Implementation of Proton Pump Inhibitor Deprescription Protocol in Geriatric Residents

Abstract

The present pilot study added to the growing body of evidence that gradual deprescription of antisecretory medications is feasible. Nonetheless, the pilot design precludes any conclusions about safety and efficacy of the intervention.

Peer-led Education Expedites De-Prescribing Proton Pump Inhibitors for Appropriate Veterans

“…Up to date de-prescribing protocols recommend closer provider driven follow up care than is presently offered SDVA veterans. Avraham and Biglow (2018) developed a guideline for PPI de-prescribing by reducing the dose in half every 3 weeks and then changing the frequency to every other day of use over 3 weeks in a pilot study of ten elderly residents de-prescribed in a nursing home. Follow up assessments were recommended by a clinical pharmacist every 3 weeks during de-prescribing, over the course of 12 weeks (Avraham & Biglow, 2018).…”

“…Thompson, Black et al, (2017) cited a plethora of findings exist that few patients require therapeutic care with long term PPI use (2017). De-prescribing constitutes multiple options: sudden abruption, tapering to half dosing and then as needed use or substituting use at the time of de-prescribing with H2Ras to control rebound GERD symptoms (Avraham & Biglow, 2018;Farrell, et al, 2017;Reeve, et al, 2015;Thompson, Black, et al, 2017). Tapering and medication substitution, are supported by the evidence.…”

“…Many patients take PPIs for years without reasons and are reluctant to stop use (Avraham & Biglow, 2018;Farrell, B. et al, 2017;Naunton, M. et al, 2018;Reeve et al, 2015;Thompson, Black et. al., 2017;Xie, et al, 2016).…”

“…PCPs are advised by gastroenterologists to de-prescribe patients with no exclusion criteria for cessation after up to 8 weeks of use (Avraham & Biglow, 2018;Farrell, et al, 2017), with minimal guideline support (Avraham & Biglow, 2018;Farrell, et al, 2017;Reeve, et al, 2015). Thompson, Black et al, (2017) cited a plethora of findings exist that few patients require therapeutic care with long term PPI use (2017).…”

“…Tapering and medication substitution, are supported by the evidence. (Avraham & Biglow, 2018;Farrell, et al, 2017;Reeve, et al, 2015;Thompson, Black, et al, 2017). Regardless, patients do sometimes abruptly cease long term use of PPIs and report symptoms of rebound acid hypersecretion (RAHS).…”