Evaluation of the National Randomized Proton Pump Inhibitor De-prescribing (RaPPID) Program

Completed · Not applicable

Conditions studied: Proton Pump Inhibitors

In brief

Proton pump inhibitors (PPIs) are medications used to treat acid-related stomach disorders, such as chronic heartburn. These medications are widely used by Veterans, with over 11 million 30-day prescriptions being filled each year. Though they are highly effective, long-term use of PPIs may be harmful. For this reason, experts recommend that PPIs be stopped in patients who do not have a clear need for these medications. Unfortunately, PPIs continue to be overused. To address this issue, the VA is implementing a national program to de-prescribe (i.e., reduce the dose of, or stop) PPIs. In this study, the investigators will be evaluating this national program by assessing: (a) how successfully the program was implemented; (b) understanding how effective the program was in improving appropriate use of PPIs; and, (c) ensuring no unintended consequences (such as peptic ulcer bleeding) occurred with PPI de-prescribing. This study addresses a potential safety concern for Veterans and aligns with VA's broader goal of de-implementing low-value care.

Key facts

Study ID

NCT03719170

Run by

VA Office of Research and Development

People needed

220306

Starts

2019-09-16

Expected to finish

2021-11-30

Last updated by the study team

2024-07-15

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Chronic PPI users defined as 90-day prescription during the 120-day period prior to a scheduled VA primary care visit who receive:
• Once-daily PPI with
• No clear indication for PPIs, OR
• Uncomplicated Gastroesophageal reflux disease (GERD) OR
• Twice-daily PPI for any indication except Zollinger-Ellison

You may not qualify if…

• Patients taking once-daily PPIs will be excluded if they have one or more of the following characteristics:
• Eosinophilic esophagitis
• Esophagitis
• Esophageal ulcer
• Esophageal stenosis/stricture
• Dysphagia (other than oropharyngeal)
• Barrett's esophagus
• Peptic ulcer
• Zollinger-Ellison
• Idiopathic pulmonary fibrosis
• NSAID + age > 65 yrs, 2nd NSAID, aspirin, anti-thrombotic, OR corticosteroid
• Aspirin + age 60 yrs, NSAID, anti-thrombotic, OR corticosteroid
• Pancreatic enzyme replacement

Where it is running

• VA Connecticut Healthcare System West Haven Campus, West Haven, CT — West Haven, Connecticut, United States
• VA Ann Arbor Healthcare System, Ann Arbor, MI — Ann Arbor, Michigan, United States
• Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA — Philadelphia, Pennsylvania, United States
• VA Salt Lake City Health Care System, Salt Lake City, UT — Salt Lake City, Utah, United States

Full record on ClinicalTrials.gov

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