(53) A Factorial Randomized Trial of Personalized Prescribing Portraits and Evidence Letters to Reduce Long-Term Proton Pump Inhibitor Prescribing in Primary Care

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 384

Presenting Author(s)

Greg A. Carney, PhD
– Research Program Manager, University of British Columbia, Christina Lake, British Columbia, Canada

Co-Author(s)

Anat Fisher, MD, PhD
– Rsearch Associate, University of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
Dana Stanley
– University of British Columbia, Victoria, BC, Canada
Malcolm Maclure
– University of British Columbia, Victoria, BC, Canada
Colin Dormuth
– University of British Columbia, Victoria, British Columbia, Canada

Background: Long-term proton pump inhibitor (PPI) use has been associated with increased risk of chronic kidney disease and gastric cancer in observational studies. It is prudent to reduce unnecessary long-term prescribing of PPIs.

Objectives: To measure the impact of mailing personalized prescribing portraits and summary evidence letters cautioning against long-term PPI prescribing in primary care.

Methods: Family physicians (n = 5,348) in the province of British Columbia, Canada, were randomized by postal code into four arms: early Portrait-Letter; delayed Portrait-Letter; early Portrait/delayed Letter, and vice versa. The primary outcome was change in defined daily doses (DDD) of PPI per patient. Secondary outcomes included duration of therapy, dose per day, and incidence of therapy discontinuation and starting. Using linear regression, outcomes in the 3-month delay period were compared with the 3-month window immediately before the first mailing.

Results: The intervention and control groups were balanced on physician age, sex, and prescribing volume. The mean baseline prescribing of PPIs was 71.5 defined daily doses (DDD) per patient. The prescribing portraits were associated with a reduction in mean DDD dispensed per patient of -1.07 (95% CI: -2.54 to 0.40). The evidence letters were associated with a reduction in mean DDD dispensed per patient of -0.66 (95% CI: -2.08 to 0.75). The combined impact of the portrait and letter was not additive, with a change in mean DDD of -1.03 (-5.88 to 3.80). The portrait and letter were also each associated with statistically non-significant reductions in duration of therapy and dose. There was no evidence of change in therapy discontinuation or new therapy starts.

Conclusions: In a randomized trial of PPI personalized prescribing portraits and evidence summary letters, we did not find a behavior change in PPI prescribing in the short term. Further research into factors that improve audit and feedback processes is needed.