Effectiveness of a Structured Physician-Led Medication Review and Educational Intervention on Inappropriate Proton Pump Inhibitor Use Among Community-Dwelling Adults: A Prospective Controlled Study

Background: Proton pump inhibitors (PPIs) are one of the most commonly used drugs globally, but a significant proportionof long-term use is without a valid continuing indication, resulting in potential avoidable harm and unnecessary costs.Structured medication review combined with patient education interventions seem to be promising, but controlled evidencein community settings is limited. The objective is to assess the effectiveness of a physician-led, structured medication reviewand education intervention to decrease inappropriate PPI use among community-dwelling adults without compromisingsymptom control. Materials and Methods: This was a prospective, parallel-group controlled study of 420 communitydwellingadults who were taking chronic PPI therapy (at least 8 weeks) for a 6-month period, with half receiving a structuredintervention (n = 210) and the other half receiving usual care (n = 210). The intervention included a medication review basedon the criteria, an individualized deprescribing plan, and a standardized educational session. The main outcome was thepercentage of participants using PPI at 6 months that had inappropriate use. Secondary outcomes were completediscontinuation, dose reduction or step down, conversion to on-demand use, PPI knowledge, symptom control, and monthlymedication cost. Analyses followed the intention-to-treat principle and used the chi-square test, independent-samples t-test,McNemar's test, and multivariable logistic regression. Results: There was no difference in baseline inappropriate use(intervention 68.6% vs control 66.7%, p = 0.68). Inappropriate use was reduced by 29.1 percentage points (95% CI 20.1–38.1; p < 0.001) at 6 months in the intervention arm compared with the control arm, with an adjusted odds ratio of 3.86 (95%CI 2.52–5.91) for appropriate use. Complete discontinuation reached 27.6% versus 8.6% and dose reduction 34.3% versus14.3% (both p < 0.001). Mean knowledge scores rose from 4.1 to 8.6 of 12 versus 4.2 to 4.9 (p < 0.001). There was nodifference in adequate symptom control (85.2% vs 83.3%, p = 0.60) and the mean monthly PPI cost decreased by 42%. Thenumber needed to treat was 3.4. Conclusion: A structured medication-review and education intervention significantlydecreased inappropriate PPI use in community-dwelling adults without adversely affecting symptom control, and increasedknowledge and reduced cost. The model is scalable and can be implemented in community practice by physicians andpharmacists.