Development of a Deprescribing Intervention for Proton Pump Inhibitors in Primary Care: A Co-Design Approach With General Practitioners and Patients.

Proton Pump Inhibitors (PPIs) are widely prescribed medications globally. PPIs are often inappropriately used - for example, prescribed without a clear indication, at higher-than-necessary doses, or for longer durations than needed - resulting in increased risks of adverse health outcomes such as nutrient deficiencies, osteoporosis-related fractures, and kidney disease. The effectiveness of current deprescribing interventions is inconsistent; this may relate to the misalignment with behavioural mechanisms, supporting the need for a mechanism-driven approach that targets key behavioural determinants. We co-designed a PPI deprescribing intervention with patients and health professionals for the Swiss primary care setting. This involved identifying behavioural determinants of PPI deprescribing from the literature at both the general practitioner (GP) and patient levels, mapping them to behaviour change techniques, selecting intervention elements, and developing contextualised intervention tools to effectively influence these determinants. The intervention tools were iteratively developed and assessed through qualitative methods with 16 patients and 18 health professionals. Participants considered the tools to be acceptable and practical for use in the Swiss primary care context.