Pharmacist Intervention Improved PPI Use Among Patients With Heartburn, Other Acid-related Disorders

In a randomly selected sample of inpatients, a pharmacy-led effort to discontinue proton pump inhibitor (PPI) use not in accordance with guidelines was feasible, although providers’ perceptions of the issue as low-priority did serve as a barrier. Researchers reported their findings in the journal Implementation Science Communications.

“Over 61% of prescribed PPIs among patients in non-intensive care unit (ICU) settings are not guideline-concordant,” researchers explained in the study background. “Unnecessary and especially long-term PPI use are associated with severe adverse outcomes, such as increased incidence of Clostridioides difficile infection. In addition, overuse of PPIs is costly, with over $11 billion spent on PPIs annually in the United States.”

The pharmacy-led intervention was tested between September 2019 and August 2020 at a hospital that serves US veterans. Biweekly, a trainee pharmacist reviewed a random sample of charts for non-ICU patients to assess whether PPI prescriptions were concordant with guidelines. If not, a recommendation to de-implement PPI therapy was issued.

Among 155 patient charts reviewed in the study, the average time needed to assess whether PPI use was concordant with guidelines was 5 minutes. Patient education took another 5 minutes, and follow-up with patients after discharge for any unintended consequences of PPI prescription changes took an average 7 minutes, according to the study.

Some 35% of patients in the intervention were taking PPIs for 5 years or more. The study found that the intervention decreased the week-to-week average number of PPI prescriptions by 0.5.

Facilitators of the effort included patients’ willingness to adjust their PPI use as well as ready access to pharmacists, researchers reported. On the other hand, providers' views of PPIs as low-priority medications proved a major barrier.

“Providers consistently recommended that they would like a specific intervention that directs them on what to do for the patient,” researchers wrote. “This is important for saving time, one of the barriers stated by providers.”

Reference:
Musuuza JS, Fong E, Lata P, et al. Feasibility of a pharmacy-led intervention to de-implement non-guideline-concordant proton pump inhibitor use. Implement Sci Commun. 2021;2(1):59. Published 2021 Jun 1. doi:10.1186/s43058-021-00161-6