# Evaluation of the National Randomized Proton Pump Inhibitor De-prescribing (RaPPID) Program

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Background: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications in the
VHA, accounting for over 11 million 30-day prescriptions and nearly $50 million in medication costs annually.
Though effective for treatment of acid-related disorders such as gastroesophageal reflux disease, PPIs have
been associated with a number of potential harms in observational studies (e.g., dementia, chronic kidney
disease, fractures), and increased mortality in Veterans. Nonetheless, PPIs continue to be used without an
appropriate indication or for longer and at higher doses than necessary. Accordingly, VHA Pharmacy Benefits
Management Services (PBM) will deploy RaPPID – a national Randomized PPI De-prescribing program – in
Fiscal Year 2018 targeting patients for whom a short course of PPI is likely sufficient. This program will
comprise activation of Clinical Pharmacy Specialists, provider education and academic detailing, and patient
education. In partnership with PBM, we propose to conduct an evaluation of this national program in a cluster-
randomized design.
Objectives: (1) identify system-, provider-, and patient-level barriers and facilitators to PPI de-prescribing
(formative evaluation); (2) assess the impact of the de-prescribing program on important clinical outcomes, and
to understand how and why these outcomes were achieved or not achieved (outcomes and process
evaluation); (3) assess the economic effects of the de-prescribing program (economic evaluation).
Methods: Using formative evaluation approaches, we will first identify barriers and facilitators to uptake of
RaPPID, prior to national randomization and deployment. We will then assess the impact of RaPPID on PPI
use (primary outcome) in a cluster randomized design (cluster = healthcare system). We will also assess a
variety of unintended effects, including impact of reduced PPI use on upper GI symptoms and complications
such as upper GI bleeding. Furthermore, we will use process evaluation approaches to understand why and
how the program was effective or ineffective in specific contexts. Finally, we will use data from the outcomes
evaluation of this proposal to estimate the budget impact of RaPPID, taking into account the impact of the
program on VHA and non-VHA healthcare utilization.
Impact: RaPPID will be among the largest concerted efforts at de-prescribing ever undertaken in VHA.
Prospective evaluation of the program therefore presents a unique opportunity not only to enhance the
program itself, but also to gain insights about how to reduce the use of low-value services more broadly, a key
VHA priority for the coming decade. Importantly, the prospective, controlled study design we propose will also
allow us to make strong claims about whether PPIs cause the putative adverse effects to which they have
been linked. Ultimately, this evaluation will provide not only valuable insight into the benefits and harms of a
national effort to appropriately de-prescribe PPIs, but al...

## Key facts

- **NIH application ID:** 9829049
- **Project number:** 5I01HX002693-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** LOREN A. LAINE
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-11-01 → 2021-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9829049

## Citation

> US National Institutes of Health, RePORTER application 9829049, Evaluation of the National Randomized Proton Pump Inhibitor De-prescribing (RaPPID) Program (5I01HX002693-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9829049. Licensed CC0.

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