Low-Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

John N. Mafi, MD, MPH; Folasade P. May, MD, PhD; Katherine L. Kahn, MD, MPH; Michelle Chong, MD; Edgar Corona, MPH; Liu Yang, MD, MPH; Margaret M. Mongare, MD; Vishnu Nair, BS; Courtney Reynolds, MD, PhD; Reshma Gupta, MD, MHPM; Cheryl L. Damberg, PhD; Eric Esrailian, MD; Catherine Sarkisian, MD, MSPH


J Am Geriatr Soc. 2019;67(12):2600-2604. 

In This Article


Among 69 352 older adults, 8729 (12.6%) were prescribed a PPI. In the chart review subsample (n = 399), 63.9% of patients were female; their mean age was 76.2 years; patients were seen by 169 PCPs (Table 1). After reviewing the guideline-based criteria, the two blinded reviewers independently agreed 100% of the time on whether the PPI prescription was low value in the training set (n = 9), indicating excellent interrater agreement.

Of the 399 prescriptions, 143 (35.8%; 95% CI = 31.3%-40.7%) were potentially low value—of which 82% began appropriately (eg, GERD) but then continued long-term without a guideline-based indication (Table 2).

Among the 41 primary care practices, 16 (39.0%) contributed to 72.4% of the potentially low-value prescriptions (Figure 1). Among 169 PCPs, 32 (18.9%) contributed to 59.2% of potentially low-value prescriptions.

Figure 1.

Rates of potentially low-value proton pump inhibitor (PPI) prescriptions among all PPI prescriptions ranked by primary care practice and primary care physician (PCP). (A) Quintiles of low-value prescribing rates ranked by primary care practices (n = 41). (B) Quartiles of low-value prescribing rates ranked by PCP prescribers (n = 169 PCPs).