The Impact of Pharmacist Interventions on the Inappropriate Use of Acid-Suppression Therapy

Hughes, Gregory; Belgeri, Myra T.; Perry, Horace M.

doi:10.4140/tcp.n.2011.485

Cited by 13 publications

(31 citation statements)

References 17 publications

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“…The presence of active GI bleeding was similar in pre‐ and post‐intervention phases of their study . In another pre‐/post‐intervention study by Hughes et al ., pharmacist intervention reduced inappropriate AST in non‐ICU patients by about 50% at discharge time …”

Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Mousavi

Dashti‐Khavidaki

Khalili

et al. 2012

International Journal of Pharmacy Practice

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Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Mousavi

Dashti‐Khavidaki

Khalili

et al. 2012

International Journal of Pharmacy Practice

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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%

“…Characteristics of 10 publications (resulting in 9 studies) conducted in the non-ICU settings are summarized in Table 2 [63-66, 69-71, 76, 78, 79]. Seven publications were within an internal medicine/general ward [63-66, 70, 71, 76] and one each within a Geriatric Evaluation and Management unit at the Veterans Affairs Medical Center [69], acute geriatric ward [79], and hematology/oncology inpatient unit [78]. Four studies were retrospective (Agee et al, Belfield et al, Buckley et al, Ziegler et al) with a prepost intervention design [63][64][65]78]; these studies did not report if patients in the pre-intervention groups received any interventions (i.e., usual care) [63][64][65]78].…”

Section: Plos Onementioning

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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“…Inclusion of a pharmacist within the interdisciplinary team has been shown to reduce unnecessary PPI use and can facilitate patient education, dose changes, monitoring, and alerting the prescriber to ongoing symptoms. 56,57…”

Section: Remarks and Values And Preference Statementmentioning

confidence: 99%

Peer-Led Education Expedites Deprescribing Proton Pump Inhibitors for Appropriate Veterans

Bowman

2020

Gastroenterology Nursing

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Objective To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. Methods Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline. Recommendations This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved. The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers. Conclusion This guideline provides practical recommendations for making decisions about when and how to reduce the dose of or stop PPIs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients. This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

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The Impact of Pharmacist Interventions on the Inappropriate Use of Acid-Suppression Therapy

Abstract: This study examined the impact of pharmacists' active participation in interdisciplinary team rounds compared with a nonpharmacist control group. These results demonstrate pharmacist participation associated with potential cost savings and improved patient care.

Cited by 13 publications

References 17 publications

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency

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

Peer-Led Education Expedites Deprescribing Proton Pump Inhibitors for Appropriate Veterans

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