Authors: (including presenting author): :
Loo CW(1), Lai WYW(2), Ng MCS(2), Li WYE(2), Yau WYW(2), Ho CLJ(1), Lui RNS(1)
Affiliation: :
(1) Department of Medicine and Therapeutics, Prince of Wales Hospital
(2) Pharmacy Department, Prince of Wales Hospital
Keyword 1: :
proton pump inhibitor
Keyword 2: :
medication reconciliation
Keyword 3: :
deprescription
Introduction: :
Inappropriate proton pump inhibitor (PPI) prescribing is prevalent in hospitalized patients, exposing them to potential adverse effects and increasing healthcare costs. A targeted programme was implemented to optimize PPI use.
Objectives: :
To evaluate the efficacy and safety of a physician-pharmacist co-directed PPI stewardship programme.
Methodology: :
A pilot programme was conducted at Prince of Wales Hospital from April to September 2025. The program combined active inpatient screening and staff education. Pharmacists in four acute medical wards (2 gastroenterology, 2 geriatrics) manually screened patients on regular PPIs, assessing their indication and cost-effectiveness using a standardized form. Readmissions during the period were excluded. Inappropriate PPI prescription was defined as lacking a clear indication (based on professional guidelines) or using a cost-ineffective one. Written suggestions for de-escalation or switch would be provided for inappropriate PPI prescriptions. Patients were followed for 3 months via the clinical management system or censored at death. The primary outcomes were changes in PPI utilization and drug cost. Secondary outcomes included adherence to suggestions and the incidence of clinical events, including GI bleed, C. diff infection, and death. Department-wide education was also provided during department meeting and by putting up posters in clinical areas. Aggregated PPI prescription data during the programme were compared to a 6-month preceding baseline (September 2024 to February 2025).
Result & Outcome: :
Among 397 screened patients (mean age 78, 51.1% male), 38.0% (151/397) had inappropriate PPI prescriptions (124 unclear indication, 27 cost-ineffective). Adherence to pharmacist suggestions was 42.4% (64/151). At 3 months, patient-level PPI use dropped by 14% and daily drug cost reduced by 31.4%. Adherent patients showed no increased adverse events versus non-adherent ones: GI bleeding (1.5% vs 3.5%, p=0.42), C. diff infection (1.5% vs 1.2%, p=0.87), or death (23.1% vs 19.8%, p=0.62). At the department level, total inpatient PPI prescriptions decreased by 1.29% (86,068 vs 84,960), while total in-patient PPI drug cost reduced significantly by 44% ($120,158 vs $66,841) compared with baseline, driven primarily by reduced lansoprazole use. A physician-pharmacist co-directed stewardship programme, featuring active screening and education, safely reduced inappropriate PPI use and yielded substantial cost savings, demonstrating an effective model for drug therapy optimization.
