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

Abstract

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.

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

“…The main meta-analysis results are consistent with a recent systematic review of pharmacy-supported interventions to reduce inappropriate continuation of SUP in patients after ICU and hospital discharge that reported similar effectiveness 29. However, our meta-analyses considered discontinuation of all potentially inappropriate medication and were unconstrained by interventions delivered by a single profession.…”

“…The main meta-analysis results are consistent with a recent systematic review of pharmacy-supported interventions to reduce inappropriate continuation of SUP in patients after ICU and hospital discharge that reported similar effectiveness. 29 However, our meta-analyses considered discontinuation of all potentially inappropriate medication and were unconstrained by interventions delivered by a single profession. Multicomponent de-prescribing interventions primarily consisted of policy-type (guidelines) and single intervention functions (education (and training) of staff), sometimes supported by audit and feedback, to affect staff behaviour change and likely intervention adoption.…”

“…1 2 4 6 28 A recent systematic review demonstrated the benefits of pharmacy-led interventions to improve de-prescribing of stress ulceration prophylaxis (SUP) at ICU and hospital discharge points. 29 However, a broader scope and multiprofessional approach is required to meet the wider medicines optimisation and communication challenges to transitional medication continuity and safety. 4 For ICU patient to hospital ward transitions, it is unclear what medication-related intervention components are required and their efficacy, timing and mode of delivery.…”

“…A recent systematic review demonstrated the benefits of pharmacy-led interventions to improve de-prescribing of stress ulceration prophylaxis (SUP) at ICU and hospital discharge points. 29 However, a broader scope and multiprofessional approach is required to meet the wider medicines optimisation and communication challenges to transitional medication continuity and safety. 4 For ICU patient to hospital ward transitions, it is unclear what medication-related intervention components are required and their efficacy, timing and mode of delivery.…”

Pharmacist‐Led Intervention on the Inappropriate Use of Stress Ulcer Prophylaxis Pharmacotherapy in Intensive Care Units: A Systematic review

“…Compared with published reviews ( Singh-Franco et al, 2020 ; Orelio et al, 2021 ), we standardized the calculation process of the inappropriate rate so that the results of the studies were comparable. We also discussed the primary outcome at different time points including during ICU hospitalization, at ICU transfer and hospital discharge.…”