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Abstract：
Background: Heightened scrutiny surrounds the inappropriate use of proton pump inhibitors (PPIs) due to concerns regarding potential serious adverse effects (AEs). Understanding the impact of these AEs on real-world practice is crucial. This study aimed to assess physicians\' perceptions, experiences, awareness, and beliefs regarding published data on potential AEs associated with PPIs. Additionally, it sought to determine alterations in PPI prescribing patterns resulting from these AEs, explore attitudes towards PPI use, and ascertain recommendations for PPI use in clinical scenarios with varying levels of risk for upper gastrointestinal bleeding (UGIB). Method: A quantitative, cross-sectional study utilized a self-administered questionnaire, inviting 282 physicians from 55 primary healthcare centers and 334 internal medicine physicians from seven governmental hospitals to participate. Results: With a response rate of 87.8% (541/616), 74% (95% CI: 70.2-77.7) of respondents were somewhat or very familiar with published data on PPI AEs. Among the familiar, 69.5% (CI: 65.2-73.5) had somewhat or very much changed their PPI prescribing patterns. General concerns about AEs when prescribing PPIs were reported by 62% (CI: 56.7-65.1). Respondents displayed awareness of a median (IQR) of 15 (9) different AEs associated with long-term PPI use, including osteoporosis or osteopenia (90.2%), hypomagnesemia (81.5%), vitamin B12 deficiency (80.6%), and bone fracture (80.0%). Respondents believed that PPIs elevate the risk for a median (IQR) of 7 (6) different AEs, with osteoporosis or osteopenia (81.8%) being the most common, followed by hypomagnesemia (67.1%), and vitamin B12 deficiency (62.3%). The most common strategies for PPI de-escalation were PPI discontinuation (61%) and using PPI on-demand/as-needed (57.9%). The majority (87.4%) agreed or strongly agreed that PPI overuse is prevalent in Kuwait and 78.2% emphasized the necessity for large-scale education on rational PPI use for medical staff and the public. In the UGIB prevention scenarios, 43.6% recommended appropriately the PPI discontinuation in the minimal-risk scenario, while 56% recommended appropriately the PPI continuation in the high-risk scenario. Associations and comparative analyses revealed predictors influencing physicians\' practices and attitudes toward PPI usage. Conclusion: These findings lay the foundation for future research and targeted interventions aimed at optimizing PPI prescribing practices and ensuring patient safety.
摘要：
背景：由于担心潜在的严重不良反应（AE），对质子泵抑制剂（PPI）的不当使用进行了严格的审查。了解这些AE对现实世界实践的影响至关重要。这项研究旨在评估医生的看法，经验,意识,以及对已发表的与PPI相关的潜在不良事件数据的信念。此外,它试图确定由这些AE引起的PPI处方模式的变化，探索对PPI使用的态度，并确定在上消化道出血(UGIB)风险不同的临床情况下使用PPI的建议.方法：定量，横断面研究使用了一份自我管理的问卷，邀请来自55个基层医疗中心的282名医生和来自7个政府医院的334名内科医生参加。结果：有效率为87.8%(541/616)，74%（95%CI：70.2-77.7）的受访者对PPI不良事件的公布数据有些或非常熟悉。在熟悉的人中，69.5%(CI:65.2-73.5)的PPI处方模式发生了一些或很大的变化。62%的人报告了处方PPI时对不良事件的一般担忧（CI：56.7-65.1）。受访者显示出与长期PPI使用相关的15（9）种不同AE的中位数（IQR）意识，包括骨质疏松症或骨质减少（90.2%），低镁血症（81.5%），维生素B12缺乏（80.6%），骨折（80.0%）。受访者认为PPI会提高7(6)种不同AE的中位数(IQR)风险，最常见的是骨质疏松或骨量减少（81.8%），其次是低镁血症（67.1%），维生素B12缺乏（62.3%）。PPI降级的最常见策略是PPI停药（61％）和按需/按需使用PPI（57.9％）。大多数人(87.4%)同意或强烈同意科威特普遍使用PPI，78.2%的人强调对医务人员和公众进行合理使用PPI的大规模教育的必要性。在UGIB预防方案中，43.6%建议在最低风险情况下适当停用PPI，而56%的人建议在高风险情景下适当延续PPI。关联和比较分析揭示了影响医生对PPI使用的实践和态度的预测因素。结论：这些发现为未来的研究和旨在优化PPI处方实践并确保患者安全的针对性干预措施奠定了基础。
