{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:52:36Z","timestamp":1790794356688,"version":"4.1.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n Importance<\/jats:title>\n Inappropriate use of proton pump inhibitors (PPIs) is associated with severe adverse drug reactions and may significantly increase health care costs. Deprescribing should be considered when inappropriate use is identified.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effectiveness of a patient- and general practitioner (GP)\u2013facing intervention in reducing potentially inappropriate PPI use in primary care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This pragmatic, cluster-randomized, open-label, clinical trial was conducted between November 12, 2020, and November 11, 2021. Participants were adults aged 18 years or older with at least 1 year of PPI use in GP practices in 2 regions of western France, and their GPs were included. Data were analyzed from January to July 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n GP practices were randomized to 3 groups in a 1:1:1 ratio as follows: (1) a patient- and GP-facing deprescribing intervention combining a patient education brochure on PPI deprescribing posted directly to patients with a letter outlining a PPI deprescribing algorithm sent to their GPs; (2) a GP-facing intervention, in which only the GP received the letter and algorithm; or (3) usual care.<\/jats:p>\n <\/jats:sec>\n \n Main outcomes and measures<\/jats:title>\n The primary outcome was PPI dose reduction, defined as a 50% or more reduction in annual PPI use, measured in defined daily doses (DDDs) and proxied by reimbursement claims. Secondary measures included Gastroesophageal Reflux Disease Impact Scale (GIS) scores, assessed in a 10% sample.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 1498 GPs and 34\u202f409 patients were included from 683 primary care practices. The mean (SD) patient age was 68.6 (14.0) years, and 19\u202f507 (56.7%) were female. Mean (SD) baseline annual PPI use was 413.7 (113.9) DDDs. PPI dose reduction was higher in the patient- and GP-facing intervention group compared with the usual care groups (1710 of 11\u202f442 patients [14.9%] vs 825 of 11\u202f732 [7.0%]; adjusted absolute difference, 6.9%; 95% CI, 5.7%-8.3%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and with the GP-facing intervention (1710 of 11\u202f442 patients [14.9%] vs 862 of 11\u202f235 [7.7%]; adjusted absolute difference, 6.7%; 95% CI, 5.4%-8.2%,\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). GIS scores did not significantly differ between groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n This randomized clinical trial found that the patient- and GP-facing intervention was effective in reducing potentially inappropriate PPI use without any meaningful impact on long-term gastroesophageal reflux disease activity.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04255823<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.0584","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:30:30Z","timestamp":1776094230000},"page":"668","source":"Crossref","is-referenced-by-count":5,"title":["Deprescribing Intervention and Reduction of Proton Pump Inhibitor Use in Primary Care"],"prefix":"10.1001","volume":"186","author":[{"given":"Jean-Pascal","family":"Fournier","sequence":"first","affiliation":[{"name":"Nantes Universit\u00e9, D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de M\u00e9decine, F-44000, Nantes, France"},{"name":"Universit\u00e9 d\u2019Angers, POPS, SFR ICAT, F-49000, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Gaultier","sequence":"additional","affiliation":[{"name":"Nantes Universit\u00e9, D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de M\u00e9decine, F-44000, Nantes, France"},{"name":"Direction de la recherche, Plateforme de M\u00e9thodologie et Biostatistique, CHU Nantes, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9ry-Pierre","family":"Riche","sequence":"additional","affiliation":[{"name":"Service \u00c9valuation \u00c9conomique et D\u00e9veloppement des Produits de Sant\u00e9, CHU de Nantes, Nantes Universit\u00e9, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Tessier","sequence":"additional","affiliation":[{"name":"Service \u00c9valuation \u00c9conomique et D\u00e9veloppement des Produits de Sant\u00e9, CHU de Nantes, Nantes Universit\u00e9, Nantes, France"},{"name":"SPHERE-UMR INSERM 1246, Nantes Universit\u00e9, Universit\u00e9 de Tours, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Rat","sequence":"additional","affiliation":[{"name":"Nantes Universit\u00e9, D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de M\u00e9decine, F-44000, Nantes, France"},{"name":"Universit\u00e9 d\u2019Angers, POPS, SFR ICAT, F-49000, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Nguyen-Soenen","sequence":"additional","affiliation":[{"name":"Nantes Universit\u00e9, D\u00e9partement de M\u00e9decine G\u00e9n\u00e9rale, Facult\u00e9 de 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