Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program

Impact of Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program on Hospitalized Older Patients: A Non-Randomized Controlled Study

To evaluate the impact of clinical pharmacist-led appropriate acid suppression therapy stewardship program in hospitalized older patients.

This prospective, nonrandomized controlled study was conducted in older patients who ordered proton pump inhibitor (PPI) at admission in an internal medicine service of tertiary training and research hospital. In the intervention group, clinical pharmacist-led services (including medication reconciliation and medication review) were conducted during hospitalization and at discharge by using the guidelines and potentially inappropriate medications (PIM) criteria [American Geriatric Society-AGS Beers Criteria©, 2019]. Medication Appropriateness Index (MAI), inappropriate PPI cost, and hospitalization for gastrointestinal bleeding within 1 year after discharge were calculated in both groups

Inclusion Criteria:

• 65 years old or greater
• Admitted to the hospital with any reason
• Ordered at least one PPI dose within 48 hours of admission

Exclusion Criteria:

• Transferred to another ward (including an intensive care unit)
• Having active gastrointestinal bleeding
• Having active malignity