Background Proton pump inhibitors (PPIs) are often used inappropriately, without an indication, or for longer durations than recommended. Deprescribing is defined as the reduction, withdrawal or discontinuation of inappropriate medication. We aimed to reduce inappropriate drug use by developing and implementing a PPI process in a nursing home.
Purpose To determine the effectiveness of multidisciplinary intervention to deprescribe inappropriate PPIs in older adults in a nursing home.
Material and methods A prospective study completed between January and February 2017. The deprescribing process consisted of four steps: medication reviews conducted by the clinical pharmacist, identification of residents who have completed a minimum of 8 weeks of treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms have resolved. The recommendations do not apply to those who have or have had Barrett oesophagus, severe oesophagitis, a documented history of bleeding gastrointestinal ulcers or were taking nonsteroidal anti-inflammatory drugs, presentation and discussion of the results to the medical and nurse staff reminding them to reassess therapy together with tailored educational information, arranging health examinations to planning the withdrawal regimen and monitoring during the 7 months after medication withdrawal.
Results One hundred residents of the 160 living in the nursing home (62.5%) were on PPIs. Fifty-three per cent of the cases met the criteria to encourage deprescription and were discussed with the medical team. Eighty-five per cent of the proposed interventions were accepted, resulting in 10 patients having their dose reduced and 45 patients having their PPI deprescribed. Seven months’ later. 12 patients (26.6%) resumed the original dose due to worsening gastrointestinal symptoms. The multidisciplinary intervention resulted in a 33% decrease in PPI use.
Conclusion Discontinuation of PPIs is feasible in a nursing home and a substantial number of the residents treated without a clear indication can safely reduce or discontinue treatment. The multidisciplinary approach facilitates decision making by involving everyone in the intervention.
No conflict of interest
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