PMID- 27289201
OWN - NLM
STAT- MEDLINE
DCOM- 20171127
LR  - 20220408
IS  - 1538-9375 (Electronic)
IS  - 1525-8610 (Linking)
VI  - 17
IP  - 7
DP  - 2016 Jul 1
TI  - Effect of a Proton Pump Inhibitor Deprescribing Guideline on Drug Usage and Costs 
      in Long-Term Care.
PG  - 673.e1-4
LID - S1525-8610(16)30114-1 [pii]
LID - 10.1016/j.jamda.2016.04.020 [doi]
AB  - OBJECTIVES: To assess the effect of a proton pump inhibitor (PPI) deprescribing 
      guideline on PPI usage and PPI drug costs in one long-term care home in Ontario, 
      Canada. DESIGN: Interrupted time-series analysis to compare monthly PPI usage and 
      average monthly PPI cost per resident 9 months before guideline implementation to 
      12 months after. SETTING: One long-term care home in Ottawa, Ontario, Canada. 
      PARTICIPANTS: Long-term care residents prescribed a PPI over a 21-month period 
      (n = 335). INTERVENTION: PPI deprescribing guideline and decision support tool 
      used during quarterly medication reviews. MEASUREMENTS: (1) Total number of PPI 
      prescriptions (PPI usage) and (2) average PPI drug cost per resident. We also 
      measured the proportion of residents whose PPI was deprescribed in the 
      preguideline period and postguideline period. RESULTS: The deprescribing 
      guideline was associated with a decrease in PPI usage but the association was not 
      statistically significant (-8.7 prescriptions, 95% confidence interval [CI] -22.0 
      to 4.6). The PPI guideline led to a significant decrease in average monthly PPI 
      drug cost per resident over time (0.16 CAD reduction per month; 95% CI -0.29 
      to -0.03). In the 9 months before intervention, 57 (27.8%) of 205 eligible 
      residents had their PPI deprescribed, and in the 12 months after intervention 134 
      (50.0%) of 268 eligible residents had their PPI deprescribed (difference in 
      proportions of 22.2%; 95% CI 13.4-30.4). DISCUSSION/CONCLUSION: The deprescribing 
      guideline was associated with a decline PPI usage; however, this negative 
      association was not statistically significant. PPI usage declined in the initial 
      6 months after guideline implementation but began to climb back to baseline after 
      this, which may explain the lack of a significant reduction in PPI usage. This 
      suggests that it was difficult to maintain PPI deprescribing efforts long-term. 
      Although implementation of a PPI deprescribing guideline may lead to an initial 
      reduction in PPI usage, and a significant reduction in the average cost of PPI 
      prescriptions over time, it is imperative to explore ways to sustain 
      deprescribing guideline use.
CI  - Copyright (c) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine. 
      Published by Elsevier Inc. All rights reserved.
FAU - Thompson, Wade
AU  - Thompson W
AD  - Bruyere Research Institute, Ottawa, Canada. Electronic address: 
      wthomp01@gmail.com.
FAU - Hogel, Matthew
AU  - Hogel M
AD  - Bruyere Research Institute, Ottawa, Canada.
FAU - Li, Yan
AU  - Li Y
AD  - Bruyere Research Institute, Ottawa, Canada.
FAU - Thavorn, Kednapa
AU  - Thavorn K
AD  - Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.
FAU - O'Donnell, Denis
AU  - O'Donnell D
AD  - Medical Pharmacies Group Limited, Markham, Canada.
FAU - McCarthy, Lisa
AU  - McCarthy L
AD  - Women's College Research Institute, Women's College Hospital, Toronto, Canada.
FAU - Dolovich, Lisa
AU  - Dolovich L
AD  - Department of Family Medicine, McMaster University, Hamilton, Canada.
FAU - Black, Cody
AU  - Black C
AD  - Bruyere Research Institute, Ottawa, Canada.
FAU - Farrell, Barbara
AU  - Farrell B
AD  - Bruyere Research Institute, Ottawa, Canada.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160608
PL  - United States
TA  - J Am Med Dir Assoc
JT  - Journal of the American Medical Directors Association
JID - 100893243
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - *Drug Costs
MH  - Female
MH  - *Guidelines as Topic
MH  - Homes for the Aged
MH  - Humans
MH  - Inappropriate Prescribing/*prevention & control
MH  - Long-Term Care
MH  - Male
MH  - Ontario
MH  - *Practice Patterns, Physicians'
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Deprescribing
OT  - homes for the aged
OT  - inappropriate prescribing
OT  - long-term care
OT  - proton pump inhibitors
EDAT- 2016/06/13 06:00
MHDA- 2017/11/29 06:00
CRDT- 2016/06/13 06:00
PHST- 2016/04/19 00:00 [received]
PHST- 2016/04/21 00:00 [revised]
PHST- 2016/04/21 00:00 [accepted]
PHST- 2016/06/13 06:00 [entrez]
PHST- 2016/06/13 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
AID - S1525-8610(16)30114-1 [pii]
AID - 10.1016/j.jamda.2016.04.020 [doi]
PST - ppublish
SO  - J Am Med Dir Assoc. 2016 Jul 1;17(7):673.e1-4. doi: 10.1016/j.jamda.2016.04.020. 
      Epub 2016 Jun 8.