124 Proton pump inhibitors: implementation of a de-prescribing strategy

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Abstract

Objectives

Proton pump inhibitors (PPI) are the most consumed drugs and omeprazole is one of the most prescribed drugs in our health system. It has been estimated that 10% of people in our region take a PPI daily.

Objectives

Prescribing a PPI without indication contributes to polypharmacy and drug interactions. Besides, chronic administration can lead to safety problems such as hypomagnesaemia, enteric infections or osteoporotic fractures.

Objectives

To develop a strategy in order to optimize the use of PPI in a northern region of Spain (6 16 758 inhabitants).

Method

A so-called ‘PPI optimization strategy’ was implemented including the following activities: 1) A multidisciplinary group (gastroenterologists, general practitioners (GPs) and primary care pharmacists (PCP)) was established to design the strategy; 2) Evidence on PPIs and gastroprotection was assessed; 3) Criteria for selection of candidates for intervention was agreed (≥65 years treated with PPI without authorized indication); 4) Pharmacists presented the program to GPs and nurses. 5) Patient-oriented support materials were provided to doctors (explanatory leaflets for candidates and general public too); 6) Candidates for intervention were retrieved through an in-house developed software that interacts with all clinical records in our province; 7) A message to all retrieved clinical records was sent asking the doctor to withdraw the drug; 8) A mass media campaign supporting the strategy was launched that included press release for local newspapers. 8) PPIs withdrawal was monitored and evaluated.

Results

PPI optimization strategy was created. PCP gave training sessions for the GPs and nurses with the purpose of providing education and awareness. A mass media campaign was carried out for the population. Inclusion criteria:≥65 years old and treated with PPI without authorized indication for it registered in medical records. Patients´ list was obtained from Observa (Observatory of medication safety), an in-house developed software that allows a communication between PCP and GPs linked to the medical records. Through this tool PCPs sent a message to doctors whose patients met the inclusion criteria. The message included information about the low benefit of chronic PPI treatment in patients without risk factors, the risk of adverse events and a discontinuation of the PPI treatment was proposed. A total of 9325 patients were candidates for the intervention. Preliminary results showed that GPs evaluated 40% of the proposals and 43% were accepted.

Conclusions

There is a high use of PPI in elderly patients. The use of web tools such as Observa can contribute to the optimization of pharmacotherapy and avoids PPI overuse. Almost half of the evaluated proposals of de-prescribing were accepted.

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