Deprescribing Antipsychotics and Proton Pump Inhibitors in Long-Term Care: A Prescribing Portraits Approach.

Abstract

Introduction: Antipsychotics (APs) and proton pump inhibitors (PPIs) are commonly prescribed in long-term care (LTC) despite potential risks with prolonged use.

Objective: This study evaluates the frequency of AP and PPI prescriptions and assesses the impact of "prescribing portraits" on deprescribing in LTC residents at 2 LTC facilities in British Columbia.

Methods: This multicenter, prospective quality improvement (QI) study was conducted at two LTC homes: Holy Family Hospital (site A) and Queen's Park Care Centre (site B). The QI approach involved collecting data on prescribing appropriateness, implementing a real-time intervention, and tracking its impact. Prescribing portraits-personalized reports detailing individual prescribing patterns, evidence-based indications, and deprescribing recommendations-were presented to prescribers by clinical pharmacists. The primary outcomes were the proportion of prescriptions eligible for deprescribing and the deprescribing rate at 3 months post-intervention.

Results: At site A, 21 of 48 residents receiving AP were identified as eligible for deprescribing, with 31.6% receiving deprescribing orders within 3 months. Among 12 residents previously assessed in our earlier QI study at site A who remained on PPIs, 33% were newly deprescribed after reassessment in this study. At site B, 23 of 48 residents on antipsychotics were eligible, with a deprescribing rate of 20%. For PPIs, 31 of 38 residents were considered eligible at site B, and 36% had deprescribing orders initiated.

Conclusions: Integrating prescribing portraits into multidisciplinary medication reviews promotes appropriate deprescribing of APs and PPIs in LTC, encouraging safer prescribing practices and improving medication safety.