Effect of a Proton Pump Inhibitor Deprescribing Guideline on Drug Usage and Costs in Long-Term Care

Thompson, Wade; Hogel, Matthew; Li, Yan; Thavorn, Kednapa; O'Donnell, Denis; McCarthy, Lisa; Dolovich, Lisa; Black, Cody; Farrell, Barbara

doi:10.1016/j.jamda.2016.04.020

Cited by 47 publications

(46 citation statements)

References 18 publications

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“…A study examining implementation of the proton pump inhibitor (PPI) deprescribing guideline in a long‐term care home found an initial reduction in use after implementation (increased deprescribing), but this was not sustained, with an increase towards baseline after 6 months. There was, however, a significant reduction in the average cost of PPI prescriptions . Additionally, these deprescribing guidelines may increase clinicians’ self‐efficacy for deprescribing …”

Section: Tools To Aid the Overall Process Of Deprescribingmentioning

confidence: 99%

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Reeve

2020

Pharmacy Practice and Res

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The importance of deprescribing, which is the process of withdrawing an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes, is increasingly recognised as part of good clinical care. With this, a number of tools have been developed with the purpose of aiding health professionals to deprescribe in regular practice. The types of tools vary significantly in their form and include tools to aid in the overall process of deprescribing (such as generic frameworks and drug‐specific deprescribing guidelines) as well as tools that may assist in a specific part of the process (such as identifying inappropriate medications or engaging the patient). While many tools are available, most provide little (if any) information on how they were developed, and limited implementation research has been conducted. This paper provides an overview of the types of available tools and how they might be used in clinical practice.

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Section: Tools To Aid the Overall Process Of Deprescribingmentioning

confidence: 99%

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Reeve

2020

Pharmacy Practice and Res

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“…However, surveillance must be close and continuous since the attained benefits could be short lasting. Indeed, in a recent Canadian study [446], de-prescribing guidelines were associated with a decline in PPI use during the initial 6 months, but prescription patterns began to climb back to baseline afterwards.…”

Section: Discussionmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

358

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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“…Since then, the methodology for developing the OPEN deprescribing algorithms has been published (in August 2016). 29 Thompson and others 27 implemented and evaluated the OPEN PPI deprescribing algorithm at 3 residential care sites and found that it could decrease PPI prescribing. We used the algorithm to assess whether residents fit the criteria for discontinuation and then monitored those with PPI discontinuation to assess for recurrent gastrointestinal symptoms that would warrant re-initiation of the PPI.…”

Section: Discussionmentioning

confidence: 99%

“…Linksy and others 26 performed a retrospective study looking at characteristics of PPI discontinuation in residential care settings, and concluded that many residents can have their PPI therapy discontinued without issues. Thompson and others 27 found that PPI prescribing at 3 residential care sites could be reduced by means of a deprescribing algorithm. However, they did not assess rates of symptom relapse following PPI discontinuation.…”

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confidence: 99%

Outcome after Discontinuation of Proton Pump Inhibitors at a Residential Care Site: Quality Improvement Project

Lee

Ubhi

et al. 2017

CJHP

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Background: Increased prescribing of proton pump inhibitors (PPIs) in the past few decades can be attributed mainly to long-term use of this type of therapy. Recent evidence indicates signals of harm associated with long-term use of PPIs, such as increased risk of Clostridium difficile infection, recurrence of C. difficile infection, and fracture. A few studies have assessed the effectiveness of step-down management of patients receiving long-term PPI therapy in ambulatory care settings. However, it is unknown whether PPIs can be discontinued in older people without return of gastrointestinal symptoms.

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Effect of a Proton Pump Inhibitor Deprescribing Guideline on Drug Usage and Costs in Long-Term Care

Cited by 47 publications

References 18 publications

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Outcome after Discontinuation of Proton Pump Inhibitors at a Residential Care Site: Quality Improvement Project

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