Guideline implementation is effective at reducing proton pump inhibitor use in hematology-oncology units: A multidisciplinary intervention for reducing <i>Clostridioides difficile</i> risk

Ziegler, Matthew J.; Freyer, Craig W.; Landsburg, Daniel J.; Pegues, David A.; Bilker, Warren B.; Hirsh, Rebecca; Kucharczuk, Colleen; Gilmar, Cheryl; Gorman, Theresa; Palmer, Melissa; Harker, Christina; Lightheart, Erin; Han, Jennifer H.

doi:10.1017/ice.2019.238

Cited by 3 publications

(42 citation statements)

References 10 publications

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“…The PRISMA flowchart of study inclusion is illustrated in Fig 1 [55]. After screening and determination of eligibility of 14,422 citations, 17 articles published between 2007 and 2019 were ultimately included in the meta-analysis [63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. These 17 publications resulted in 16 studies since Buckley et al [65] reported data for both the ICU and non-ICU settings in a single publication and two authors published results of pre-and post-intervention data in separate articles; in the ICU setting: Wohlt et al (pre-implementation) [75] and Hatch et al (post-implementation) [68]; in the non-ICU setting: Khudair et al (pre-implementation) [71] and Khudair et al (post-implementation) [70].…”

Section: Study Inclusionmentioning

confidence: 99%

“…Education and awareness campaigns. Eight studies described pharmacists providing education to health care providers (including pharmacy staff) about appropriate AST prescribing via in-person, electronically and/or as printed materials [63,64,66,67,74,[77][78][79]. Agee et al provided a single educational seminar for Family Medicine residents [63].…”

Section: Pharmacy-supported Intervention Characteristicsmentioning

confidence: 99%

“…Selection. All studies in the ICU setting used a sample representative of the general population and selected the non-exposed cohort from the same community as the exposed cohort [78]. The non-exposed cohort was selected from the same community as the exposed cohort.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…The non-exposed cohort was selected from the same community as the exposed cohort. These varied populations are similarly at increased risk for AST overuse and subsequent exposure to adverse events and costs (as those admitted to the ICU or medical floors) [69,78,79]. Seven studies provided patients' age and/or gender [64,65,67,68,70,71,73,75,79] and several described differences between the intervention group versus comparator group.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.

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Section: Study Inclusionmentioning

confidence: 99%

Section: Pharmacy-supported Intervention Characteristicsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

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Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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“…There has also been much discussion regarding the clinical significance of such side effects and their association with PPIs [5], with emphasis on potential discontinuation or dose reduction of these medications [6]. Recently, PPI de-escalation initiatives have been launched at various institutions [7,8]. PPIs are available over the counter and are prescribed by both primary care and specialist gastroenterologists.…”

Section: Introductionmentioning

confidence: 99%

“Get Me Off This Medication!”: A Comparison Between Gastroenterology and Primary Care Regarding Patient’s Perceptions of Proton Pump Inhibitor Therapy

Khan

Hadi

Gayam

2020

Cureus

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Background Not much is known about patient perceptions regarding proton pump inhibitor (PPI) de-escalation. We sought to determine the knowledge of adverse effects (AEs) and willingness to de-escalate therapy among patients presenting to primary care and subspecialty clinics. Methods We conducted an anonymous survey of patients presenting to family medicine, internal medicine, and gastroenterology clinics who use PPIs. Survey topics included awareness of and concern for AEs of PPIs, and willingness to de-escalate PPI therapy. Results The sample comprised 206 participants presenting to the gastroenterology (29.8%), internal medicine (32.2%), and family medicine clinics (38%). Of the participants, 16% were "extremely concerned" about AEs and 28.2% reported attempting to stop PPIs by themselves in the past. Many patients (54.9%) reported that providers had not discussed AEs before initiation. Patients visiting digestive disease clinics were no more likely to report discussions on AEs and de-escalation or discontinuation attempts compared to primary care patients (p-values > 0.05). On logistic regression analysis, concern for AEs and counseling regarding PPI discontinuation were found to be significantly associated with attempts to discontinue PPI. Conclusions Although many patients on PPIs are concerned about AEs, a low number of patients reported providerinitiated discussions on AEs of PPI at initiation.

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Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options

Di Bella,

Sanson,

Monticelli

et al. 2024

Clin Microbiol Rev

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SUMMARY Clostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.

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Guideline implementation is effective at reducing proton pump inhibitor use in hematology-oncology units: A multidisciplinary intervention for reducing Clostridioides difficile risk

Cited by 3 publications

References 10 publications

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

“Get Me Off This Medication!”: A Comparison Between Gastroenterology and Primary Care Regarding Patient’s Perceptions of Proton Pump Inhibitor Therapy

Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options

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