Pharmacy residents have the opportunity to complete a research project during their residency training, which provides them with skills on how to conduct and manage a research project. Projects often represent an area of interest and need that has been recognized by the host institution’s pharmacy department. Projects are presented as a poster at an annual CSHP Ontario Branch Residency Research Night, and many eventually go on to be published in a peer-reviewed journal.Rationale:
The long term use of proton pump inhibitors (PPIs) has been associated with an increased risk of morbidity. The ongoing need for PPIs is often not reassessed in a timely fashion. The transition of care between the community and the hospital may present a suitable opportunity for the review of a patient’s medications, and hospital pharmacists have the potential to instigate the deprescribing process.
Objectives:
To determine the effectiveness and feasibility of the implementation of a systematic pharmacist-led PPI deprescribing process in an acute care setting.
Methods:
A prospective before and after study was conducted in patients newly admitted to the Internal Medicine service with a PPI as a part of their home medication regimen. The pre-intervention phase consisted of usual care, followed by the intervention phase where a pharmacist-led PPI deprescribing process was implemented. The PPI deprescribing tool created through the “Deprescribing Guidelines for the Elderly Project” was used to aid in the deprescribing process.
Results:
There was no statistically significant difference in the percentage of PPIs deprescribed on discharge between the pre-intervention and intervention phases (6.4% vs. 14.3%, p=0.373). In the intervention phase, 21 patients receiving a PPI prior to admission were assessed for appropriateness of deprescribing by the investigator. Deprescribing was appropriate for seven patients, of which six were agreeable to a deprescribing trial. Deprescribing was suggested to the physician by the clinical pharmacist for three patients, all of which were agreed to by the physician. At discharge, one patient’s PPI was deprescribed. The average time used by the investigator to determine the PPI indication and assess for appropriateness was nine minutes.
Conclusion:
The implementation of a pharmacist-led PPI deprescribing process in an acute care setting did not significantly impact deprescribing rates
