Pharmacist-Driven Step-Down of Long-Term Proton-Pump Inhibitor Therapy

Area of Science:

• Pharmacology
• Gastroenterology
• Health Services Research

Background:

• Long-term use of proton-pump inhibitors (PPIs) is common in outpatient settings.
• Assessing the appropriateness of long-term PPI prescribing is crucial for optimizing patient care and reducing potential harms.
• Identifying patients with inappropriate long-term PPI indications is the first step toward intervention.

Purpose of the Study:

• To evaluate the appropriateness of proton-pump inhibitor (PPI) prescribing in an outpatient setting.
• To reduce the number of outpatients receiving long-term PPI therapy (≥1 year).
• To assess the efficacy of a pharmacist-driven PPI step-down protocol.

Main Methods:

• Phase I: Retrospective chart review to determine PPI prescribing appropriateness.
• Phase II: Prospective implementation of a pharmacist-led PPI step-down protocol for patients with inappropriate long-term use.
• Intervention involved pharmacist contact and a structured step-down process with follow-up calls.

Main Results:

• Phase I revealed that 68.4% of patients were on long-term PPI therapy without a clear indication.
• Phase II demonstrated that 71.4% of patients successfully stepped down from PPIs.
• The average duration for successful PPI step-down was 13 weeks, utilizing alternative acid-suppression therapies.

Conclusions:

• A significant majority of long-term PPI prescriptions lack appropriate indications.
• A pharmacist-driven step-down protocol is effective in managing patients on long-term PPI therapy.
• Most patients can successfully discontinue long-term PPIs with appropriate support and alternative therapies.