The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Too much of a good thing - Deprescribing Proton Pump Inhibitors (PPIs), can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Too much of a good thing – Deprescribing Proton
Pump inhibitors (PPIs)
Eoin Moroney
Practice Pharmacist for Montpelier Surgery
Lead Clinical Pharmacist for North & Central Brighton PCN
Eoin.moroney@nhs.net
References
1. NHS-Digital. Prescription Cost Analysis – England – 2021/22 [internet]. London. NHS Business
Services Authority, 2022 [cited 01 July 2023]. Available via Prescription Cost Analysis – England –
2021/22 | NHSBSA.
2. OpenPrescribing.net. Part of chapter 1 Gastro-Intestinal System, section 1.3 Antisecretory
drugs and mucosal protectants [internet]. Oxford. Bennett Institute for Applied Data Science,
2023 [cited 21 July 2023]. Available via BNF 1.3.5: Proton pump inhibitors | OpenPrescribing.
3. Vaezi MF, Yang YX, Howden CW. Complications of Proton Pump Inhibitor Therapy.
Gastroenterology. 2017; 153 (1):35-48.
4. Safe Use of Proton Pump Inhibitors. Llandough. All Wales Medicines Strategy Group, 2018
[cited 01 July 2023]. Available via awttc.nhs.wales/files/guidelines-and-pils/safe-use-of-proton-pump-
inhibitors-pdf/.
5. Farrell B, Pottie K, Thompson W, Boghossian T, Lisa Pizzola L, Rashid FJ. et al. Deprescribing
proton pump inhibitors. Canadian Family Physician. 2017; 63 (5):354-364.
6. A-guide-to-deprescribing-proton-pump-inhibitors [internet]. Tasmania. Bennett Institute for
Primary Health Tasmania, 2022 [cited 01 June 2023]. Available via A-guide-to-deprescribing-proton-
pump-inhibitors.pdf (primaryhealthtas.com.au).
Background
▪ Prescribing of PPIs are currently ubiquitous in clinical practice
▪ In 2021/22, the NHS in England only generated 71, 117,576
prescriptions for PPIs which amounted to an annual spend of £161,
931, 0901
▪ In England for July 2023, 6,201,925 prescriptions were generated in
general practice for PPIs accounted for a spend of £20, 225, 7172
▪ PPIs are generally viewed as well tolerated medicines, with a low
incidence of adverse effects associated with short-term use
▪ Nevertheless, cumulative evidence that long-term use is associated
with an increased risk of adverse effects
▪ Older adults more susceptible to adverse effects of long-term PPI use
Figure 1; Reported adverse consequences of long-term PPI therapy3
Reaudit patient cohort in three
months
Feedback to clinical staff at
practice meeting
All patients prescribed high
intensity PPI regimens
reviewed*
See separate outcome data*
Identify patients from clinical
searches in GP electronic records
aged >65years prescribed higher
than standard doses of PPIs (n = 13)
Evaluate if continuing PPI clinical
appropriate
Engage with patient cohort &
encourage deprescribing using
validated algorithms
Patient
ID
Age
(years)
Medication Consultation
Duration of
treatment
Outcome
1 67 Omeprazole 20mg Severe oesophagitis with gastric ulcer 4 months Switched to PRN use
2 70 Pantoprazole 20mg Gastric angiodysplasia with hx of etOH misuse 3.5 years Not engaging
3 95 Esomeprazole 20mg New diagnosis of Barrett's oesophagus 6 months Not appropriate currently
4 72 Omeprazole 20mg Barrett's oesophagus 6 years Out of the country
5 69 Omeprazole 20mg GORD with hx of etOH misuse 1 year Not engaging
6 69 Omeprazole 20mg Laryngopharyngeal reflux 3 months Switched to PRN use
7 76 Zoton FasTab 30mg Oesophageal ulcer & hiatus hernia 9 months
Currently weaning down as per reduction
plan
8 88 Omeprazole 20mg Barrett's oesophagus 13 years
Currently weaning down as per reduction
plan
9 70 Omeprazole 20mg Gastritis & duodenitis 1 year Switched to PRN use
10 72 Omeprazole 20mg Gastritis & oesophagitis & severe diverticular disease 15 years
Reduced slowly as awaiting sigmoid
colectomy
11 65 Omeprazole 20mg Supportive medication for advanced rectal cancer 3.3 years Not appropriate currently
12 71 Omeprazole 20mg
Duodenitis & hiatus hernia & umbilical hernia &
diverticulosis
4.5 years Reduced slowly as awaiting surgery
13 79 Omeprazole 20mg GORD & inguinal hernia 12 years Switched to PRN use
Conclusions and Next Steps
▪ Patient confidence & education essential for empowering patients as
part of shared decision making process
▪ For patients initially prescribed PPIs from secondary care, both
patients & GPs more reluctant to deprescribe PPIs
▪ Patients were keen to engage with supported reduction to reduce pill
burden
▪ Plethora of deprescribing algorithms available to support
deprescribing
▪ Plan is to expand review to patients aged >65 years prescribed
standard intensity PPI regimens
Interventions/Outcomes
Method
Aim
To reduce prescribing of high dose/intensity PPIs in older adults aged
>65years via application of All Wales Medicines Strategy Group
deprescribing algorithm6