Prescribing practices for proton pump inhibitors among primary care physicians in England: an evaluation

Proton pump inhibitors (PPIs), the most frequently prescribed drug class globally, are often overused.

To assess PPI prescribing practice in England.

Electronic medical record (EMR) evaluation from 62 primary care GP practices in England.

Adult patients on continuous PPI treatment (repeat prescription or ≥4 acute prescriptions 6 months before data extraction) were included (August 2021-June 2022) to compare PPI prescribing practices versus National Institute for Health and Care Excellence (gastro-oesophageal reflux disease [GORD] and dyspepsia management) and Medicines and Healthcare products Regulatory Agency (clopidogrel and PPI interaction) guidelines.

We identified 77 356 patients on continuous PPI treatment. The most common (68%) diagnosis recorded in patients' EMRs and indicated for PPI use was gastroprotection, although 62% had no recorded indication. Of these 62% of patients, 40% had no medication review in the preceding year. Among those with diagnoses indicated for ≤3 months of PPI therapy (34%), 99% received their first PPI prescription ≥3 months previously. Of patients with diagnoses indicated for long-term treatment (4%), 41% had no medication review in the preceding year. Furthermore, 18% of patients using omeprazole or esomeprazole were also prescribed clopidogrel, and 19% of those prescribed treatments associated with gastrointestinal risk (n = 14 826) were not prescribed PPIs.

This study shows that PPI prescribing in England is not in alignment with existing clinical guidelines and highlights the need for appropriate measures to increase awareness of overuse and support deprescribing where appropriate.