Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program

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

Detailed Description
-----------------
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

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

Conditions
-----------------
Geriatric

Intervention / Treatment
-----------------
* Other: Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 65 Years
Maximum Age: 95 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Clinical pharmacist-led services<br>Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program | Other: Clinical Pharmacist-led Appropriate Acid Suppression Therapy Stewardship Program<br>* Clinical pharmacist provided medication reconciliation and medication review during the hospital stay.<br>|
| No Intervention: Control group<br>Usual care | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Appropriateness of Proton Pump Inhibitors Usage | The rate of appropriateness use of proton pump inhibitors based on the guidelines at hospital stay | during hospital stay, an average of 14 days | 
| Potentially Inappropriate Proton Pump Inhibitors Usage | The rate of potentially inappropriate use of proton pump inhibitors based on American Geriatric Society Beers Criteria© 2019 | at discharge, an average of 14 days after admission to hospital | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical outcome | The number of patients who hospitalized for bleeding within 1 year after discharge | 1 year | 
| Cost saving during hospital stay | Medication cost for inappropriate PPI during hospital study | during hospital stay, an average of 14 days | 
| Medication Appropriateness Index for Proton Pump Inhibitors at hospital stay | Medication Appropriateness Index (MAI); included 10 items. Each item was weighted from 1-3. The highest score per medication was 18. Higher scores of this index represent more inappropriateness of each medication. | during hospital stay, an average of 14 days | 
| Cost saving after discharge | Medication cost for potentially inappropriate PPI after discharge | a month | 
| Medication Appropriateness Index for Proton Pump Inhibitors at discharge | Medication Appropriateness Index (MAI); included 10 items. Each item was weighted from 1-3. The highest score per medication was 18. Higher scores of this index represent more inappropriateness of each medication. | at discharge, an average of 14 days after admission to hospital |