P2031 - Resident Education Is an Effective Method to Decrease Proton Pump Inhibitor (PPI) Over-Prescription in a Resident Primary Care Clinic

Patrick Lee, MD, MS, Selena Zhou, MD, Robert Tungate, MD, David Chung, MD, MBA, Jennifer Marks, MD, Sonia Lin, MD
University of Southern California, Los Angeles, CA

Introduction: The American College of Gastroenterology (ACG) recommends 8 weeks of therapy with proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD) and dyspepsia. PPIs are frequently prescribed in the primary care setting, but inappropriate prescriptions can lead to polypharmacy and other adverse medication-associated side effects. We previously showed that 32% (49/155) of patients seen in LAC+USC’s resident primary care clinic were prescribed PPIs without a documented indication and that 67% (49/73) of patients prescribed PPIs for GERD or dyspepsia were on therapy for longer than 2 months without a trial off. Our team subsequently created a short informative video paired with a standardized note template that was shared with residents in hopes of decreasing inappropriate PPI prescriptions.

Methods: We created a 2.5-minute educational video on guideline-based PPI use for GERD and dyspepsia and provided an algorithm for deescalating PPIs. We also distributed a standardized note template to aid in medical documentation. We then retrospectively analyzed the medical records of all patients seen in clinic during one week of resident exposure to this intervention and compared it to our original cohort. Multivariate logistic regression was performed for the primary outcome of a trial off PPI. All models were adjusted for age, sex, language, comorbidities, and receiving care from a gastrointestinal specialist.

Results: The average age of the patients was the same in the control cohort compared to the intervention cohort (mean age 56.2 (95% CI 54.0-58.4) vs 56.4 (95% CI 51.4-61.3), p=1.0, respectively), and the two cohorts were similarly distributed in sex, languages spoken, comorbidities, and receiving care from a gastrointestinal specialist. In the control and intervention cohorts, 51/73 (70%) and 25/34 (74%) of patients, respectively, were on PPIs for GERD or dyspepsia inappropriately; however, in the control cohort, only 2/51 (4%) of patients received a trial off while 8/25 (32%) of patients in the intervention cohort received a trial off PPIs (p< .01). In multivariate analysis, our intervention was independently associated with receiving a trial off (OR 13.33, 95% CI 2.3-76.9). Unfortunately, 0/34 medical records utilized the standardized note template.

Discussion: Preliminary results suggest that targeted educational contents may be a valid method to decrease PPI over-prescription in a resident primary care clinic.



Disclosures:


Patrick Lee, MD, MS, Selena Zhou, MD, Robert Tungate, MD, David Chung, MD, MBA, Jennifer Marks, MD, Sonia Lin, MD. P2031 - Resident Education Is an Effective Method to Decrease Proton Pump Inhibitor (PPI) Over-Prescription in a Resident Primary Care Clinic, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.