Internists' Misconceptions About PPIs: Increasing Knowledge and Implementing Guidelines

Misconceptions about proton-pump inhibitor (PPI) adverse effects were common among internists, and many had changed prescribing. Among 4 scenarios representing a risk spectrum for upper gastrointestinal bleeding, 86% of physicians properly chose discontinuing PPI for a minimum-risk patient with previous gastroesophageal reflux disease, but 79% inappropriately chose discontinuing PPI for a high-risk patient with a peptic ulcer history taking low-dose aspirin. Physician self-assessment is often inaccurate. Time barriers to learning and unanswered clinical questions, especially drug issues, are common. Unscientific information can influence both physicians and patients. Strategies for increasing the guideline implementation include making scientific information available more rapidly and systematically monitoring guideline use.