Proton Pump Inhibitors Prescribing Behaviors and Rationalization Strategies Among Healthcare Providers in Southeast Asia

Abstract

Despite widespread use, real-world evidence regarding proton pump inhibitor (PPI) prescribing and rationalization practices in Southeast Asia (SEA) remains limited; therefore, we aimed to characterize current prescribing behaviors and rationalization strategies among healthcare professionals in the region. The SEA PPI Rationalisation Working Group developed and disseminated an online questionnaire via professional networks across SEA to collect data on respondent demographics, PPI prescribing practices, and rationalization approaches; instrument reliability testing produced a Cronbach's α of 0.799 and content validity was confirmed by a panel of 10 gastroenterology experts with complete agreement on relevance and clarity (I-CVI, kappa, SCVI/Ave = 1.0). K-mode clustering was applied to delineate prescribing patterns. Of 869 responses received, 763 valid entries were analyzed (response rate 87.8%), 49% of whom were gastroenterologists. PPIs were most frequently prescribed for gastroesophageal reflux disease (67.8%) and peptic ulcer disease (43.8%); 48.9% of respondents reported long-term PPI use, while 59.2% reported reassessment of indications at every follow-up visit. Common rationalization strategies comprised dose tapering (46.8%), on-demand administration (45.9%), and step-down to antacids or alginates (44.8%). Cluster analysis identified two distinct prescriber profiles: proactive prescribers (n = 326, 42.7%), who adhered to clinical guidelines, implemented individualized dosing, and routinely reassessed therapy; and conservative prescribers (n = 437, 57.3%), who employed PPIs more restrictively and engaged less frequently in rationalization. The considerable variability in PPI prescribing and rationalization practices across SEA underscores the need for a regional consensus to promote evidence-based practice.