Clinical Pharmacists Can Identify PPI Misuse

Drug-related problems such as overdose and drug-drug interactions frequently occur in patient populations at risk for polymorbidity and polypharmacy. Among these problems is proton pump inhibitor (PPI) misuse.

Although research on inappropriate drug use is regularly conducted in the elderly, one recent study found that drug-related problems commonly occur in patients admitted to general internal medicine wards, as well.

This prospective, interventional study was conducted in 2 internal medicine wards at a 2000-bed university health center in Switzerland.

In the study, a clinical pharmacist and pharmacologist (physician specializing in clinical pharmacology and internal medicine) attended physician rounds on a weekly basis to discuss drug-related problems with 22 prescribers managing 145 patients.

A total of 383 drug-related problems were identified, an average of 2.7 per patient. The most frequently recorded issues were drug interactions (21%), untreated indications (18%), overdosages (16%), and drugs used without a valid indication (10%).

Most overdosages were associated with PPIs, particularly esomeprazole. Pharmacists also frequently found PPIs to have no valid indication, which aligned with previous research suggesting up to 70% of all PPI prescriptions lack appropriate medical indications.

Of the 161 verbal suggestions offered by the pharmacist and pharmacologist during the rounds, prescribers accepted 84% with high satisfaction. A common suggestion was to reduce or stop PPI use.

The study authors concluded that input from a clinical pharmacist can make a notable impact on reducing drug-related problems.

Because of the modest allocation of pharmacists in Swiss hospitals, these research findings are more applicable to US hospitals where pharmacists are more readily available.

Further studies isolating drug-related problems involving PPI use are necessary.

The current study titled “Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist” was published in the European Journal of Internal Medicine.