Both the structured and targeted educational interventions for appropriate omeprazole prescribing in the primary care setting are effective in reducing the rates of inappropriate omeprazole prescription at Marine Parade Polyclinic in Singapore, a study has shown.
“To reduce inappropriate prescriptions of proton pump inhibitors (PPIs), we recommend that primary care centres consider assessing physicians’ knowledge gaps related to appropriate PPIs use and consider implementation of relevant education programmes to address these gaps,” said lead study author Dr Jun Jie Seng, Department of Family Medicine, Marine Parade Polyclinic, Singhealth Polyclinics, Singapore.
A multidisciplinary team of doctors and pharmacists conducted a quality improvement initiative and assessed the appropriateness of prescriptions using international guideline-based criteria.
Four key contributors to inappropriate prescribing were identified via root cause analysis using an Ishikawa diagram and Pareto chart. These included lack of deprescribing resources, limited consultation time due to high patient load, insufficient clinician education, and concerns about symptom recurrence after deprescribing. [Proc Singap Healthc 2026;doi:10.1177/20101058261500162]
In the first Plan-Do-Study-Act (PDSA) cycle, Seng and his team developed educational materials centred on evidence-based prescribing of omeprazole and appropriate deprescribing strategies. In a subsequent audit, five clinicians were found to have persistently high inappropriate prescribing rates, which prompted a second PDSA cycle involving targeted educational sessions for these individuals.
The median rate of inappropriate omeprazole prescriptions after the first PDSA cycle dropped to 19.1 percent from 34.7 percent. In the second cycle following targeted education, the rate further decreased to 12.5 percent.
The biggest decline in inappropriate omeprazole prescriptions was observed among locum doctors (n=3; from 52.2 percent to 9.0 percent) and family medicine residents (n=12; from 40.6 percent to 9.1 percent). The two main reasons for inappropriate omeprazole prescriptions were inappropriate dose (n=49, 45.4 percent) and no indication (n=40, 37 percent).
Based on feedback received from physicians, one of the most common difficulties they experienced was broaching the topic of deprescribing on busier clinic days with higher patient loads.
Overall, 31 omeprazole prescriptions were deprescribed during the study period, with no adverse events associated with deprescription seen.
“To ensure sustainability of the project, the education materials for appropriate omeprazole use were incorporated into the orientation materials for new doctors joining the clinic,” Seng said.
Attendance
Notably, a physician was absent during the education lecture during the monthly doctors’ meeting, which then contributed to continued high rates of inappropriate omeprazole prescription by this physician. Ensuring the presence of members of the target population could guarantee the maximal impact for these educational programmes.
“Another challenge we noted was incorporating deprescribing into daily clinic consultation as only 5-10 min are allocated for each patient consultation in our centre,” according to Seng and colleagues.
“With the recent introduction of the collaborative prescribing practice model where pharmacists can prescribe medications after completion of training, it is hoped that future deprescribing efforts can be led by pharmacists within the clinic to improve patient outcomes,” they added. [Pharmacy 2024;12: 31]
Seng and his team also pointed out that the targeted feedback provided during the second PDSA cycle might have introduced a Hawthorne effect, in which physicians modified their prescribing behaviour due to the awareness that their practices were being monitored. [Cochrane Database Syst Rev 2012;2012:Cd000259]
“While this may have contributed to the observed improvements, such audit-and-feedback mechanisms are themselves recognized quality improvement strategies for changing clinician behaviour,” Seng and colleagues said.
Omeprazole is a widely used PPI for gastritis. Inappropriate use of this medication may lead to higher risks of osteoporotic fractures and vitamin deficiencies, according to the authors.