Who has the guts to deprescribe proton pump inhibitors? A pharmacist‐led intervention in a long‐term care facility setting

Abstract

Proton pump inhibitors (PPIs) are acid-suppressant drugs that are widely prescribed for a number of gastrointestinal (GI) indications. In 2015, PPIs accounted for Can$253.3 million in public drug program spending in Canada, and were one of the top ten drug classes with the highest spending. 1 Furthermore, pantoprazole was found to be the fifth most common drug prescribed in Canada, with more than 11 million prescriptions dispensed in 2012. 2 With pantoprazole's high prevalence of use, there is a growing concern in the appropriateness and duration of its use. A Canadian prospective study found that 30.7% of patients were inappropriately prescribed with PPIs, in relation to the Quebec guidelines. 3 In addition, a retrospective cross-sectional study conducted in British Columbia found that the proportion of PPI orders without a documented common evidence-based indication or broad evidencebased indication were 43.7% and 16.2%, respectively. 4 While PPIs are generally well-tolerated, the long-term safety profiles of PPIs This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjective: Long-term use of proton pump inhibitors (PPIs) has been associated with an increased risk of harm. There are few studies evaluating pharmacist-led PPI deprescribing interventions within a long-term care facility setting. The aim of this study was to describe the changes and influencing factors seen with a pharmacist-led PPI deprescribing intervention in two Fraser Health Authority long-term care facilities in British Columbia. Methods:This 4-month intervention involved lists of residents who had active PPI orders being handed out to physicians from two facilities. The pharmacist conducted weekly reviews of residents from Facility 1 and offered deprescribing recommendations. The number and methods of PPI deprescribing orders per facility were determined after the intervention.Results: Out of 58 residents from the two facilities, 30 (62.5%) had a deprescribing order. Facility 1 had 83.3% (20/24) of residents with a PPI deprescribing order, in contrast to 41.7% (10/24) from Facility 2. Overall, 80.0% of residents had successfully completed PPI deprescribing orders by the end of the study period. Conclusion: Clinical pharmacist intervention may increase the rate of initiation in PPI deprescribing orders within a long-term care facility setting. Factors that influence success include intervention timing, active collaboration, having residents under direct care, and clear documentation of PPI indications. K E Y W O R D S deprescribing, pharmacist, proton pump inhibitors [Correction added on 16 May 2019, after first online publication: The corresponding author's email address has been corrected.] | 113 TANDUN eT Al.are controversial, as they are often associated with an increased risk of Clostridium diffici...

Appropriateness and Associated Factors of Stress Ulcer Prophylaxis for Surgical Inpatients of Orthopedics Department in a Tertiary Hospital: A Cross-Sectional Study

“…Continuous education programs for clinicians detailing evidence-based indications for SUP and the adverse reaction of AST are required to correct doctors’ misunderstandings ( Hussain et al, 2010 ; Savarino et al, 2018 ). The intervention of clinical pharmacists could decrease the inappropriate usage of ASMs, as well as drug expenditures and the risk of adverse events, effectively ( Hussain et al, 2010 ; Jarchow-Macdonald and Mangoni, 2013 ; Buckley et al, 2015 ; Masood et al, 2018 ; Tandun et al, 2019 ). Clinical pharmacists could help strengthen regulation of clinical application of PPIs.…”

Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process

“…Table summarises the characteristics of the 59 included papers. The majority of studies were located in the United States, UK and Australia with smaller numbers from the Netherlands, Canada and Belgium . Twelve papers reported randomised controlled trials, and five were non‐randomised controlled studies, with the remainder pre‐/post‐uncontrolled interventions conducted as service evaluations.…”

“…Thirteen papers stated that the pharmacist delivering the service was a ‘consultant’, and twelve papers noted that the pharmacist was described as ‘clinical’ . Five papers reported that the pharmacist had completed an accreditation process, one of which described the training as consisting of consultation skills, identification of drug‐related problems, guidelines and how to create pharmaceutical care plans.…”

“…The ability to work in a multidisciplinary manner and train others were also commonly cited activities which require practical knowledge. The importance of good inter‐professional working skills and development of effective relationships with homes were identified in four papers and with general practitioners in one . Care home staff training was identified as an important element in developing those relationships …”

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

“…There may be a need to explore and implement mechanisms that encourage the systematic and routine practice of assessing ongoing PPI use in general practice. Possible solutions to explore may include: involving other healthcare providers such as nurses or pharmacists [28,29] in initiatives that address PPI use, including expected durations/reassessment dates and indications on initial PPI prescriptions, dedicated consultations for deprescribing, or setting up for systems for triaging PPI refills.…”