Implementation of pharmacist-initiated proton pump inhibitor deprescribing for ambulatory care patients

Abstract

Background

The 2022 American Gastroenterological Association Proton Pump Inhibitor (PPI) Deprescribing Clinical Guidelines recommend regular review of patients prescribed PPI therapy; however, this may be limited due to insufficient provider time and resources. This evaluation aimed to assess the impact of pharmacist-initiated PPI deprescribing interventions for ambulatory care patients.

Objectives

The objectives of this evaluation were to describe (a) PPI deprescribing interventions defined as PPI discontinuation or de-escalation of dose by Veterans Affairs clinical pharmacists in the outpatient setting; (b) the percentage of appropriate indications documented within the electronic medical record for high-dose PPI therapy; (c) the percentage of PPI deprescribing success at 3-week follow-up and 1-year follow-up; and (d) estimated total cost savings annually.

Methods

This was a single-centered, quality improvement, evaluation that utilized a patient monitoring tool dashboard to identify ambulatory patients with an active outpatient prescription for high-dose PPI therapy. Inclusion criteria included adult patients without an indication for long-term PPI therapy. Pharmacists contacted eligible patients to assess interest in PPI deprescribing via implementation of a shared decision-making intervention(s) based on an approved institution-specific algorithm.

Results

Of the 50 patients eligible for PPI deprescribing, 33 (66%) were agreeable to PPI deprescribing interventions. In patients without an indication, pharmacist intervention led to 25 indications being added to the electronic health record. PPI deprescribing success at the 3-week follow-up occurred in 27 patients (82%) of patients. A 1-year follow-up was conducted with 91% deprescribing interventions sustained and an estimated total cost savings of $58,919.90 annually.

Conclusion

A pharmacist-initiated shared decision model demonstrated sustained outcomes in PPI deprescribing. Overall, this evaluation provided data to support pharmacist deprescribing interventions as an effective way to minimize inappropriate continuation of high-dose PPI therapy. Further research is warranted to determine the long-term feasibility, sustainability, and safety benefits.