Continuation or deprescribing of proton pump inhibitors: A consult patient decision aid
Introduction Many patients continue on long term proton pump inhibitor (PPI) therapy unnecessarily. Evidence based guidance suggests attempting to reduce or stop PPIs in patients whose symptoms abate and have no indication for long term use. Patients may therefore be faced with the decision to continue or reduce PPI use. Deprescribing is the planned, supervised dose reduction or stopping of a medication (for PPIs: lower dose or use "on demand" [as needed] Patients are generally open to discussing ongoing PPI use; however, the decision to continue or reduce PPI use depends on preferences and values. Patients would like to be part of such discussions and planning surrounding ongoing PPI use. Thus, a structured tool to guide such a discussion would be helpful in clinical practice. Patient decision aids (PtDAs) are tools that facilitate shared decision making between patients and clinicians. They educate patients on the decision being made, as well as the benefits and harms of treatment options, and allow patients to clarify which outcomes matter most to them, thereby incorporating values and preferences into decisions. Traditional PtDAs are typically reviewed by a patient on their own prior to a consultation with a health care provider. Consult PtDAs are specifically designed to be used during a health care visit, where the patient and health care provider would go through the consult PtDA together. Consult PtDAs may be preferred over traditional PtDAs because they encourage discussion and decision making in real time. Pharmacists are accessible drug therapy experts and are well suited to have discussions surrounding ongoing medication use with patients. The aim of our study was to develop and pilot test a consult PtDA aimed at continuation or deprescribing of PPIs.
Canadian pharmacists journal CPJ Revue des pharmaciens du Canada RPC