Deprescribing in a family health team: a study of chronic proton pump inhibitor use
Kate Walsh 1 4 , Debbie Kwan 2 , Patricia Marr 2 , Christine Papoushek 2 , W. Kirk Lyon 31 Pharmacist, Toronto Central Community Care Access Centre
2 Pharmacist, Toronto Western Family Health Team
3 Family Physician, Toronto Western Family Health Team
4 Correspondence to: Kate Walsh, 250 Dundas St West, Toronto, ON M5T 2Z6, Canada. Email: katewalsh478@gmail.com
Journal of Primary Health Care 8(2) 164-171 https://doi.org/10.1071/HC15946
Published: 30 June 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
BACKGROUND: Proton pump inhibitors (PPIs) are often used inappropriately, without an indication, or for longer durations than recommended. Few tools exist to guide reassessment of their continued use and deprescribing if required. We aimed to reduce inappropriate drug use by developing and implementing a PPI deprescribing tool and process in a family medicine unit.
ASSESSMENT OF PROBLEM: Primary care providers of adults taking a PPI for 8 weeks with an upcoming periodic health examination were reminded to reassess therapy via electronic medical record (EMR) messaging. A PPI Deprescribing Tool was uploaded into the EMR as a second reminder and to guide reassessment and deprescribing where indicated. Ten weeks after the examination a chart review assessed changes to PPI use. A follow up survey of providers assessed the utility and barriers to implementing the Deprescribing Tool.
RESULTS: Forty-three of 46 patients on PPIs (93%) had their PPI reassessed, resulting in 11 patients (26%) having their PPI deprescribed.
Strategies for Improvement: Routine reassessment of long-term medications is often overlooked because of extensive demands on primary care providers’ time. Deprescribing likely improved because potentially eligible patients were identified to the provider and a tool was provided at the time of the encounter to guide the deprescribing process.
LESSONS: Reassessment and deprescribing of PPIs can be supported by implementing a standardised process and use of guidance tools for clinicians. Providers found the timely and selective reminder message to deprescribe the most useful component of the intervention.
KEYWORDS: proton pump inhibitor; deprescribing; reassessment; primary care; medication therapy management; gastroesophageal reflux disease
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