PMID- 35074761
OWN - NLM
STAT- MEDLINE
DCOM- 20220321
LR  - 20220321
IS  - 1544-1717 (Electronic)
IS  - 1544-1709 (Print)
IS  - 1544-1709 (Linking)
VI  - 20
IP  - 1
DP  - 2022 Jan-Feb
TI  - Barriers to Guideline-Based Use of Proton Pump Inhibitors to Prevent Upper 
      Gastrointestinal Bleeding.
PG  - 5-11
LID - 10.1370/afm.2734 [doi]
AB  - PURPOSE: Gastrointestinal (GI) bleeding is one of the most common serious adverse 
      drug events. Guidelines recommend proton pump inhibitor (PPI) gastroprotection to 
      prevent upper GI bleeding in high-risk patients, but this practice is underused. 
      METHODS: To explore prescribing practices and barriers to the use of PPI 
      gastroprotection, including dynamics within and across specialties, we conducted 
      semistructured interviews with physicians in 4 specialties at a single 
      institution. We performed thematic analysis of barriers, organized around the 
      theoretical domains framework. RESULTS: The sample included 5 primary care 
      physicians (PCPs), 4 cardiologists, 3 gastroenterologists, and 3 vascular 
      surgeons. Most PCPs, gastroenterologists, and vascular surgeons seldom prescribed 
      PPI gastroprotection. Cardiologists varied most in their use of PPI 
      gastroprotection, with some prescribing it consistently and others never. Major 
      barriers related to the following 3 themes: (1) knowledge, (2) decision 
      processes, and (3) professional role. Knowledge of guidelines was greatest among 
      cardiologists and gastroenterologists and low among PCPs and vascular surgeons, 
      and PCPs tended to focus on adverse effects associated with PPIs, which made them 
      reluctant to prescribe them. For cardiologists, prevention of bleeding was 
      usually a priority, but they sometimes deferred prescribing to others. For the 
      other 3 specialties, PPI gastroprotection was a low priority. There was unclear 
      delineation of responsibility for prescribing gastroprotection between 
      specialties. CONCLUSIONS: Major barriers to PPI gastroprotection relate to 
      knowledge, decision processes, and professional role, which operate 
      differentially across specialties. Multicomponent interventions will likely be 
      necessary to improve guideline-based use of PPIs to prevent upper GI 
      bleeding.VISUAL ABSTRACT.
CI  - (c) 2022 Annals of Family Medicine, Inc.
FAU - Kurlander, Jacob E
AU  - Kurlander JE
AD  - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 
      jkurland@umich.edu.
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
      Arbor, Michigan.
AD  - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, 
      Michigan.
FAU - Helminski, Danielle
AU  - Helminski D
AD  - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
FAU - Kokaly, Alex N
AU  - Kokaly AN
AD  - UCLA Health Department of Medicine, Los Angeles, California.
FAU - Richardson, Caroline R
AU  - Richardson CR
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
      Arbor, Michigan.
AD  - Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
FAU - De Vries, Raymond
AU  - De Vries R
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
      Arbor, Michigan.
AD  - Department of Learning Health Sciences, University of Michigan, Ann Arbor, 
      Michigan.
AD  - Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann 
      Arbor, Michigan.
FAU - Saini, Sameer D
AU  - Saini SD
AD  - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
      Arbor, Michigan.
AD  - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, 
      Michigan.
FAU - Krein, Sarah L
AU  - Krein SL
AD  - Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
AD  - Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
      Arbor, Michigan.
AD  - Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, 
      Michigan.
LA  - eng
GR  - I01 HX002693/HX/HSRD VA/United States
GR  - K23 DK118179/DK/NIDDK NIH HHS/United States
GR  - RCS 11-222/HX/HSRD VA/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Ann Fam Med
JT  - Annals of family medicine
JID - 101167762
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - *Gastrointestinal Hemorrhage/chemically induced/drug therapy/prevention & control
MH  - Humans
MH  - *Proton Pump Inhibitors/therapeutic use
PMC - PMC8786436
OTO - NOTNLM
OT  - barriers
OT  - gastrointestinal bleeding
OT  - gastroprotection
OT  - prevention
OT  - proton pump inhibitors
EDAT- 2022/01/26 06:00
MHDA- 2022/03/22 06:00
PMCR- 2022/01/01
CRDT- 2022/01/25 05:47
PHST- 2020/09/15 00:00 [received]
PHST- 2021/02/18 00:00 [revised]
PHST- 2021/03/30 00:00 [accepted]
PHST- 2022/01/25 05:47 [entrez]
PHST- 2022/01/26 06:00 [pubmed]
PHST- 2022/03/22 06:00 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 20/1/5 [pii]
AID - 10.1370/afm.2734 [doi]
PST - ppublish
SO  - Ann Fam Med. 2022 Jan-Feb;20(1):5-11. doi: 10.1370/afm.2734.