Alanna Doell1, Ashley Walus2, Jaclyn To3, Allison Bell4. 1. , BScPharm, ACPR, is a Staff Pharmacist with Seven Oaks General Hospital of the Winnipeg Regional Health Authority, Winnipeg, Manitoba. 2. , BScPharm, ACPR, is a Clinical Resource Pharmacist with the Winnipeg Regional Health Authority, Winnipeg, Manitoba. 3. , BScPharm, ACPR, is a Staff Pharmacist with the Victoria General Hospital of the Winnipeg Regional Health Authority, Winnipeg, Manitoba. 4. , BScPharm, is the Pharmacy Manager with the Long Term Care Program of the Winnipeg Regional Health Authority, Winnipeg, Manitoba.
Abstract
BACKGROUND: Proton pump inhibitors (PPIs) are a commonly prescribed drug class used to inhibit gastric acid secretion. They are prescribed for both treatment and prophylaxis of several gastrointestinal conditions. Although PPIs can be used safely in the short term, several serious adverse effects have been reported following long-term use, including increased risk of falls and fragility fractures. Long-term care home (LTCH) residents represent a population in which the long-term adverse effects of PPIs can be significant and PPI deprescribing should be considered when appropriate. OBJECTIVES: To determine the proportion of LTCH residents with PPI prescriptions who were eligible for PPI deprescribing, and to examine vitamin B12 deficiencies and fall risk in the study population. METHODS: This cross-sectional, multisite chart review involved LTCH residents who had an active PPI prescription during October 2016. A convenience sample of 150 charts was randomly selected, and the appropriateness of PPI deprescribing was determined using Canadian guidelines. Descriptive statistics were used to examine demographic characteristics, PPI dosing and indication, vitamin B12 supplementation, fall history, and fall risk. RESULTS: Three of the selected charts were excluded because of missing information. Of the 147 residents included in the chart review, 93 (63%) were candidates for deprescribing. PPI use for gastroesophageal reflux disease for more than 8 weeks without a deprescribing attempt in the past year was the most frequently observed opportunity for deprescribing (49/93 [53%]). Twenty-nine residents (20%) had no documented indication for PPI use. Thirteen residents (9%) had had a fall within the past 30 days, and 53 (36%) had a prescription for vitamin B12 supplements and/or had low serum vitamin B12 levels. CONCLUSIONS: A majority of the residents whose charts were reviewed were candidates for PPI deprescribing. This finding suggests an opportunity for clinicians who care for LTCH residents to increase their deprescribing efforts.
BACKGROUND: Proton pump inhibitors (PPIs) are a commonly prescribed drug class used to inhibit gastric acid secretion. They are prescribed for both treatment and prophylaxis of several gastrointestinal conditions. Although PPIs can be used safely in the short term, several serious adverse effects have been reported following long-term use, including increased risk of falls and fragility fractures. Long-term care home (LTCH) residents represent a population in which the long-term adverse effects of PPIs can be significant and PPI deprescribing should be considered when appropriate. OBJECTIVES: To determine the proportion of LTCH residents with PPI prescriptions who were eligible for PPI deprescribing, and to examine vitamin B12 deficiencies and fall risk in the study population. METHODS: This cross-sectional, multisite chart review involved LTCH residents who had an active PPI prescription during October 2016. A convenience sample of 150 charts was randomly selected, and the appropriateness of PPI deprescribing was determined using Canadian guidelines. Descriptive statistics were used to examine demographic characteristics, PPI dosing and indication, vitamin B12 supplementation, fall history, and fall risk. RESULTS: Three of the selected charts were excluded because of missing information. Of the 147 residents included in the chart review, 93 (63%) were candidates for deprescribing. PPI use for gastroesophageal reflux disease for more than 8 weeks without a deprescribing attempt in the past year was the most frequently observed opportunity for deprescribing (49/93 [53%]). Twenty-nine residents (20%) had no documented indication for PPI use. Thirteen residents (9%) had had a fall within the past 30 days, and 53 (36%) had a prescription for vitamin B12 supplements and/or had low serum vitamin B12 levels. CONCLUSIONS: A majority of the residents whose charts were reviewed were candidates for PPI deprescribing. This finding suggests an opportunity for clinicians who care for LTCH residents to increase their deprescribing efforts.
Authors: Daniel H Solomon; Susan J Diem; Kristine Ruppert; Yin Juan Lian; Chih-Chin Liu; Alyssa Wohlfart; Gail A Greendale; Joel S Finkelstein Journal: J Bone Miner Res Date: 2015-02 Impact factor: 6.741
Authors: Mark Reid; Angela Keniston; J Christie Heller; Marshall Miller; Sofia Medvedev; Richard K Albert Journal: J Hosp Med Date: 2011-12-21 Impact factor: 2.960
Authors: Ian A Scott; Sarah N Hilmer; Emily Reeve; Kathleen Potter; David Le Couteur; Deborah Rigby; Danijela Gnjidic; Christopher B Del Mar; Elizabeth E Roughead; Amy Page; Jesse Jansen; Jennifer H Martin Journal: JAMA Intern Med Date: 2015-05 Impact factor: 21.873