Deprescribing Statins and Proton Pump Inhibitors in Nursing Home Residents; a Pragmatic Exploratory Study

Abstract

Introduction Polypharmacy is common in the frail nursing home population and associated with an increased risk of adverse events, unplanned hospitalizations, and increased all-cause mortality. Deprescribing using a deprescribing algorithm might reduce unnecessary polypharmacy. This exploratory study was performed to determine the effect of this implicit deprescribing algorithm in deprescribing statins and proton pump inhibitors (PPIs) in nursing home residents. Method Multicenter, longitudinal, single-arm exploratory study. All participants received the same deprescribing intervention to identify and deprescribe potentially inappropriate statins and/or PPIs. Residents across 10 nursing homes in the Netherlands were included if they used a statin and/or PPI. Residents in hospices or short-stay wards were excluded. The intervention involved a deprescribing algorithm in which nursing home physicians identified and, if possible, deprescribed potentially inappropriate statins and/or PPIs. Results Sixty-seven residents participated in the study. At 3 months, deprescribing was successful in 52% of the residents. Six months after the intervention, all these residents still had their medication sustainably deprescribed. Conclusion Based on this study, deprescribing statins and PPIs using an implicit deprescribing algorithm is possible in a considerable number of nursing home residents.

Medication use in Italian nursing homes: preliminary results from the national monitoring system

“…However, based on our data, NSAIDs are only rarely used, as well as the prevalence of main gastrointestinal diagnoses should be low. Moreover, differences with other countries suggest that Italian nursing homes should implement deprescribing initiatives on PPIs, taking advantage of relevant evidence from original studies and authoritative guidelines ( Visser et al, 2021 ; Onder et al, 2022 ).…”

Determinants of and interventions for Proton Pump Inhibitor prescription behavior: A systematic scoping review

“…Previous research on changing physician behavior has revealed promise of such multifaceted interventions [ 64 – 66 ], but it is impossible to ascribe intervention success to one component like education if more intervention functions are used. For enablement, very consistent positive effects were observed [ 12 , 38 , 39 , 41 , 44 , 47 , 48 , 51 – 62 ]. These effective interventions mostly focused on deprescribing and involved algorithms, quality check improvements and involvement of pharmacists.…”

“…Intervention studies ( n = 55, 74%) comprised of longitudinal studies in which a policy change was evaluated (prospectively or retrospectively) as well as studies that evaluated a specific intervention as part of the study itself. The majority of these studies included publication or dissemination of (new) guidelines [ 36 , 37 ], implementation of algorithms [ 38 , 39 ], and pharmacist oversight or interventions [ 40 , 41 ].…”

“…Regarding enablement, the vast majority of studies reported desired effects on (in)appropriate PPI prescribing and deprescribing outcomes [ 12 , 38 , 39 , 41 , 44 , 47 , 48 , 51 – 62 ]. These studies included algorithms, other deprescribing tools, quality check interventions or other quality improvement strategies, and often involved pharmacists.…”