Authors (including presenting author) :
Lin HS(1), Leung KY(2), Hor CK(1), Chan WYM(1), Mak CK(1), Mak LKK(1), Tsang WCS(3), Chow CW(3), Lai WCJ(3), Wong CK(3), Shum CY(3), Chui WY(3)
Affiliation :
(1)Pharmacy Department, Tseung Kwan O Hospital, (2)Department of Pharmacology and Pharmacy, The University of Hong Kong, (3)Department of Medicine, Tseung Kwan O Hospital
Introduction :
Proton pump inhibitors have been prescribed worldwide for various gastrointestinal conditions. The chronic use of them was increasingly linked to a wide range of side effects, such as fracture and gastric cancer. In order to provide better overall benefit-and-risk management, several international guides have formulated the proton pump inhibitor deprescribing strategy. The most optimal approach in local practice was not yet well-established.
Objectives :
The objective of this study was to examine the local acceptance to proton pump inhibitor deprescribing. This study also explored the success rate of deprescribing and patients’ safety gastrointestinal outcome.
Methodology :
In this prospective pilot study, the pharmacist identified patients with long-term proton pump inhibitors without definite indications, and recommended deprescribing to their prescribers at medical follow-up. After the medical consultation, the pharmacist reviewed the electronic clinical note to see whether the recommendations were accepted. The pharmacist further assessed the patients’ recurrent gastrointestinal symptoms, and identified any gastrointestinal-related admissions or resumption of proton pump inhibitors four weeks after the follow-up.
Result & Outcome :
Of the 452 long-term users screened, a total of 61 patients was enrolled and completed the study, without any loss to follow-up. 57 (93.4%) of the deprescribing suggestions were accepted. The majority of proton pump inhibitor orders (86%) were stepped down to regular or as-required histamine-2 receptor antagonists. Of the deprescribed cases, 47 (82.5%) were considered as successful deprescribing. 3 (5.3%) required proton pump inhibitor resumption from gastrointestinal-related conditions. No alarming symptoms or gastrointestinal-related admission, serious adverse events or sudden death were reported during the period. Overall, the study demonstrated high prescriber acceptability to proton pump inhibitor deprescribing in eligible patients identified by the pharmacist according to evidence-based criteria established as a team. Further studies are required to investigate the complete and comprehensive deprescribing processes, with an adequate follow-up timeframe, and an integrated tapering schedule.
