Patient Awareness of Reported Adverse Effects Associated with Proton Pump Inhibitors in a Medically Underserved Community

Abstract

Reports of adverse effects associated with proton pump inhibitors (PPIs) are concerning because of high usage and over-the-counter availability. We sought to determine the awareness of PPI adverse effects among our patient population, which is medically underserved, low-income, and racially diverse. A 21-item survey was administered to gastroenterology-clinic outpatients. It collected information about age, gender, education, race, specialty of the prescriber, specific PPI, indication, knowledge of dose, adherence, duration of use and awareness of any risks. Medical records were reviewed to verify survey responses pertaining to indication, dosing, and adherence. A vast majority (96%) of 101 participants were not aware of PPI adverse effects. In total, 63% of the patients completed a high school education or less, which was associated with a higher risk of long-term PPI use than completion of at least an undergraduate degree (p = 0.05). In contrast to other studies, the shockingly low patient awareness about PPI adverse effects in our patient population is particularly concerning, especially as it is tied to their demographic attributes. This may lead to long-term and high-dose PPI use. Our study highlights the need for effective provider-driven education regarding medication risks, especially in the communities with significant health disparities.

Assessment of Awareness and Knowledge of Proton Pump Inhibitors Among the General Population in Saudi Arabia

“…Our study is consistent with previous studies that showed that GERD/heartburn constituted the majority of indications for PPI prescriptions [ 18 , 19 ]. For example, the participants in another study were mainly prescribed PPIs by gastroenterologists [ 9 ]. Another study reported that most participants were taking PPIs for gastroprotection [ 15 ].…”

“…Our study showed that the most common cause of medication discontinuation was symptom disappearance (71.7%); other causes included fear of side effects (13.1%) and the presence of side effects (5.2%). Another study reported various reasons for PPI discontinuation, including provider's instructions, failure of medication to achieve relief, affordability, and the decision to switch to a different therapy [ 9 ]. In our study, 76.8% of patients who used PPIs reported that the duration of use was as needed, 11.6% were not regular, 4.5% were regular for more than four weeks, 3.6% were regular for less than four weeks, and 3.6% used the medication but did not continue for the recommended duration.…”

“…Notably, this study found no differences in medication compliance among participants of different ages. White and his colleagues also described a lack of risk perception regarding PPIs in a population with a high poverty rate and low educational attainment [ 9 ]. A different study found that 63% of patients had a high school diploma or lower.…”

“…Even when PPIs are well tolerated, many recent studies have reported their associations with adverse effects [ 8 ]. According to some studies, patient awareness of the adverse effects associated with PPIs is very low, showing that most participants were unfamiliar with any adverse effects associated with PPI use [ 9 - 10 ]. Therefore, this study aimed to determine the awareness, attitude, and behavior of the general population of Saudi Arabia regarding PPIs through a cross-sectional study design using self-administered questionnaires.…”

Appropriateness of proton pump inhibitor therapy in an ambulatory geriatrics clinic: A retrospective cross-sectional analysis

“…Patient dissatisfaction with medication cessation, a lack of symptom control with abrupt discontinuation and the belief that PPIs are a benign class of medications are all reasons found to contribute to the increasing use of PPIs. [18][19][20] However, the long-term use of PPIs has been linked to increased falls and fractures, Clostridioides difficile infections, pneumonia, acute interstitial nephritis, acute kidney injury and electrolyte and micronutrient deficiencies. 11,21 The geriatric population is at greater risk for adverse effects of PPIs due to their inherently higher risk of falls, infections associated with age-related immunosenescence, declining kidney function and polypharmacy.…”