Successful deprescribing of unnecessary proton pump inhibitors in a primary care clinic.

OBJECTIVE

The objective of this study was to determine the rate of successful deprescribing of unnecessary proton pump inhibitors (PPIs) after implementation of a clinical pharmacist- managed program that included detailed tapering instructions, patient education, and follow-up.

SETTING

The setting was a family medicine clinic in St. Paul, MN, in an underserved community.

PRACTICE DESCRIPTION: Eligible patients were taking a long-term PPI for gastroesophageal reflux disease without esophagitis, or without a clear indication. Each morning, the clinical pharmacist generated a report in the electronic medical record that identified patients with appointments who were currently prescribed a PPI. After chart review, the pharmacist determined if patients were candidates for PPI deprescribing. If so, a focused visit with these patients was conducted.

PRACTICE INNOVATION: A unique pharmacist-managed PPI tapering schedule was developed and implemented to deprescribe unnecessary PPI therapy in a family medicine clinic.

EVALUATION: Eligible patients were seen by the pharmacist and initiated on a PPI taper. After 8 weeks, the patients who were initiated on a PPI taper were evaluated to determine if they successfully discontinued the PPI completely, decreased the dose or frequency, or were unsuccessful at tapering the PPI.

RESULTS

Of the patients assessed (N = 126), 60% were excluded, 19% were unable to be seen, and 21% were willing to attempt the taper and discontinue their PPI. Of the 22 patients who initiated PPI deprescribing, 19 (86%) successfully discontinued their PPI completely, 2 (9%) decreased the dose or frequency, and 1 (5%) was unable to decrease or discontinue their PPI. This success rate of PPI discontinuation was higher than that in previous studies in primary care settings (31%-66%).

CONCLUSION

Deprescribing long-term PPI therapy can be successful in a family medicine clinic when implementing a clinical pharmacist-managed program that includes detailed tapering instructions, patient education, and follow-up.