Date Approved
4-1-2024
Graduate Degree Type
Dissertation
Degree Name
Nursing (D.N.P.)
Degree Program
College of Nursing
First Advisor
Dr. Nicole Harpold, DNP RN AGPCNP-BC
Second Advisor
Dr. Kellie Riley, DNP, FNP-BC
Third Advisor
Dr. Laura Reincke, MD
Academic Year
2023/2024
Abstract
Background: Proton pump inhibitors (PPIs) have been extensively prescribed for gastrointestinal pathologies, contributing to $14 billion in annual expenditure in the United States alone. Inappropriate PPI prescriptions, affecting 48% of adults, raise concerns about prolonged usage and associated health risks. Addressing these issues is vital, considering the significant impact of PPIs on patient health and healthcare costs.
Local Problem: A Midwestern clinic grapples with inappropriate and unnecessary PPI use among patients. In response, a comprehensive deprescribing intervention combining a provider algorithm with patient education was implemented to reduce PPI usage that was medically unnecessary.
Methods: A literature review spanning 2016 to 2023 identified key themes and characteristics related to PPI deprescribing. Barriers and facilitators were analyzed, and an organizational assessment informed targeted intervention. The Health Promotion Model and Six Sigma model guided project implementation, including data collection, medication reconciliation and provider-led deprescribing decisions.
Interventions: The deprescribing approach integrated a provider algorithm and patient education materials. Medical Assistants identified PPI users, and Primary Care Providers (PCPs) utilized a deprescribing algorithm to guide tapering or discontinuation. Eligible patients received educational handouts outlining risks, benefits, and lifestyle modifications.
Results: Of the 35 initially targeted patients, 33 were included, with a 72.7% success rate in PPI deprescription. Statistical analysis using the Agresti-Coull test demonstrated a significant reduction in PPI use, with a confidence interval of 55.61% to 85.1%.
Conclusion: The study achieved a statistically significant reduction in PPI use, highlighting the potential impact of tailored deprescribing interventions. The success of the deprescribing algorithm emphasizes the significance of evidence-based decision support for PCPs.
Implications: PCPs play a pivotal role in fostering patient understanding and adherence to deprescribing regimens. The success of the deprescribing algorithm reinforces the importance of evidence-based decision-support tools for PCPs, contributing to optimized PPI practices in primary care settings.
ScholarWorks Citation
Barney, Jason Thomas, "Deprescribing Proton Pump Inhibitors in a Rural Health Clinic" (2024). Doctoral Dissertations. 61.
https://scholarworks.gvsu.edu/dissertations/61
