JAMA Intern Med
Patient-facing nudges cut inappropriate PPI use in primary care
Clinical Takeaway: For patients on long-term PPIs without a clear indication, pairing patient education with clinician deprescribing guidance can safely and meaningfully reduce use.
Inappropriate proton pump inhibitor (PPI) use is linked to avoidable patient risks, including adverse drug effects, and adds substantially to healthcare costs.
In this pragmatic cluster randomized clinical trial, a multilevel deprescribing intervention significantly reduced potentially inappropriate PPI use in primary care.
The study included 34,409 adults with at least one year of PPI use across 683 general practices in western France. Practices were randomized to usual care, a general practitioner (GP)-only deprescribing intervention, or a combined patient- and GP-facing intervention. At one year, 14.9% of patients in the combined-intervention group achieved a 50% or greater reduction in annual PPI use, compared with 7.0% with usual care and 7.7% with the GP-only approach. The adjusted absolute difference vs. usual care was 6.9 percentage points (95% confidence interval, 5.7–8.3).
Importantly, reflux-related symptoms didn't worsen. In a sampled subgroup, Gastroesophageal Reflux Disease Impact Scale scores were similar across groups.
“These findings suggest that … effectiveness appears to derive its effect primarily from the patient-facing component,” the authors wrote, highlighting the role of direct patient engagement in deprescribing efforts.
Source: Fournier JP, et al. (2026, April 14). JAMA Intern Med. Deprescribing Intervention and Reduction of Proton Pump Inhibitor Use in Primary Care: A Cluster Randomized Clinical Trial