The Current Status and Factors Influencing Long-term Proton Pump Inhibitor Use and Deprescribing among Community Residents

Abstract

Background The potential risks of long-term use of proton pump inhibitor (PPI) and the potentially inappropriate medication are gradually being taken into account, and PPI deprescribing has been widely recognised, but the situation of long-term use of PPI and the willingness to deprescribing of PPI among the community residents in our country are not yet clear. Objective To understand the current situation of long-term PPI use and PPI deprescribing among community residents, explore its influencing factors and propose improvement measures. Methods From April 2018 to January 2020, a survey was conducted among 389 residents of the Shichahai Community Health Service Center in Xicheng District, Beijing, who had been taking proton pump inhibitors (PPIs) chronically. Data on participants' demographics, PPI usage patterns, concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet agents, presence of comorbid chronic diseases, medication quantities, potential for PPI deprescribing, and polypharmacy status were collected via the community electronic health information system and telephone-administered questionnaires. Subsequently, between June and December 2020, telephone interviews were conducted with 92 residents still using PPIs long-term to assess their perceptions regarding prolonged PPI use and attitudes toward deprescribing. Multivariate Logistic regression analysis was employed to identify factors influencing the continuous PPI use exceeding six months among those deemed eligible for deprescribing. Results After excluding individuals who declined to participate, could not be reached, or had not taken PPIs continuously, the final study population consisted of 318 residents who were chronically using PPIs. The mean age of long-term PPI residents was (63.9±12.5) years, 61.0% were female, the mean number of types of comorbid chronic diseases was (3.3±1.4) , and the mean number of medications was (6.1±3.3) , and the majority of the residents were able to carry out PPI deprescribing (231, 72.6%) . The prescribing indications for PPIs to prevent nonsteroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs for gastrointestinal damage were the most frequent (202, 63.5%) . Multifactorial Logistic regression analysis showed that residents' age and number of medications were influential factors for taking PPIs continuously for >6 months[OR=1.044, 95%CI (1.016-1.073) ; OR=1.175, 95%CI (1.009-1.376) , P<0.05]. Residents who were still taking PPIs chronically between June and December 2020 and were available to carry out deprescribing was available for a total of 92 residents, 82.6% of respondents were aware of the indications for medication use, 70.7% (65/92) of respondents were unaware of the potential risks of long-term PPI use, 71.7% (66/92) were willing to deprescribe PPI with the help of their GP, and the main concern about deprescribing was recurring symptoms. Conclusion Long-term PPI residents in community health services are older and predominantly female, with a high proportion of multiple medication use; attention should be paid to the use of PPI medication by residents who are older and use a larger number of medications, and there is a need to strengthen the education on the potential risks of long-term use of PPIs, and long-term PPI users have a positive attitude towards PPI deprescribing, and there is a need to strengthen the management of long-term use of PPIs.

Keywords

• proton pump inhibitor|long-term use|deprescribing|telephone questionnaire survey|community health services|root cause analysis