Abstract
Objectives
To assess the effect of a proton pump inhibitor (PPI) deprescribing guideline on PPI
usage and PPI drug costs in one long-term care home in Ontario, Canada.
Design
Interrupted time-series analysis to compare monthly PPI usage and average monthly
PPI cost per resident 9 months before guideline implementation to 12 months after.
Setting
One long-term care home in Ottawa, Ontario, Canada.
Participants
Long-term care residents prescribed a PPI over a 21-month period (n = 335).
Intervention
PPI deprescribing guideline and decision support tool used during quarterly medication
reviews.
Measurements
(1) Total number of PPI prescriptions (PPI usage) and (2) average PPI drug cost per
resident. We also measured the proportion of residents whose PPI was deprescribed
in the preguideline period and postguideline period.
Results
The deprescribing guideline was associated with a decrease in PPI usage but the association
was not statistically significant (−8.7 prescriptions, 95% confidence interval [CI] −22.0
to 4.6). The PPI guideline led to a significant decrease in average monthly PPI drug
cost per resident over time (0.16 CAD reduction per month; 95% CI −0.29 to −0.03).
In the 9 months before intervention, 57 (27.8%) of 205 eligible residents had their
PPI deprescribed, and in the 12 months after intervention 134 (50.0%) of 268 eligible
residents had their PPI deprescribed (difference in proportions of 22.2%; 95% CI 13.4–30.4).
Discussion/conclusion
The deprescribing guideline was associated with a decline PPI usage; however, this
negative association was not statistically significant. PPI usage declined in the
initial 6 months after guideline implementation but began to climb back to baseline
after this, which may explain the lack of a significant reduction in PPI usage. This
suggests that it was difficult to maintain PPI deprescribing efforts long-term. Although
implementation of a PPI deprescribing guideline may lead to an initial reduction in
PPI usage, and a significant reduction in the average cost of PPI prescriptions over
time, it is imperative to explore ways to sustain deprescribing guideline use.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Guidelines for the diagnosis and management of gastroesophageal reflux disease.Am J Gastroenterol. 2013; 108: 308-328
- Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors.Ann Pharmacother. 2015; 49: 29-38
- Four-year trends of inappropriate proton pump inhibitor use after hospital discharge.South Med J. 2013; 106: 270-273
- Overutilization of proton-pump inhibitors: What the clinician needs to know.Therap Adv Gastroenterol. 2012; 5: 219-232
- Potential costs of inappropriate use of proton pump inhibitors.Am J Med Sci. 2014; 347: 446-451
- Use of proton pump inhibitors and other acid suppressive medications in newly admitted nursing facility patients.J Am Med Dir Assoc. 2007; 8: 607-609
- A benefit-risk assessment of the use of proton pump inhibitors in the elderly.Drugs Aging. 2014; 31: 263-282
- Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: Meta-analysis.Am J Gastroenterol. 2012; 107: 1011-1019
- Use of acid-suppressive drugs and risk of pneumonia: A systematic review and meta-analysis.CMAJ. 2011; 183: 310-319
- Proton pump inhibitors and risk of fractures: A meta-analysis of 11 international studies.Am J Med. 2012; 124: 519-526
Canadian Institute for Health Information. Prescribed drug spending in Canada, 2012: A focus on public drug programs spending and health workforce. 2014. Available at: https://secure.cihi.ca/free_products/Prescribed_Drug_Spending_in_Canada_EN.pdf. Accessed March 11, 2016.
- Evidence-based deprescribing algorithm for proton pump inhibitors.(Available at:) (Accessed March 11, 2016)
- Developmental evaluation as a strategy to enhance the uptake and use of deprescribing guidelines: Protocol for a multiple case study.Implement Sci. 2015; 10: 91
Ontario Drug Benefit Formulary. Formulary search 2016. Available at: https://www.healthinfo.moh.gov.on.ca/formulary/. Accessed March 11, 2016.
- Regression based quasi-experimental approach when randomisation is not an option: Interrupted time series analysis.BMJ. 2015; 350: h2750
- The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings.J Eval Clin Pract. 2008; 14: 888-897
- Strategies for discontinuation of proton pump inhibitors: A systematic review.Fam Pract. 2014; 31: 625-630
- Patient-directed strategy to reduce prescribing for patients with dyspepsia in general practice: A randomized trial.Aliment Pharmacol Ther. 2004; 19: 917-922
- Proton pump inhibitor discontinuation in long-term care.J Am Geriatr Soc. 2011; 59: 1658-1664
- Impact of clinical pharmacists’ recommendations on a proton pump inhibitor taper protocol in an ambulatory care practice.J Manag Care Pharm. 2013; 19: 325-333
- Segmented regression analysis of interrupted time series studies in medication use research.J Clin Pharm Ther. 2002; 27: 299-309
Article info
Publication history
Published online: June 08, 2016
Footnotes
The authors declare no conflicts of interest.
The “Deprescribing Guidelines in the Elderly Project” is a research program of The Ontario Pharmacy Research Collaboration (OPEN), which is funded by the Government of Ontario. BF received the funding. The views of the funding bodies have not influenced the content of this study. The views expressed in this article are those of the authors and do not represent those of the Government of Ontario. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Grant #06674 http://www.health.gov.on.ca/en/pro/ministry/research/hsrf.aspx.
Identification
Copyright
© 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
