Proton Pump Inhibitors Prescribing Behaviors and Rationalisation Strategies among Healthcare Providers in the Southeast Asia

BackgroundDespite its widespread use, real-world evidence on proton pump inhibitor (PPI) prescribing and rationalisation practices in Southeast Asia (SEA) remains limited. This study aimed to investigate current prescribing behaviors and rationalisation strategies among SEA healthcare professionals. MethodsThe SEA PPI Rationalisation Working Group designed and disseminated an online survey across SEA via professional networks. The questionnaire included sections on demographics, PPI prescribing habits, and rationalisation strategies. Reliability testing of the questionnaire yielded a Cronbachs alpha of 0.799. Content validity was confirmed by a panel of 10 gastroenterology experts, with perfect agreement on relevance and clarity (I-CVI, kappa, SCVI/Ave = 1.0). K-mode clustering was used to explore prescribing patterns. The main outcome was the identification of prescribing patterns and rationalisation strategies for long-term PPI use. FindingsAmong the 869 responses received, 763 valid entries were analysed (response rate: 87.8%), with 49% of the respondents being gastroenterologists. PPIs were most prescribed for gastroesophageal reflux disease (67.8%) and peptic ulcer disease (43.8%). Long-term PPI use was reported by 48.9% of the participants, while 59.2% reported reassessing indications at every follow-up visit. Rationalisation strategies included dose tapering (46.8%), on-demand use (45.9%), and step-down to antacids or alginates (44.8%). Cluster analysis identified two profiles: proactive prescribers (n=326, 42.7%) who followed clinical guidelines, applied individualised dosing, and routinely reassessed therapy, and conservative prescribers (n=437, 57.3%) who used PPIs more restrictively and rationalised less frequently. InterpretationMarked variability in PPI prescribing and rationalisation across SEA highlights the need for regional consensus to support evidence-based practice. FundingThis study was supported by Reckitt Benckiser (Singapore) Pte Ltd., which provided funding for article processing charge Evidence before this studyAlthough proton pump inhibitors (PPIs) are widely prescribed across Southeast Asia (SEA), there is limited real-world evidence examining the prescribing behaviors and rationalisation practices within the region. Previous research predominantly focused on Western countries and raised concerns regarding the over-prescription and prolonged use of PPIs. However, no studies have comprehensively addressed the regional variability in PPI prescribing or the strategies employed to rationalise their use in SEA. Added value of this studyThis study provides the first region-wide analysis of PPI prescribing practices and rationalisation strategies in SEA. By employing cluster analysis, the study identifies two distinct prescriber profiles: proactive prescribers, who follow clinical guidelines and individualise treatment, and conservative prescribers, who use PPIs more restrictively and apply rationalisation strategies less frequently. The study offers critical insights into the current prescribing landscape in SEA, highlighting the need for evidence-based regional guidelines to optimise PPI use. Implications of all the available evidenceThe findings suggest that significant variability in PPI prescribing exists across SEA, underscoring the necessity for region-specific guidelines. Policymakers should use these insights to inform evidence-based clinical guidelines for PPI use and rationalisation. Additionally, future research should explore the effectiveness of rationalisation strategies and identify barriers to their implementation within diverse healthcare systems in SEA.