(123) Improving Prescription Appropriateness of Proton Pump Inhibitors: The LAPTOP-PPI Study

Background: Proton pump inhibitors (PPIs) are among the most commonly and inappropriately prescribed drugs by general practitioners (GPs), resulting in increased risk of adverse outcomes for patients and in avoidable costs for the National Health System (NHS).

Objectives: This study aims to assess the effectiveness of a low-cost and easily implementable informative intervention directed at GPs to enhance the appropriate prescription of PPIs among community-dwelling aged ≥65 individuals.

Methods: The LAPTOP-PPI study is a pragmatic, cluster-randomized controlled trial designed to improve the appropriateness of PPIs prescriptions among community-dwelling individuals aged ≥65 years. In June 2021 GPs in the Local Health Units (LHUs) of Bergamo (Northern Italy) and Caserta (Southern Italy) were randomly allocated to either intervention group (summary reports on prescribing habits, scientific documents on Italian Medicine Agency’s therapeutic indications, strategies for PPIs deprescribing, along with educational materials for patients), and control group (standard practice). We analyzed data obtained from the administrative databases of Bergamo and Caserta LHUs, routinely updated for reimbursement purposes. PPIs appropriateness was assessed through an algorithm specifically designed and based on NHS prescription appropriateness and reimbursement criteria. Intervention efficacy was evaluated comparing data from baseline period (July 1 to December 31, 2019) with those from the follow-up period (July 1 to December 31, 2021), six months after randomization. Statistical significance was assessed using chi-square tests.

Results: At baseline, 79,116 and 92,862 patients aged ≥65 received drug prescriptions for acid-related diseases (ATC = A02B) and were assessable for evaluation of appropriateness in Bergamo and Caserta, respectively. At follow-up, these numbers were 78,477 and 86,369. According to the algorithm, 54.0% and 63.0% deemed inappropriately prescribed at baseline, respectively. After the intervention, these proportions were 63.0% and 59.9%, respectively. The pre-post variation was -9.0% for the control group and -8.9% for the intervention group in Bergamo (p=0.568), and 2.9% and 3.1% respectively in Caserta, (p=0.561).

Conclusions: Given the widespread use, especially in the elderly, improving prescription quality of PPIs is a major concern. Educational interventions for GPs and patients are routine strategies to address inappropriateness, but they appear to be insufficient to improve prescribing practice independently, especially in a critical period such as the post-pandemic one and especially in particularly affected areas, such as the LHU of Bergamo.