Impact of A Collaborative Strategy to Reduce the Inappropriate Use of Acid Suppressive Therapy in Non–Intensive Care Unit Patients

Belfield, Kristen; Kuyumjian, Arpi G; Teran, Rafael; Amadi, Mariette; Blatt, Melissa; Bicking, Keri

doi:10.1177/1060028017698797

Cited by 7 publications

(27 citation statements)

References 25 publications

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“…The PRISMA flowchart of study inclusion is illustrated in Fig 1 [55]. After screening and determination of eligibility of 14,422 citations, 17 articles published between 2007 and 2019 were ultimately included in the meta-analysis [63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. These 17 publications resulted in 16 studies since Buckley et al [65] reported data for both the ICU and non-ICU settings in a single publication and two authors published results of pre-and post-intervention data in separate articles; in the ICU setting: Wohlt et al (pre-implementation) [75] and Hatch et al (post-implementation) [68]; in the non-ICU setting: Khudair et al (pre-implementation) [71] and Khudair et al (post-implementation) [70].…”

Section: Study Inclusionmentioning

confidence: 99%

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.

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Section: Study Inclusionmentioning

confidence: 99%

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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“…Twenty studies evaluated targeted drug programs (Table S3). The majority of these evaluations utilized study designs at high risk of bias. Nonrandomized posttest designs with a historical control comprised 55% studies, followed by single‐group posttest (15%), single‐group pretest‐posttest (10%), and nonrandomized pretest‐posttest with a historical control (5%).…”

Section: Resultsmentioning

confidence: 99%

“…Antimicrobial cost per patient day was reported to be lower with pharmacist stewardship, which ranged from $3.09 to $64.13 . Other targeted drug programs evaluated stewardship of other drug types such as erythropoietin and acid suppression . These studies reported cost savings, which ranged between $37000 and $198352 annually.…”

Section: Resultsmentioning

confidence: 99%

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Talon

Pérez

Yan

et al. 2019

J Am Coll Clin Pharm

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Studies evaluating the cost-effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient-level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies wereincluded. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non-randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59-95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost-effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence. K E Y W O R D Scost-benefit analysis, health services research, pharmacoeconomics, pharmacy

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“…( 2 , 7 ) However, in spite of reduced major bleeding with acid suppressants, little or no effect of acid suppressive therapy was noted on mortality and patients in non-intensive care unit. ( 8 , 9 ) As much as pharmacologic therapy with anti-secretary drugs, enhanced gastric defense system can be alternate or combinational enhancer to cover the limitation of acid suppressive therapy since pre-epithelial factors, an epithelial barrier, and subepithelial factors are also principally implicated in SRMD. ( 10 )…”

Section: Introductionmentioning

confidence: 99%

<i>Dolichos lablab</i> L. extracts as pharmanutrient for stress-related mucosal disease in rat stomach

Kim

Lee

et al. 2020

J. Clin. Biochem. Nutr.

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Gastric stress-related mucosal disease (SRMD) presented from superficial gastritis to deep ulceration consequent to insufficient perfusion, ischemia, and oxidative stress. Though pharmacologic interventions to optimize tissue perfusion or to enhance defensive mechanism are essential, limited clinical outcome necessitates strong acid suppressors or natural agents. Under the hypothesis that Dolichos lablab L. (NKM 23-1) can enhance defense against SRMD, water immersion restraint stress (WIRS) were imposed to rats and additional groups pretreated with differing doses of NKM 23-1 were monitored. On gross and microscopic evaluation, they significantly rescued SRMD ( p <0.01). The levels of inflammatory mediators such as IL-18, IL-1β, IL-8, iNOS, TNF-α, caspase-1, NOXs as well as MMPs accompanied with NF-κB p50 activation were all significantly increased in WIRS, but their levels were significantly decreased in Groups pretreated with NKM 23-1. WIRS significantly increased apoptosis, but significantly decreased with NKM 23-1 accompanied with significantly increased levels of cyclin D/E and HSP70/HSP27. Gastric mucin was significantly preserved in Groups pretreated with NKM 23-1, while depleted in WIRS, accompanied with increased expressions of Muc5A. Gastric levels of HO-1 and NQO1 were significantly increased in Group treated with NKM 23-1 with transcriptional activation of Nrf2. Conclusively, preemptive intake of NKM 23-1 significantly rescued SRMD.

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Impact of A Collaborative Strategy to Reduce the Inappropriate Use of Acid Suppressive Therapy in Non–Intensive Care Unit Patients

Abstract: A collaboration between clinical pharmacists and a hospitalist service can significantly reduce the inappropriate use of AST in non-ICU patients.

Cited by 7 publications

References 25 publications

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

<i>Dolichos lablab</i> L. extracts as pharmanutrient for stress-related mucosal disease in rat stomach

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