Reducing inappropriate prescription of omeprazole in primary care (project RIP-omeprazole) – A quality improvement project
Jun Jie Benjamin Seng, Sok Hui Ng, May Lin Tang, Kwang Han Sim, Pei Lin HuIntroduction
Omeprazole, a widely used proton pump inhibitor for gastritis, is often prescribed inappropriately. Its inappropriate use contributes to increased risks of osteoporotic fractures and vitamin deficiencies. An audit from February to June 2024 which was conducted in Marine Parade Polyclinic, a primary care centre in Singapore identified a high rate (34.7%) of inappropriate omeprazole prescriptions. This project aimed to reduce this rate to 20% over 6 months.
Methods
A quality improvement initiative was performed by a multidisciplinary team of doctors and pharmacists. Appropriateness of prescriptions was assessed using international guideline-based criteria. Root cause analysis using an Ishikawa diagram and Pareto chart revealed four key contributors to inappropriate prescribing: lack of deprescribing resources, limited consultation time due to high patient load, insufficient clinician education, and concerns about symptom recurrence after deprescribing. The first Plan-Do-Study-Act (PDSA) cycle involved developing educational materials focusing on evidence-based prescribing of omeprazole and appropriate deprescribing strategies. A subsequent audit identified five clinicians with persistently high inappropriate prescribing rates, prompting a second PDSA cycle involving targeted educational sessions for these clinicians.
Results
After the first PDSA cycle, the median rate of inappropriate omeprazole prescriptions decreased from 34.7 to 19.1%. Following targeted education in the second cycle, the rate further declined to 12.5%.
Conclusion
Educational interventions, including both general and targeted strategies, effectively reduced inappropriate omeprazole prescribing in the primary care setting. This project highlights the value of structured education and guideline-based deprescribing support in appropriate medication use.