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Implementing a Systematic Approach to Deprescribing Proton Pump Inhibitor Therapy in Older Adults

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OBJECTIVE: To investigate the efficacy of a population health management initiative aimed at reducing the unnecessary use of proton pump inhibitors (PPIs) in elderly patients via a tapering process by measuring 1) the percentage of patients that initiate the PPI taper, 2) the number of patients 65 years of age and older with undocumented or unknown indication on PPI therapy for longer than eight weeks, and 3) the percentage of pharmacists' discontinuation recommendations accepted by the provider.

DESIGN: Prospective, interventional pilot study.

SETTING: Tier 3 patient-centered medical home within a major academic medical center with multiple sites.

PARTICIPANTS: Five hundred fifteen elderly patients were identified with an active PPI prescription for longer than eight weeks.

INTERVENTIONS: A report was generated using the electronic health record to identify patients 65 years of age and older on PPI therapy. Patients were contacted via secure portal or telephone and provided with the risks and benefits by use of an educational online tool from RxFiles. Patients who were agreeable to begin a taper were provided an individualized plan. PPI use was monitored at a predesignated interval.

MAIN OUTCOME MEASURES: Patients initiating PPI taper, documented indication for PPI, and percent pharmacist recommendations accepted.

RESULTS: Two hundred thirty-eight (46%) were eligible for intervention; 53 of 238 didn't have a documented indication. The provider approval rate of the pharmacist-recommended intervention was 86%, and 103 patients initiated the taper. Of these, 84 (81.6%) were successfully weaned off their PPI.

CONCLUSION: A systematic approach to deprescribing PPI therapy was successfully implemented for an elderly patient population.
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Keywords: DEPRESCRIBING; ELDERLY; GERIATRIC; PHARMACIST; POPULATION HEALTH MANAGEMENT; PROTON; PUMP INHIBITOR; TAPER

Document Type: Research Article

Publication date: January 1, 2019

More about this publication?
  • The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Senior Care Pharmacist® will want to consider joining ASCP.

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