Long-term proton pump inhibitor (PPI) use: less can be more when treating heartburn

26 Jun 2020 Long-term proton pump inhibitor (PPI) use: less can be more when treating heartburn

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Posted at 16:50h in Portrait by

An individual Portrait on prescribing PPIs to patients age 19 and older was distributed to approximately 5400 family doctors in BC, randomized to receive the Portrait in two groups. The Portraits were mailed to the early group in March 2020 and to the delayed group in June 2020. This Portrait was accompanied by Therapeutics Letter #126: Serious harms with long-term PPI use in older adults.

Below is a sample Portrait containing fictional individual physician data. View this sample Portrait in PDF format, or click on the DOWNLOAD button above. If you are a BC family physician and wish to sign up for (or opt out of) receiving Portrait, click on the REGISTER button above.

Sample Portrait

References and additional information

References

  1. Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013 May 31; (5):CD002095. https://doi.org/10.1002/14651858.CD002095.pub5
  2. Hussain S, Singh A, Habib A, NajmiAK. Proton pump inhibitors use and risk of chronic kidney disease: Evidence-based meta-analysis of observational studies. Clinical Epidemiology and Global Health. 2019 March; 7(1):46-52. https://doi.org/10.1016/j.cegh.2017.12.008
  3. Wan QY, Wu XT, Li N, Du L, Zhou Y. Long-term proton pump inhibitors use and risk of gastric cancer: a meta-analysis of 926,386 participants. Gut. 2019 April; 68(4):762-764. https://doi.org/10.1136/gutjnl-2018-316416
  4. Boghossian TA, Rashid FJ, Thompson W, Welch V, Moayyedi P, Rojas‐Fernandez C, et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Cochrane Database Syst Rev. 2017 March 16; (3):CD011969. https://doi.org/10.1002/14651858.CD011969.pub2
  5. PPI Deprescribing Guideline
    1. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, et al. Deprescribing proton pump inhibitors.Evidence-based clinical practice guideline. Can Fam Physician. 2017 May; 63(5):354–64. http://www.cfp.ca/content/63/5/354
    2. Summary flowsheet https://deprescribing.org/wp-content/uploads/2018/08/ppi-deprescribing-algorithm_2018_En.pdf
  6. Therapeutics Initiative. Serious harms with long-term proton pump inhibitor use in older adults. Therapeutics Letter 126. 2020 (Mar-Apr); 126:1-2. https://ti.ubc.ca/letter126
  7. Therapeutics Initiative. Trends in utilization of proton pump inhibitors in British Columbia. Therapeutics Letter 118. 2002 (Jun-Sep); 118:1-2. https://ti.ubc.ca/letter118

Patient resources

2-page patient info sheet,“Is a proton pump inhibitor still needed? including lifestyle/diet changes and over the counter remedies”: https://deprescribing.org/wp-content/uploads/2018/08/Deprescribing-Pamphlet_PPI_ENG_CFP.pdf by org

12-page, easy-to-read patient workbook – “Do I still need this medication? Proton pump inhibitor (PPI)” http://www.criugm.qc.ca/fichier/pdf/PPI-EN-Men.pdf at https://www.deprescribingnetwork.ca/deprescribing by Canadian Deprescribing Network (available in multiple languages).

Data definitions

Who received this Portrait?

BC physicians meeting allof the following criteria received an individual PPI prescribing Portrait:

      • family practitioners  and general practice physicians, who were registered by the BC Medical Services Plan (MSP) as a private practice, post graduate, salaried, or temporary license, and
      • had a valid mailing address in BC according to the College of Physicians and Surgeons of British Columbia’s public physician information, and
      • had ≥25 prescriptions filled at a community pharmacy in 2018 (early group) and 2019 (delayed group) according to PharmaNet claims data, and
      • prescribed a PPI to ≥1 eligible patient in Dec. 2018 to Nov. 2019 (early group) or in Apr. 2019 to Mar. 2020 (delayed group) according to MSP and PharmaNet claims data.

Physicians may have received a Portrait with masked or missing elements (i.e. no blue bars shown) because they met the above requirements but prescribed between 1 and 5 PPI prescriptions for that section of the Portrait. Portrait’s data access agreement requires the suppression of data elements that contain <6 patients. Physician with no prescriptions (“0 prescriptions”) will have this information available.

How were patients assigned to this Portrait?

Patients were included in a physician’s Portrait if they met all of the following criteria:

      • were continuously registered with the MSP in Dec. 2018 to Nov. 2019 (early group) or in Apr. 2019 to Mar. 2020 (delay group), and
      • were at least 19 years old, and
      • were not on PharmaCare plan P (palliative) or plan B (long-term care) at the time of the prescription refill, and
      • had a medical encounter recorded in MSP fee-for-service claims with that physician’s billing number, and/or were prescribed a medication with that physician’s prescribing number in PharmaNet. A specific refill record could be assigned to multiple physicians if the aforementioned conditions were fulfilled.

Prescription data for patients who are federally insured (e.g. Veterans, RCMP, Armed Forces and beneficiaries of Non-Insured Health Benefits) or those enrolled in the First Nations Health Benefits (PharmaCare Plan W) were not included.

What prescriptions were included in this Portrait?

PPI prescriptions were identified  from the PharmaNet claims data and included all prescriptions filled at a community pharmacy in BC with a physician’s prescribing number. Reversed prescription claims, out-of-province prescriptions, or medication dispensed in hospital were not included.

PPIs were identified by the Anatomical Therapeutic Chemical (ATC) Classification System and include pantoprazole (A02BC02), rabeprazole (A02BC04), esomeprazole (A02BC05), lansoprazole (A02BC03), omeprazole (A02BC01), dexlansoprazole (A02BC06).

Research component

The research objective is to determine the impact of the Portrait on physician prescribing of PPIs. This impact is evaluated at an aggregated level  by comparing pooled prescribing data from physicians in the early mailing group to pooled prescribing data from physicians in the delayed group. All prescribing data analyzed for this evaluation do not contain names, only encrypted patient and physician numbers. No physician or patient will be identified in any reports or publications. As a reminder, Portrait’s data access agreement requires the masking of data elements when <6 individuals (patients or physicians) are included. Ethics approval for this evaluation was obtained from the University of British Columbia Clinical Ethics Review Board (H19-00997). This evaluation is being led by Drs. Colin Dormuth and Greg Carney, University of British Columbia, Faculty of Medicine, Department of Anesthesiology, Pharmacology, & Therapeutics.

If you have any questions or would like further information with respect to this evaluation, you may contact the Portrait team at (604) 822-4887 or email Portrait@ti.ubc.ca

FAQ

Can I request the names of my patients included in this Portrait?

No. Portrait’s data access agreement only permits access to encrypted patient identifiers. There is no way for us to identify individual patients in the data or to provide you with a list.

However, other resources may be available for you. Contact your Practice Support Program (PSP) regional teamto discuss how they might help you use your EMR to identify these patients.

I don’t see my question here. Where can I find more information?

We welcome your feedback.  Questions can be directed to our Portrait team by phone (604) 822-4887 or email Portrait@ti.ubc.ca. You can also check out our program FAQ page.

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