Effectiveness of a structured physician-led medication review and educational intervention on inappropriate proton pump inhibitor use among community-dwelling adults: A prospective controlled study

Background

Proton pump inhibitors (PPIs) are one of the most commonly used drugs globally, but a significant proportionof long-term use is without a valid continuing indication, resulting in potential avoidable harm and unnecessary costs.Structured medication review combined with patient education interventions seem to be promising, but controlled evidencein community settings is limited. The objective is to assess the effectiveness of a physician-led, structured medication reviewand education intervention to decrease inappropriate PPI use among community-dwelling adults without compromisingsymptom control. Materials and Methods: This was a prospective, parallel-group controlled study of 420 communitydwellingadults who were taking chronic PPI therapy (at least 8 weeks) for a 6-month period, with half receiving a structuredintervention (n = 210) and the other half receiving usual care (n = 210). The intervention included a medication review basedon the criteria, an individualized deprescribing plan, and a standardized educational session. The main outcome was thepercentage of participants using PPI at 6 months that had inappropriate use. Secondary outcomes were completediscontinuation, dose reduction or step down, conversion to on-demand use, PPI knowledge, symptom control, and monthlymedication cost. Analyses followed the intention-to-treat principle and used the chi-square test, independent-samples t-test,McNemar's test, and multivariable logistic regression.