"But Doctor, Why Am I On This Medication?!": An Analysis Of Patients' Perceptions Of Proton Pump Inhibitor Therapy

INTRODUCTION: While proton pump inhibitor (PPI) de-escalation initiatives have garnered much attention lately, not much is known about patient perceptions regarding PPI de-escalation. We sought to determine the knowledge of adverse effects and willingness to de-escalate therapy among patients presenting to primary care and subspecialty clinics. METHODS: We conducted an anonymous survey of patients presenting to Family Medicine, Internal Medicine and Gastroenterology clinics who use PPIs. Topics in the survey included awareness of, and concern for AEs of PPIs and willingness to de-escalate PPI therapy. RESULTS: The sample comprised 206 participants presenting to GI (29.8%), Internal Medicine (32.2%) and Family Medicine clinics (38%). Mean age was 54.9 years (SD 15.74 years). PPIs were prescribed by primary care providers in 61.7%; 16% were ‘extremely concerned’ and 28.6% were ‘somewhat concerned’ about AEs of PPIs, and 30.6% reported having tried to reduce the dosage and 28.2% reported attempting to stop PPIs by themselves in the past. Many patients (54.9%) reported that providers had not discussed AEs before initiation. Patients visiting digestive disease clinics were no more likely to report discussions of AEs, or provider-led de-escalation or discontinuation attempts compared to primary care patients (P values > 0.05). On logistic regression analysis, more concern for AEs and having been told by providers to discontinue PPIs were found to be significantly associated with attempts to discontinue PPI. CONCLUSION: Although many patients on PPIs are concerned about AEs, low number of patients reported provider-initiated discussions on PPI adverse effects at initiation. The reasoning behind attempts to discontinue PPI therapy without provider recommendation requires further study and exploration. Patients should always be advised to talk with their providers regarding the potential adverse effects of the medications they are taking before attempting to make any medication changes, even those involving medications that are available over-the-counter. Providers should also assume a more responsible role in discussing the side effects of the PPIs their patients are currently taking, the intended duration of treatment, the potential risks of stopping PPIs in patients who meet clinical criteria for benefit with continuation as well as engage in shared decision making with the patients on long term PPI therapy without an appropriate indication.Table 1.: Characteristics of study populationTable 2.: Logistic Regression Analysis for factors associated with attempts at discontinuation of proton pump inhibitor therapy