Authors (including presenting author) :
TANG HY(1)(2), LAU WM(1), CHEUNG LP(1), SIT WY(1), ZHOU R(2), LAU ST(3)
Affiliation :
(1) Pharmacy Department, Our Lady of Maryknoll Hospital, Hong Kong
(2) School of Pharmacy, The Chinese University of Hong Kong, Hong Kong
(3) Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Hong Kong
Introduction :
Proton pump inhibitor (PPI) is commonly prescribed to geriatric patients for antiplatelet gastroprotection. Long-term PPI therapy is however associated with potential increased risk of adverse effects such as osteoporosis-related fracture as indicated in the U.S. Food and Drug Administration safety warnings. Appropriate PPI use can reduce such risk of adverse effects.
Objectives :
This study aimed to evaluate the impact of pharmacist intervention through electronic reminders on de-prescribing PPI for antiplatelet gastroprotection in an outpatient elderly population.
Methodology :
The study population was elderly patients aged ≥60 years who had follow-up at geriatric specialist outpatient clinic of Our Lady of Maryknoll Hospital (OLMH) between 1 May 2019 and 31 July 2019 and on PPI for antiplatelet gastroprotection. Pharmacists performed case review according to guideline-defined criteria and sent electronic reminders to physicians on de-prescribing PPI via Clinical Management System at OLMH outpatient setting. This study primarily evaluated the prescribing appropriateness of PPI for antiplatelet gastroprotection before and after pharmacist intervention via electronic reminders. The secondary outcome was the acceptance rate of the pharmacist intervention.
Result & Outcome :
Sixty patients aged on average 86.1 ± 6.5 years were included in this study via random sampling. The mean duration of PPI use was 50.7 ± 34 months. Before pharmacist intervention, only 34 out of 60 (57%) patients were prescribed with PPI appropriately for antiplatelet gastroprotection. After intervention via electronic reminders, clinical pharmacists could improve PPI prescribing appropriateness for antiplatelet gastroprotection by 22% (95% CI: 11%-32%, p = 0.0002). The result was comparable to a similar Canadian study applying electronic reminders in the setting of a family health team, which resulted in de-prescribing of chronic PPI in 26% of patients. Among the 26 electronic reminders sent, 12 (46 %) were accepted by physicians. To conclude, clinical pharmacist intervention by electronic reminders on PPI de-prescribing could effectively improve prescribing appropriateness of PPI for antiplatelet gastroprotection in elderly outpatients. Electronic reminder was an efficient and flexible tool to assist clinical intervention at outpatient setting.
