Determinants of and interventions for Proton Pump Inhibitor prescription behavior: a systematic scoping review

Gestel, L.C. van; Adriaanse, M.A.; Kanis, S.L.; Mensink-Bout, S.M.; Schoones, J.W.; Numans, M.E.; Jong, J.C.K.D.; Brink, G. van den

doi:doi:10.1186/s12875-024-02459-5

Background Proton Pump Inhibitors (PPI) are frequently prescribed. Long-term use is associated with side-efects and patients often lack a valid indication. Inappropriate PPI prescribing thus needs to be addressed. This review aims to scope 1) what determinants are studied as reasons for PPI prescribing, 2) what strategies are used for changing PPI (de)prescribing, and 3) whether important determinants are addressed in these interventions. Methods We searched eight databases for papers on determinants of physician PPI prescribing. Studies were included if they were conducted in a Western country and focused on oral PPIs for an adult population. By follow‑ ing the Behaviour Change Wheel, we extracted information regarding PPI prescribing behavior, behavioral determi‑ nants and intervention strategies. Findings We included 74 papers. Most focused on the determinants knowledge and beliefs about consequences. The latter was consistently related to PPI prescribing. Results for...Show moreBackground Proton Pump Inhibitors (PPI) are frequently prescribed. Long-term use is associated with side-efects and patients often lack a valid indication. Inappropriate PPI prescribing thus needs to be addressed. This review aims to scope 1) what determinants are studied as reasons for PPI prescribing, 2) what strategies are used for changing PPI (de)prescribing, and 3) whether important determinants are addressed in these interventions. Methods We searched eight databases for papers on determinants of physician PPI prescribing. Studies were included if they were conducted in a Western country and focused on oral PPIs for an adult population. By follow‑ ing the Behaviour Change Wheel, we extracted information regarding PPI prescribing behavior, behavioral determi‑ nants and intervention strategies. Findings We included 74 papers. Most focused on the determinants knowledge and beliefs about consequences. The latter was consistently related to PPI prescribing. Results for knowledge were mixed. Most interventions used education or enablement (e.g., algorithms, quality check improvements, involvement of pharmacists) as strategies. Enablement consistently improved PPI prescribing, while results for education were mixed. Interpretation There is an overemphasis on refective processes in studies on PPI prescribing. Future research should comprehensively identify behavioral determinants, focusing on refective and impulsive processes, such that interven‑ tions can address the most important determinants.
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Determinants of and interventions for Proton Pump Inhibitor prescription behavior: a systematic scoping review