Deprescribing proton pump inhibitors in long-term care: Outcomes of a pharmacist-led initiative.

BACKGROUND

Proton pump inhibitors (PPIs) are frequently continued without clear indication in long-term care (LTC) settings. Evidence-based deprescribing strategies may reduce unnecessary exposure, but real-world data from Middle Eastern LTC facilities remain limited.

OBJECTIVE

To evaluate the feasibility, implementation, and short-term safety of a pharmacist-led PPI deprescribing initiative in a long-term care facility.

METHODS

This retrospective cohort study included LTC residents receiving PPIs who underwent pharmacist-led medication review between September and November 2024. Residents were classified eligible or ineligible for deprescribing using guideline-aligned criteria. Deprescribing required approval from the attending physician and resident or family. Outcomes included deprescribing implementation, maintenance off PPIs at 3-month follow-up, symptom recurrence, PPI reinitiation, and gastrointestinal (GI) bleeding events.

RESULTS

Among 68 residents, 35 (51.5%) were eligible for deprescribing. Deprescribing was implemented in 26 eligible residents (74.3%; 95% CI 56.7-87.5). Sustained PPI discontinuation occurred in 25 of 35 eligible residents (71.4%; 95% CI 53.7-85.4). Among the 26 residents who discontinued therapy, 25 (96.2%; 95% CI 80.4-99.9) remained off PPIs at 3 months. One resident (3.8%; 95% CI 0.1-19.6) had GI bleeding during follow-up. No other adverse events were observed, and no resident required rescue acid-suppressive therapy or urgent evaluation.

CONCLUSION

A pharmacist-led deprescribing initiative was feasible to implement in a long-term care facility and was associated with high deprescribing uptake and maintenance off therapy among eligible residents. These findings support the potential role of pharmacist-led deprescribing in LTC settings and highlight opportunities for further evaluation of deprescribing programs in underrepresented regions.