Understanding the Patient PPI Journey: Results of a Survey on PPI Treatment Initiation and Patient Experience

Abstract

Introduction: Proton pump inhibitors (PPIs) used in the management of gastro-esophageal reflux disease (GORD) are among the most frequently prescribed classes of drug worldwide. Currently, however, physicians are prescribing PPIs for extended periods, often without an indication, which is not in line with current guidance and therefore preventing appropriate reflux management. Inappropriate or excessive PPI prescribing is becoming increasingly visible, yet there is currently little research available on the impact such current practice has on the patient experience. This study aims to understand patient attitudes toward their PPI treatment and the impact current PPI prescribing patterns have on the patient experience. Methods: An online survey of current and previous users of PPI for GORD was conducted in the UK and Germany. Topics covered included prior steps taken before first consultation with a physician, initial recommendations, PPI treatment initiation and duration, use of PPI, management of reflux whilst taking a PPI, stopping PPI treatment, and patient attitudes. Results: Among 566 patient participants (UK, n = 372; Germany, n = 194) 69% to 79% reported being prescribed medication at their first visit to a physician, of which 61% to 68% were prescribed a PPI either alone or combined with another treatment. 41% to 48% of patients answered “don’t know” when asked how long they expected to continue taking their PPI. 49% to 50% of patients currently on PPIs also reported having concerns with regards to long-term treatment. 70% of patients recalled being well informed on dosage and treatment regimens. However, other safety and usage information was reported as being less frequently discussed. Conclusions: Although patients reported concerns regarding ongoing long-term PPI treatment, this was not reflected in the prescribing pattern from physicians. More can be done to ensure patients are fully informed about their PPI treatment at consultation. Findings also suggest a disconnect exists between standard treatment guidelines and prescribing patterns, as experienced by patients.

Characteristics of prescribing activity within primary care in Scotland 2013–2022 of general practitioners, nurse, pharmacist and allied health prescribers: A retrospective cross‐sectional study

“…This pattern reflects a global demand in prescribing in this area and may be attributed to the effectiveness of the medication in managing gastro-oesophageal reflux disease, withdrawal of H2 receptor antagonists, an increasingly aging population, near patient testing for Helicobacter pylori and concomitant use of PPIs when prescribing drugs with gastrointestinal side effects. Conversely studies suggest that there is a mismatch between current PPI prescribing guidance and practice (Plehhova et al, 2022), indications for prescribing are poorly or not documented in up to 60% of cases (Patterson Burdsall et al, 2013) and clinicians and service users may be reluctant to stop treatment once initiated (Moriarty et al, 2016). Adverse events associated with inappropriate prescribing of PPIs such as antimicrobial resistance, electrolyte imbalance and increase risk of falls (Islama et al, 2018) suggest interventions to reduce inappropriate or unnecessary prescribing activity by prescribers in this area is a priority.…”

Holistic management of symptomatic reflux: rising to the challenge of proton pump inhibitor overuse

“…HCPs are also often faced with a strong patient expectation for a pharmaceutical solution for their symptoms; indeed, in one study, physicians expressed the opinion that the ‘pressure to prescribe PPIs [as exerted by the patient] was outweighed by the pressure not to prescribe’ . 14 And yet, in another study, approximately half of patients reported concerns with being on a PPI in the long term, and a third indicated that they wanted to stop their PPI, 15 demonstrating a clear need for continued patient–physician communication beyond initial prescription. For those patients who go on to derive benefit from PPIs, the impetus to address dietary factors or consider other therapeutic options is removed so long as symptom relief is maintained.…”

Management of GERD After Myotomy for Achalasia

“…14,15 In patients who fail to respond to PPI, poor adherence has been cited as the reason. 14 Furthermore, patient attitudes toward long-term PPI are mixed 45 and therefore additional treatments are warranted.…”