{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:38:11Z","timestamp":1791041891181,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T00:00:00Z","timestamp":1567641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR001882"],"award-info":[{"award-number":["KL2TR001882"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["L1TR001881"],"award-info":[{"award-number":["L1TR001881"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1U19HS024067\u201001"],"award-info":[{"award-number":["1U19HS024067\u201001"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1K24AG047899\u201001"],"award-info":[{"award-number":["1K24AG047899\u201001"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007185","name":"University of California, Los Angeles","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007185","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Older adults are particularly vulnerable to complications from proton pump inhibitor (PPI) drugs. We sought to characterize the prevalence of potentially low\u2010value PPI prescriptions among older adults to inform a quality improvement (QI) intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      We created a cohort of patients, aged 65\u2009years or older, receiving primary care at a large academic health system in 2018. We identified patients currently prescribed any PPI using the electronic health record (EHR) medication list (current defined as September 1, 2018). A geriatrician, a gastroenterologist, a QI expert, and two primary care physicians (PCPs) created multidisciplinary PPI appropriateness criteria based on evidenced\u2010based guidelines. Supervised by a gastroenterologist and PCP, two internal medicine residents conducted manual chart reviews in a random sample of 399 patients prescribed PPIs. We considered prescriptions potentially low value if they lacked a guideline\u2010based (1) short\u2010term indication (gastroesophageal reflux disease [GERD]\/peptic ulcer disease\/\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      gastritis\/dyspepsia) or (2) long\u2010term (&gt;8\u2009weeks) indication (severe\/refractory GERD\/erosive esophagitis\/Barrett esophagus\/esophageal adenocarcinoma\/esophageal stricture\/high gastrointestinal bleeding risk\/Zollinger\u2010Ellison syndrome). We used the Wilson score method to calculate 95% confidence intervals (CIs) on low\u2010value PPI prescription prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 69 352 older adults, 8729 (12.6%) were prescribed a PPI. In the sample of 399 patients prescribed PPIs, 63.9% were female; their mean age was 76.2\u2009years, and they were seen by 169 PCPs. Of the 399 prescriptions, 143 (35.8%; 95% CI = 31.3%\u201040.7%) were potentially low value\u2014of which 82% began appropriately (eg, GERD) but then continued long term without a guideline\u2010based indication. Among 169 PCPs, 32 (18.9%) contributed to 59.2% of potentially low\u2010value prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>\n                      One in eight older adults were prescribed a PPI, and over one\u2010third of prescriptions were potentially low\u2010value. Most often, appropriate short\u2010term prescriptions became potentially low value because they lacked long\u2010term indications. With most potentially low\u2010value prescribing concentrated among a small subset of PCPs, interventions targeting them and\/or applying EHR\u2010based automatic stopping rules may protect older adults from harm.\n                      <jats:bold>J Am Geriatr Soc 67:2600\u20132604, 2019<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16117","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T07:01:25Z","timestamp":1567666885000},"page":"2600-2604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Low\u2010Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System"],"prefix":"10.1111","volume":"67","author":[{"given":"John N.","family":"Mafi","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA  Los Angeles California"},{"name":"RAND Corporation  Santa Monica California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folasade P.","family":"May","sequence":"additional","affiliation":[{"name":"Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLA  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA  Los Angeles California"},{"name":"RAND Corporation  Santa Monica California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Medicine David Geffen School of Medicine at UCLA  Los Angeles 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