Enhancing deprescription of proton pump inhibitors in older patients

Abstract

Proton pump inhibitors (PPIs) in older patients can cause adverse effects including hypomagnesaemia, pneumonia and fractures. Hospitalisation presents an opportunity for assessing PPI appropriateness and dose reduction or drug discontinuation should be considered. The aim of this current study was to determine PPI deprescribing practices in older patients and to contribute to improving appropriateness by clinical pharmacist intervention. In Phase 1, patients aged 65 years and older who were admitted to Karin Grech Hospital on PPI treatment and discharged during January to July of 2021, were identified by retrospective review of pharmacy patient profiles. Data on indication, dose, dosing frequency, concurrent medication, comorbidities, deprescribing practices and pharmaceutical care issue documentation by clinical pharmacists was collected. Findings were disseminated to the clinical pharmacy team through an oral presentation by the researcher to promote rational use of PPIs and proper documentation. Periodic email reminders reinforced by recent publications regarding PPI deprescribing were sent to the clinical pharmacy team during September to December of 2021. Phase 2 was carried out on a similar cohort of patients discharged during January to July of 2022 to assess changes in deprescribing practices and care issue documentation following researcher intervention. Results were analysed using IBM® SPSS®, Microsoft Excel and the Ztest for two population proportions. In Phase 1, PPI overuse decreased significantly from 71% to 40% during admission (N=137, p<0.001). Pharmaceutical care issue documentation for inappropriate prescriptions (n=97) was 43%. In Phase 2, PPI overuse decreased significantly from 59% to 32% during admission (N=154, p<0.001). Pharmaceutical care issue documentation for inappropriate prescriptions (n=91) was 52%. Improvement in deprescribing and documentation between Phase 1 and Phase 2 was not statistically significant. Findings of this current study demonstrated PPI overuse in older patients. Significant improvement in deprescribing was achieved during admission to the rehabilitation hospital. PPI deprescribing and documentation of pharmaceutical care issues improved following dissemination of findings to clinical pharmacists.