Wong Su Li, Sulaiman Norharlina, Ng Kar Mun, Lee Zhe Yen
Bachelor of Degree (Honours), Pharmacy (UCSI University) Department of Pharmacy, Pejabat Kesihatan Daerah Klang, Klang Selangor Darul Ehsan, Malaysia, Email:
Master in Pharmacy Practice (UiTM Shah Alam), Bachelor of Degree Pharmacy (University Malaya), Department of Pharmacy, Pejabat Kesihatan Daerah Klang, Klang Selangor Darul Ehsan, Malaysia.
Malays Fam Physician. 2021 Oct 3;16(3):87-96. doi: 10.51866/oa1153. eCollection 2021 Nov 30.
In the primary care setting, proton pump inhibitor (PPI) overutilisation often stems from the failure to discontinue prophylaxis treatment prior to tertiary care discharge and consider step-down therapy following discharge. Long-term PPI use can result in potential drug-related problems and unnecessary drug expenditure. This study aimed to evaluate the effectiveness of pharmacist-structured review in reducing inappropriate PPI prescriptions and estimate the potential cost saving.
This non-randomised controlled study was conducted for 16 weeks at 17 government health clinics in Selangor, Malaysia. Eligible patients attending the outpatient pharmacies of intervention clinics were recruited consecutively and their consent was obtained. A structured review of PPIs was performed in which pharmacists identified patient demographics, indications and the length of PPI therapy using a PPI intervention form. Recommendations were discussed with physicians before prescription changes were made and documented. Moreover, standard management was conducted in the control clinics.
A total of 568 patients with prescriptions containing PPIs were sampled, with a total of 284 patients being placed into the control and intervention groups, respectively. Compared to the control group, inappropriate PPI utilisation in the intervention group significantly decreased from 79.9 to 30.4% (p<0.05). The changes to PPI prescriptions observed in the intervention group included: stop PPI therapy (30.8%), step-down therapy (22.9%), start substitution therapy (15.9%) and no change (30.4%). The physicians' acceptance rate for pharmacist intervention was 67.8%. A 66.1% reduction in monthly PPI pill count and a 72.0% reduction in monthly medication expenditure (RM44.85/patient/year) were observed.
The pharmacist-structured review was effective in increasing appropriate PPI utilisation and led to substantial cost savings.
在基层医疗环境中，质子泵抑制剂（PPI）的过度使用往往源于在三级医疗出院前未停止预防性治疗，以及出院后未考虑逐步降级治疗。长期使用PPI可能导致潜在的药物相关问题和不必要的药物支出。本研究旨在评估药师结构化审查在减少不适当PPI处方方面的有效性，并估算潜在的成本节约。
这项非随机对照研究在马来西亚雪兰莪州的17家政府健康诊所进行了16周。连续招募干预诊所门诊药房符合条件的患者并获得其同意。对PPI进行结构化审查，药师使用PPI干预表格确定患者的人口统计学信息、用药指征和PPI治疗时长。在更改处方之前，与医生讨论建议并记录下来。此外，对照诊所进行标准管理。
共抽取了568例开具含PPI处方的患者，分别将284例患者纳入对照组和干预组。与对照组相比，干预组中不适当的PPI使用从79.9%显著降至30.4%（p<0.05）。干预组中观察到的PPI处方变化包括：停止PPI治疗（30.8%）、逐步降级治疗（22.9%）、开始替代治疗（15.9%）和无变化（30.4%）。医生对药师干预的接受率为67.8%。观察到每月PPI药片数量减少66.1%，每月药物支出减少72.0%（44.85林吉特/患者/年）。
药师结构化审查有效地提高了PPI的合理使用，并带来了可观的成本节约。
