Impact of Academic Detailing on Proton Pump Inhibitor Prescribing Behaviour in a Community Hospital

Chui, Donna; Young, Flora; Tejani, Aaron M; Dillon, Edward

doi:10.3821/1913-701x-144.2.66

Cited by 5 publications

(5 citation statements)

References 49 publications

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“…Previous systematic attempts to reduce inappropriate PPI prescriptions in hospital have met with varied success. Several of these studies were unable to achieve a demonstrable effect . In contrast, Hamzat et al described a successful educational intervention targeting inpatients on a geriatric ward.…”

Section: Discussionmentioning

confidence: 99%

“…Several of these studies were unable to achieve a demonstrable effect. 23,[29][30][31] In contrast, Hamzat et al 30 described a successful educational intervention targeting inpatients on a geriatric ward. A 4-week educational strategy was employed, and they were able to discontinue PPIs in 10 of 60 (17%) patients without indication during a limited period of study.…”

Section: Discussionmentioning

confidence: 99%

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Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

McDonald

Jones

Green

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Proton pump inhibitors (PPIs) are overprescribed despite concerns regarding associated adverse drug events. OBJECTIVE To reduce inappropriate PPI prescriptions using hospitalization as the point of contact to effect meaningful change. DESIGN Before‐after study design. SETTING Forty‐six–bed medical clinical teaching unit in a 417‐bed university teaching hospital in Montreal, Canada. PATIENTS Four hundred sixty‐four consecutively admitted patients in the preintervention control group, and 640 consecutively admitted patients in the intervention group. INTERVENTION A monthly educational intervention paired with a Web‐based quality improvement tool. MEASUREMENTS We determined the proportion of patients admitted on PPIs, their indications, and appropriateness of use. We then compared the proportion of patients whose PPIs were discontinued at discharge before and after our intervention. RESULTS Forty‐four percent of patients were already using a PPI prior to their hospitalization. In evaluated patients, only 54% of these patients had an evidence‐based indication for ongoing use. The proportion of PPIs discontinued at hospital discharge increased from 7.7% per month in the 6 months prior to intervention, to 18.5% per month postintervention (P = 0.03). CONCLUSIONS Strategies to combat PPI overuse are needed to improve the overall quality of patient care. We significantly reduced discharge prescriptions for PPIs through the implementation of an educational initiative paired with a Web‐based quality improvement tool. An active interventional strategy is likely required considering the increasingly recognized and preventable adverse events associated with PPI misuse. Journal of Hospital Medicine 2015;10:281–286. © 2015 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

McDonald

Jones

Green

et al. 2015

Journal of Hospital Medicine

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“…Inappropriate prescribing within the hospital setting and a growing list of serious adverse events associated with PPIs have prompted health care providers to develop various strategies to reduce inappropriate use [ 31 ]. These include deprescribing [ 12 , 32 – 34 ], applying SUP guidelines, checklists and protocols [ 35 – 38 ], completing medication reconciliation activities [ 39 , 40 ], communicating concerns in-person and/or electronically [ 41 – 44 ], academic detailing [ 45 ], and educational campaigns [ 36 , 44 , 46 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

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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“…Chui et al performed an intervention with academic detailing wherein a one-on-one visit with a physician took place, providing education to improve physician prescribing behavior. 13 In this study, academic detailing focused on the most common instances for which PPIs were inappropriately utilized at that hospital (eg, surgical prophylaxis, anemia). Inappropriate use of double-dose PPIs was also targeted.…”

Section: Educationmentioning

confidence: 99%

Reducing Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis and Nonvariceal Gastrointestinal Bleeding in the Hospital: A Narrative Review and Implementation Guide

et al. 2021

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Proton pump inhibitors (PPIs) are among the most commonly used medications in the world; however, these drugs carry the risk of patient harm, including acute and chronic kidney disease, Clostridium difficile infection, hypomagnesemia, and fractures. In the hospital setting, PPIs are overused for stress ulcer prophylaxis and gastrointestinal bleeding, and PPI use often continues after discharge. Numerous multifaceted interventions have demonstrated safe and effective reduction of PPI use in the inpatient setting. This narrative review and the resulting implementation guide summarize published interventions to reduce inappropriate PPI use and provide a strategy for quality improvement teams.

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Impact of Academic Detailing on Proton Pump Inhibitor Prescribing Behaviour in a Community Hospital

Cited by 5 publications

References 49 publications

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

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

Reducing Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis and Nonvariceal Gastrointestinal Bleeding in the Hospital: A Narrative Review and Implementation Guide

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