Deprescribing Intervention and Reduction of Proton Pump Inhibitor Use in Primary Care

Importance Inappropriate use of proton pump inhibitors (PPIs) is associated with severe adverse drug reactions and may significantly increase health care costs. Deprescribing should be considered when inappropriate use is identified. Objective To evaluate the effectiveness of a patient- and general practitioner (GP)–facing intervention in reducing potentially inappropriate PPI use in primary care. Design, Setting, and Participants This pragmatic, cluster-randomized, open-label, clinical trial was conducted between November 12, 2020, and November 11, 2021. Participants were adults aged 18 years or older with at least 1 year of PPI use in GP practices in 2 regions of western France, and their GPs were included. Data were analyzed from January to July 2025. Interventions GP practices were randomized to 3 groups in a 1:1:1 ratio as follows: (1) a patient- and GP-facing deprescribing intervention combining a patient education brochure on PPI deprescribing posted directly to patients with a letter outlining a PPI deprescribing algorithm sent to their GPs; (2) a GP-facing intervention, in which only the GP received the letter and algorithm; or (3) usual care. Main outcomes and measures The primary outcome was PPI dose reduction, defined as a 50% or more reduction in annual PPI use, measured in defined daily doses (DDDs) and proxied by reimbursement claims. Secondary measures included Gastroesophageal Reflux Disease Impact Scale (GIS) scores, assessed in a 10% sample. Results A total of 1498 GPs and 34 409 patients were included from 683 primary care practices. The mean (SD) patient age was 68.6 (14.0) years, and 19 507 (56.7%) were female. Mean (SD) baseline annual PPI use was 413.7 (113.9) DDDs. PPI dose reduction was higher in the patient- and GP-facing intervention group compared with the usual care groups (1710 of 11 442 patients 14.9% vs 825 of 11 732 7.0%; adjusted absolute difference, 6.9%; 95% CI, 5.7%-8.3%; P lt; .001) and with the GP-facing intervention (1710 of 11 442 patients 14.9% vs 862 of 11 235 7.7%; adjusted absolute difference, 6.7%; 95% CI, 5.4%-8.2%, P lt; .001). GIS scores did not significantly differ between groups. Conclusions and relevance This randomized clinical trial found that the patient- and GP-facing intervention was effective in reducing potentially inappropriate PPI use without any meaningful impact on long-term gastroesophageal reflux disease activity. Trial Registration ClinicalTrials.gov Identifier: NCT04255823