KNOWLEDGE AND PRESCRIBING PATTERNS OF INTERNAL MEDICINE RESIDENTS ON PROTON PUMP INHIBITORS IN GASTROESOPHAGEAL REFLUX DISEASE

Background: Proton pump inhibitors (PPI) are the mainstay of treatment and symptomatic remission in GERD. Recently, PPI over-utilization has been a major concern due to associated increased risk of adverse events and unnecessary healthcare cost. Internal Medicine residents treat patients with GERD and prescribe a significant amount of PPI. However, very few studies have assessed their knowledge and prescription practices of PPI in GERD.

Methods: We carried out a cross-sectional survey of internal medicine residents in our institution to assess the PPI prescription knowledge and practices in GERD. The questionnaire was designed based on current guidelines to capture information on demographics, baseline PPI knowledge, how residents prescribe PPI and subsequent follow-up. Proportions were calculated using frequency tables and multivariate regression was used to examine the association between demographics, previous GI rotation, baseline education on PPI and PPI prescription knowledge and patterns among residents.

Results: A total of 50 residents completed the questionnaire and the median age range was 21-30 years. Twenty-eight (55%) respondents had rotated through the GI department at least once, and 61% had some form of education on PPI via educational conferences and didactics. All the respondents had prescribed PPI for GERD at some point. Esomeprazole and omeprazole were the two predominantly prescribed PPIs due to perceived superiority to other PPIs. 81% of respondents answered yes to an initial daily PPI dosing regimen. However, the responses to initial treatment duration varied; 12 weeks (26%), 8 weeks (12%), 6 weeks (10%), and 6-8 weeks (5%). Only 21% of respondents said PPIs should be stopped when symptoms resolve after initial therapy. 36% of the residents admitted to not knowing the recommendation regarding PPI long-term therapy and the appropriate dose in refractory cases. More than 90% of the residents had a good knowledge of PPI side effects. There was no statistically significant difference in the association between residents’ demographics, previous GI rotation, education on PPI and PPI prescription practice (P = 0.19).

Conclusions: Despite specific guidelines on PPI treatment in GERD, our study demonstrated inadequate knowledge of internal medicine residents on appropriate utilization of PPI for treatment of GERD. irrespective of PGY level and previous GI rotation. Also, education on PPI during residency didactics and conferences did not appear to have an impact on prescription practices. About one-third of the residents were not familiar with the guidelines on long term therapy in refractory GERD. Tailored education of internal medicine residents on the appropriate use of PPI in GERD based on national guidelines may help maximize benefits from PPI in GERD, reduce the risk of side effects and minimize excessive healthcare cost from inappropriate PPI prescription.