Primary and Specialty Care Trainees' Perceptions About Proton Pump Inhibitor Use

Alex Al Khoury; Maryam Taheri Tanjani; Bretton Hari; Majid A Almadi; Myriam Martel; Alan N Barkun

doi:10.1097/MCG.0000000000001983

Primary and Specialty Care Trainees' Perceptions About Proton Pump Inhibitor Use

J Clin Gastroenterol. 2024 Feb 19. doi: 10.1097/MCG.0000000000001983. Online ahead of print.

Authors

Alex Al Khoury^{1

2}, Maryam Taheri Tanjani³, Bretton Hari⁴, Majid A Almadi^{2

5}, Myriam Martel⁶, Alan N Barkun²

Affiliations

¹ Department of Medicine, Division of Gastroenterology, University of Florida, Jacksonville, FL.
² Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec.
³ Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton.
⁴ Department of Medicine, University of Calgary, Calgary, Alberta.
⁵ Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
⁶ Research Institute of the McGill University Health Center, Montreal, Canada.

PMID: 38385596
DOI: 10.1097/MCG.0000000000001983

Abstract

Objective: Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities.

Methods: Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs.

Results: Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates.

Conclusions: Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.