Trends in prescribing patterns of proton pump inhibitors surrounding new guidelines

Devin Abrahami; Emily G McDonald; Mireille Schnitzer; Laurent Azoulay

doi:10.1016/j.annepidem.2020.12.002

Trends in prescribing patterns of proton pump inhibitors surrounding new guidelines

Ann Epidemiol. 2021 Mar:55:24-26. doi: 10.1016/j.annepidem.2020.12.002. Epub 2020 Dec 16.

Authors

Devin Abrahami¹, Emily G McDonald², Mireille Schnitzer³, Laurent Azoulay⁴

Affiliations

¹ Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
² Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada; Division of Experimental Medicine, McGill University, Montreal, Canada.
³ Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
⁴ Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada. Electronic address: laurent.azoulay@mcgill.ca.

PMID: 33338647
DOI: 10.1016/j.annepidem.2020.12.002

Abstract

Purpose: The purpose of this study was to examine whether the latest National Institute for Health and Care Excellence proton pump inhibitor (PPI) guidelines changed physician prescribing patterns in clinical practice.

Methods: Using data from the United Kingdom Clinical Practice Research Datalink, we calculated monthly PPI prescribing rates in adults by dividing the number of PPI prescriptions by the number of patients in each calendar month. Using these rates, we conducted an interrupted time-series analysis to compare PPI prescription rates before (September 2010-August 2014) and after (September 2014-August 2018) guideline publication, estimating a slope and level change using segmented autoregression.

Results: In the preguideline period, monthly PPI prescription rate increased by 46.9 (95% confidence interval (CI): 40.8 to 53.0) prescriptions per 100,000 persons. Following guideline publication, there was no immediate change in the monthly PPI prescribing rate (137.6, 95% CI: -36.7 to 311.9 prescriptions per 100,000 persons), but there was a modest attenuation of the change in monthly rate (-23.9, 95% CI: -14.0 to -33.6 prescriptions per 100,000 persons). However, the predicted rates mirror the observed rates after guideline publication, suggesting limited changes.

Conclusions: Despite efforts to minimize the overprescribing of PPIs, there was little meaningful change in clinical practice following the 2014 National Institute for Health and Care Excellence recommendations.

Keywords: Deprescribing; Guidelines; Policy; Proton pump inhibitors; Quasi-experimental.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Humans
Practice Guidelines as Topic*
Practice Patterns, Physicians'* / trends
Proton Pump Inhibitors* / therapeutic use
United Kingdom

Substances

Proton Pump Inhibitors

Grants and funding

FDN-143328/CIHR/Canada