The Impact of Pharmacist Interventions on the Inappropriate Use of Acid-Suppression Therapy

OBJECTIVE The inappropriate use of acid-suppression therapy (AST) in non-intensive care unit patients contributes to inappropriate polypharmacy, drug interactions, community- and hospital-acquired pneumonia, and increased health care expenditures for institutions and individuals. The purpose of this study was to determine whether clinical pharmacist interventions significantly decreased the rate of inappropriately used AST. DESIGN A single group, pre-test post-test. SETTING The Geriatric Evaluation and Management unit in the St. Louis Veterans Affairs Medical Center. PATIENTS All patients admitted between July 1, 2006, through April 30, 2007 (control group), and May 1, 2007, through February 28, 2008 (PharmD group), were evaluated. All patients with a minimum length of stay of seven days were eligible for inclusion. Data were obtained from the Computerized Patient Record System regarding the use of proton-pump inhibitors, histamine-2 receptor antagonists, sucralfate, and the indication for these therapies. INTERVENTIONS A clinical pharmacist was present during the weekly interdisciplinary team rounds to make recommendations in the intervention group, compared with a nonpharmacist control group. OUTCOME MEASURES The percent of patients on these therapies without an appropriate indication (International Classification of Diseases, 9th Revision) were identified from the chart review, and comparisons were made between the control and PharmD groups. RESULTS A total of 142 and 151 patients were admitted during the control and PharmD arms, respectively. Of these patients, 117 in each group were eligible for inclusion in the analysis. The primary outcome, the number of patients receiving AST prior to discharge without an appropriate indication, occurred 46.2% (54/117) versus 23.9% (28/117) (P = 0.001) in the control and PharmD groups, respectively. CONCLUSIONS This study examined the impact of pharmacists' active participation in interdisciplinary team rounds compared with a nonpharmacist control group. These results demonstrate pharmacist participation associated with potential cost savings and improved patient care.