Article Figures & Data
Tables
Participants (n = 15) No. (%) Participants (n = 15) No. (%) Specialty Years of practice Primary care 5 (33.3) 1–5 5 (33.3) Cardiology 4 (26.7) 6–10 6 (40.0) Gastroenterology 3 (20) 11–15 1 (6.7) Vascular surgery 3 (20) 16–20 1 (6.7) Female 5 (33.3) 21 + 2 (13.3) Approach to Use of PPIs Primary care [PCP 3] “I can’t think of the last time I started [a PPI] for gastroprotection, but people tend to be on it already.” [PCP 2] Interviewer: “So, how do you tend to use [PPIs] in your patients?” Response: “GERD, GERD, and GERD. So, that’s number 1. And number 2 is as an offset to nonsteroidal therapy.” [PCP 1] “I’m more likely thinking about can I take that PPI away than I am thinking about what can I start to prevent an ulcer?” Cardiology [Cardiologist 1] “For example, if I had a post- [ST-elevation myocardial infarction] patient that needed to be on aspirin and Plavix, and they had a big apical thrombus and they needed to be on Coumadin...and they are going to be on triple therapy for a month, then I would probably just put them on a PPI prophylactically, just because it’s like definitely a higher bleeding risk to be on triple therapy...” [Cardiologist 4] Interviewer: “How often do you tend to prescribe it in patients who are asymptomatic just for the purposes of preventing bleeding?” Response: “I can’t think of times when I have done that.” [Cardiologist 3] “So, I put everybody I see and start on—even if they are on it, but I make sure everybody—if I have a patient who is on dual antiplatelet therapy, they go on a PPI. I pretty much—and I am super militant about this—and then, you know, I also don’t like to continue [dual antiplatelet therapy] more than what I have to.” Gastroenterology [Gastroenterologist 1] “I think, in general, PCPs or other physicians are pretty aware of the risk, and the patients, by the time they come to us, they are already on PPIs. So, I don’t usually make—I don’t usually start PPIs just for gastroprotection. I think it’s more because I don’t feel like I need to because they are already on it, typically.” [Gastroenterologist 2] “If somebody comes in to see me for a GI problem, on my checklist is not to see if they are at risk for bleeding ulcer or complicated peptic ulcer disease. Now, if they bring to my attention any upper GI symptoms, that will be a part of my evaluation, especially if it’s peptic symptoms or, again, any reflux symptoms. But every patient that I see in clinic, I don’t—you know, like in primary care they make sure somebody’s mammogram is up to date. I don’t look to see if a—I don’t assess their risk for developing a bleeding ulcer and look to see if they are on appropriate gastroprotection.” Vascular surgery [Vascular surgeon 3] “I generally do not prescribe them [PPIs] for my patients in an outpatient setting, so short of those people who get them in the perioperative setting, I am not initiating treatment for patients.” GERD = gastroesophageal reflux disease; GI = gastrointestinal; PCP = primary care physician; PPI = proton pump inhibitor; ST = section on an electrocardiogram between S wave and T wave.
Reference, No. (%) Primary Care (n = 5) Cardiology (n = 4) Gastroenterology (n = 3) Vascular Surgery (n = 3) Any mention of possible adverse effects 5 (100) 2 (50) 3 (100) 1 (33.3) Clostridioides difficile or other enteric infection 4 (80) 1 (25) 1 (33.3) 1 (33.3) Dementia 4 (80) 0 (0) 3 (100) 0 (0) Pneumonia 3 (60) 2 (50) 1 (33.3) 1 (33.3) Chronic kidney disease 3 (60) 1 (25) 2 (66.7) 0 (0) Bone disease 3 (60) 0 (0) 2 (66.7) 1 (33.3) PPI = proton pump inhibitor.
Additional Files
Visual abstract - link below
Visual abstract. What barriers exist when a physician wants to prescribe a proton pump inhibitor to a patient at high risk for upper GI bleeding?
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PNG file
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Supplemental materials
Supplemental Appendix 1. Final Interview Guide
Supplemental Appendix 2. Detailed Description of Qualitative Analysis and Coding Process
Supplemental Table 1. Supporting Quotes for Knowledge
Supplemental Table 2. Supporting Quotes for Decision Processes
Supplemental Table 3. Supporting Quotes for Professional Role
- Kurlander.pdf -
PDF file
- Kurlander.pdf -
