PT  - JOURNAL ARTICLE
AU  - Jacob E. Kurlander
AU  - Danielle Helminski
AU  - Alex N. Kokaly
AU  - Caroline R. Richardson
AU  - Raymond De Vries
AU  - Sameer D. Saini
AU  - Sarah L. Krein
TI  - Barriers to Guideline-Based Use of Proton Pump Inhibitors to Prevent Upper Gastrointestinal Bleeding
AID  - 10.1370/afm.2734
DP  - 2022 Jan 01
TA  - The Annals of Family Medicine
PG  - 5--11
VI  - 20
IP  - 1
4099  - http://www.annfammed.org/content/20/1/5.short
4100  - http://www.annfammed.org/content/20/1/5.full
SO  - Ann Fam Med2022 Jan 01; 20
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