A226 PERCEPTION OF PPI PRESCRIBING AMONGST RESIDENTS AND FELLOWS TRAINING IN PRIMARY AND SPECIALTY CARE
Bibliographic record
Abstract
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
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".