Authors: (including presenting author): :
Yam KK(1), Chan TC(1)
Affiliation: :
Department of medicine, TWGHs Fung Yiu King hospital, HK.
Keyword 1: :
proton pump inhibitor
Keyword 2: :
lansoprazole
Keyword 3: :
RCHE resident
Keyword 4: :
multidisciplinary
Keyword 5: :
cost effectiveness
Introduction: :
A substantial proportion of residents in Residential Care Homes for the Elderly (RCHE) are prescribed proton pump inhibitors (PPIs) for various clinical indications. Within the Hong Kong West Cluster Community Geriatric Assessment Team (HKWC CGAT), lansoprazole is the most frequently prescribed PPI. The daily cost of lansoprazole is approximately six times higher than that of esomeprazole and eighteen times higher than that of pantoprazole. In 2025, the Hospital Authority Drug Management Committee of the HAHO conducted a comprehensive drug utilisation review of PPIs and recommended that switching to esomeprazole or pantoprazole, where clinically appropriate, would significantly improve cost-effectiveness.
Objectives: :
To optimize PPI therapy in RCHE residents under the care of the HKWC CGAT by switching from lansoprazole to esomeprazole or pantoprazole according to the policy of the HAHO.
Methodology: :
A standardised workflow for PPI switching was implemented, which involved a multidisciplinary collaboration between geriatricians, HKWC CGAT nurses and staffs, pharmacists of FYKH and staff-in-charge of the RCHE. From March to October 2025, a designated doctor reviewed the indications for ongoing PPI therapy during CGAT clinic visits using the standardized workfow. Lansoprazole was switched to either esomeprazole (when tablet crushing was required) or pantoprazole (when crushing was not required) in the absence of contraindications including significant drug-drug interactions (e.g., esomeprazole with clopidogrel). Patient's tolerance to the new PPI was subsequently assessed at follow-up.
Result & Outcome: :
KPI: The proportion of patients managed with the standardized workflow of PPI switching under a multidisciplinary team ; The proportion of patients underwent successful PPI switching; The proportion of patients with good tolerance to PPI switching; The monthly expenditure of PPI. About 3800 RCHE residents underwent screening. A total of 312 residents in 62 RCHEs receiving lansoprazole were reviewed and deemed to have an ongoing indication for PPI therapy, in which all of these patients were managed under the standardized workflow under a multidisciplinary team: 304 patients (97.4%) were successfully switched: 271 to esomeprazole and 33 to pantoprazole. Switching was not performed in 8 patients (2.6%) due to contraindications. All patients who underwent switching tolerated the new PPI well. There was no increase in hospital admissions for gastrointestinal bleeding during the observed period. The total monthly expenditure on PPIs was also reduced substantially.
