Development and Implementation of a Pharmacist-Led Proton Pump Inhibitor Deprescribing Algorithm in a Geriatric Ambulatory Office

Abstract

Background The American Geriatrics Society 2019 Updated Beers Criteria© recommends avoiding scheduled use of proton pump inhibitors (PPIs) for greater than eight weeks in older people because of potential risk of bone loss and fractures and Clostridioides difficile infection. There are limited studies evaluating the effectiveness of deprescribing PPIs in this patient population. Objective The purpose of this study was to evaluate the implementation of a PPI deprescribing algorithm in a geriatric ambulatory office on the appropriateness of PPI use in older people. Methods This single-center study evaluated PPI use in a geriatric ambulatory office pre- and post-implementation of a deprescribing algorithm. Participants included all patients 65 years of age or older and a documented PPI on their home medication list. The PPI deprescribing algorithm was developed by the pharmacist using components of the published guideline. The primary outcome was the percentage of patients on a PPI with a potentially inappropriate indication before and after implementation of this deprescribing algorithm. Results At baseline, 228 patients were treated with a PPI, and 64.5% (n = 147) of patients were treated for a potentially inappropriate indication. Of the 228 patients, 147 patients were included in the primary analysis. Potentially inappropriate use of PPI significantly decreased after implementation of a deprescribing algorithm from 83.7% to 44.2% in the cohort of patients who were eligible for deprescribing (difference 39.5%; P < 0.0001). Conclusion Potentially inappropriate PPI use in older adults decreased after implementation of a pharmacist-led deprescribing initiative, supporting the role of pharmacists on interdisciplinary deprescribing teams.