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

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.