Results: Providers appeared to adhere to the 2005 ACG guidelines for 49.7% of patient visits. Providers appeared to adhere to the 2017 ACG/CAG guidelines for 51.0% of patient visits. Conclusions: Provider adherence with the 2005 ACG and the 2017 ACG/CAG Dyspepsia Management Guidelines was determined to be low in this study, highlighting the need to increase evidence-based medical treatment and efficient resource use for dyspepsia.

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“…In a recent survey of internist members of the American College of Physicians, 98% reported having some concern about the adverse effects of PPIs, with 63% altering the dose, 52% switching to H2 blockers, and 44% discontinuing the PPI. 21 Moreover, patients are becoming more knowledgeable about their health care and may also have concerns about PPI treatment. 22 An association between PPI use and an increased risk for CAP was observed in our cohort with laryngeal/voice disorders.…”

Section: Discussionmentioning

confidence: 99%

Associations between Community‐Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice‐Disordered Population

Lee

Leiman

Roy

et al. 2018

Otolaryngol.--head neck surg.

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Objectives: To examine the relationship between community acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment in laryngeal/voice disordered patients. Study Design: Retrospective cohort analysis. Setting: Large, national administrative U.S. claims database. Subjects and Methods: Patients ≥ 18 years of age with outpatient treatment for a laryngeal/voice disorder per ICD-9-CM codes from January 1, 2010 to December 31, 2014 with 12 months continuous enrollment prior to the index date (first laryngeal/voice disorder diagnosis), no pre-index diagnosis of CAP, and had prescription claims captured from 1 year pre-index to end of follow-up were included. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique pre-index patient encounters, and CAP diagnoses during 3 year post-index date were collected. Two models, a time-dependent Cox regression model and a propensity score based approach with marginal structural model, were each separately performed in patients with and without pre-index date PPI prescriptions. Results: 392,355 unique patients met inclusion criteria. 188,128 (47.9%) patients had a PPI prescription. The 3 year absolute risk for CAP was 4.0% and 5.3% in patients without and with pre-index PPI use, respectively. The CAP occurrence for a person who already received a PPI is 30% to 50% higher than for a person who has not yet had a PPI but may receive one later for patients without and with pre-index date PPI use, respectively. Conclusions: Patients without and with pre-index date PPI use experienced roughly 30% to 50% increased likelihood of CAP, respectively, compared to patients who had not had PPI prescriptions.

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Internists’ Perceptions of Proton Pump Inhibitor Adverse Effects and Impact on Prescribing Practices: Results of a Nationwide Survey

Cited by 12 publications

References 25 publications

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?

Guideline Adherence in Dyspepsia Investigation and Treatment

Associations between Community‐Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice‐Disordered Population

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