A226 PERCEPTION OF PPI PRESCRIBING AMONGST RESIDENTS AND FELLOWS TRAINING IN PRIMARY AND SPECIALTY CARE
Notice bibliographique
Résumé
Proton pump inhibitors (PPI) are widely prescribed in North America. Several adverse events linked to their use, most probably not causal, have been reported. Yet no prescribing guidelines have addressed how to balance PPI efficacy in light of such possible side effects. To acquire knowledge on the varying perceptions of outpatient PPI long-term prescribing (≥8 wks) amongst primary and specialty care residents/fellows in 2 Canadian Universities. A web-based survey was completed by Family Medicine (FM), Internal Medicine (IM), and Gastroenterology (GI) residents/fellows. A knowledge assessment component examined the participants’ understanding of pertinent efficacy data in the literature and approved indications, as well as literature on PPI-related possible side effects. 20 case scenarios with related targeted management questions were created. Demographics are expressed as proportions; inferential testing compared prescribing decisions between juniors (PGY1/2 FM and 1/2/3 IM) vs senior trainees, and across specialties. Between April and July 2017, 163 trainees participated in the survey (FM 51%, IM 44%, and GI 5%). 83% were junior trainees,17% senior, 59% female; 53% practicing in Ontario, 85% were aged 26–35 yrs. Only 42% had received formal education on prescribing long-term PPI, while 93% believed they would benefit from such teaching. 98% would follow detailed prescribing guidelines. No between-group differences were observed in the appropriate identification of recommended indications, nor of presumed associated side-effects when comparing juniors to seniors, or different specialties. Significant differences were noted in deprescribing PPIs appropriately or inappropriately given established indications in the presence of possible side-effects. 13 clinical stems described an absolute indication for long-term PPI use that should have overshadowed concerns about various possible PPI side effects. Inappropriate discontinuation of the PPI was suggested by 26%-76% of respondents. Amongst 7 clinical stems that described a poor indication for long-term PPI use, despite the introduction of various possible PPI side effects, respondents still elected to continue PPIs inappropriately in 15–44%. Proportions of possible inappropriate prescribing were significantly different according to training seniority in 4 of 20 scenarios, and differed by specialty in 7. There exist significant differences in prescribing attitudes according to level of training and in primary care versus specialty programs, leading to varying levels of inappropriate PPI de/prescribing practices. These findings highlight the need for the creation and wide diffusion of multidisciplinary guidelines to better assist young practitioners in learning optimal management strategies for patients being considered for long-term PPI use CAG
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».