Decreased acid suppression therapy overuse after education and medication reconciliation

Acid suppression therapy (AST) is commonly overprescribed in hospitalised patients. This indiscriminate use increases cost and drug-related side effects. Minimal data is available on interventions aimed at reducing the burden of overprescription. The aim of our study was to evaluate the impact of education and medication reconciliation forms use on admission as well as discharge, on AST overuse in hospitalised patients.

A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville was performed prior to and after the introduction of interventions (education/medication reconciliation) aimed at reducing AST overuse. The percentage of patients started on inappropriate AST, the admitting diagnosis, indications for starting AST and discharge on these medications was compared in the pre and postintervention groups.

Acid suppression therapy use declined from 70% (279/400) in the preintervention period to 37% (100/270) postintervention (p < 0.001). There was a reduction in inappropriate prescriptions from 51% (204/400) pre to 22% (60/270) postintervention (p < 0.02). Stress ulcer prophylaxis in low-risk patients or the concomitant use of ulcerogenic drugs continued to motivate inappropriate AST therapy in most patients. Postintervention, only 20% (12/60) of patients were discharged on unneeded AST compared with 69% (140/204) in the preintervention group (p < 0.001).

Interventions consisting of education and use of medication reconciliation forms decreased inappropriate prescription of AST on admission and discharge. This can significantly decrease cost to the healthcare system and the risk of drug interactions.