(P21) Deprescribing Proton Pump Inhibitors at Transition of Care: Optimal Practices

Objective/Aim: To evaluate the impact of a unified medical oversight model on the deprescription rates of PPIs among patients aged 65+ discharged to two post-acute care facilities (PACs) in northern NJ. Patients discharged to PAC-A, with a single medical director overseeing admission medication review, were hypothesized to experience higher deprescription rates compared to PAC-B, where the attending physician or an on-call provider manages admission medication review.

Background: Proton pump inhibitors (PPIs) are commonly prescribed for stress ulcer prophylaxis during ICU and hospital stays in geriatric patients. Prolonged PPI use is associated with adverse outcomes such as chronic kidney disease, infections, and fractures. The Choosing Wisely campaign emphasizes deprescribing prophylactic PPIs during transitions to post-acute and long-term care (PALTC) settings, especially as Medicare initiatives focus on minimizing unnecessary medication use in these environments. This study hypothesizes that deprescribing PPIs is more effective in post- acute care (PAC) facilities where a single physician oversees medication reconciliation for all admissions.

Quality Improvement Methods: A retrospective review was conducted on admissions from April 1 to September 30, 2024, at two PACs in northern NJ (PAC-A and PAC-B) from a single area hospital. All patients discharged from the hospital on a PPI were included, regardless of admission diagnosis. Data from hospital discharge medication lists, PAC admission reconciliations, and ongoing PPI prescriptions were analyzed through chart reviews and pharmacy records. PAC-A utilized a single medical director for all admission medication review, while PAC-B relied on the attending physician of record and on a pool of after-hours coverage providers. Deprescribing patterns at both PACs were compared.

Results : A total of 89 admissions to the PAC facilities met the inclusion criteria. Out of these 17 were at PAC-A and 72 were at PAC-B. PAC-A with a single physician (medical director) performing admission medication review had a PPI description rate of 47.6%. PAC-B with usual care had a PPI deprescribing rate of 27.8%. Findings indicate that PAC-A, with a dedicated medical director overseeing medications, had a significantly higher rate of PPI deprescription.

Conclusions: A centralized medical oversight model for admission medication reviews in PALTCs may enhance deprescription of unnecessary PPIs. This approach has potential for broader application across medication classes and facilities. Further research is needed to confirm the generalizability and effectiveness of this strategy in other PALTC settings.