TI Best Evidence Webinar
“We” Should Really Stop that PPI, eh?
PRESENTER: Dr. Carolyn Bubbar & Hafeez Dossa
DATE: Wednesday, September 16, 2020, 12 noon – 13:15
CME CREDITS: MainPro+/MOC Section 1 credits: 1.0. You must register, attend the webinar and complete the evaluation in order to receive your certificate.
Learning objectives: by the end of this session, participants should be able to learn how to overcome barriers, such as time to:
- Review a patient’s PPI use
- Communicate with prescribers a recommendation to continue, adjust, or stop medication
- Empower care staff to monitor and adjust the plan
Speaker Biographies:
Dr Carolyn Bubbar completed her undergraduate degree in Pharmacy at the University of Saskatchewan and then a hospital pharmacy residency with the Saskatoon Health Region in 2000. She worked as a hospital pharmacist in various clinical areas for several years before moving to Toronto to complete their post-graduate PharmD degree in 2006. Since then she has moved across the country with her husband and 2 kids and made a home in the White Rock area. She works at Peace Arch Hospital in White Rock as a Clinical Pharmacy Specialist in Geriatrics focused primarily on the inpatient ACE Unit (Acute Care for Elderly). She also attends weekly care conferences in the Long-Term Care Facility associated with the hospital. She has a clinical teaching role precepting both UBC pharmacy students and hospital pharmacy residents.
Hafeez Dossa is a Pharmacy Manager with Care Rx in Nanaimo, a pharmacy that services long term care and assisted living facilities across Vancouver Island. He completed his education first at SFU, where he received a B.Sc in Biomedical Physiology, and followed this with a B.Sc in Pharmacy at UBC. After traveling to Australia and New Zealand following the completion of his pharmacy degree (Skydiving over Abel Tasman National Park and Heli-Hiking the Franz Jozef Glacier were the highlights), he began his role with Care Rx.
In this practice setting, Hafeez has found many opportunities to optimize medication management, as polypharmacy is essentially a given for patients upon admission (it’s rare to see a patient taking less than 8 medications when admitted). Using his passion for reducing the use of unnecessary medications, Hafeez has, though meaningful medication reviews and care conferences, achieved significant reductions in various drug classes including antipsychotics, antihypertensives, dementia medications, and most recently, proton pump inhibitors.
RESOURCES:
Choosing Wisely Canada
- Bye Bye PPI Toolkit (https://choosingwiselycanada.org/perspective/ppi-toolkit/)
- Pharmacist recommendations, including “Don’t renew long-term proton pump inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop or reduce (taper) therapy at least once per year for most patients.” (https://choosingwiselycanada.org/pharmacist/)
- Gastroenterology recommendations “Don’t maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients.”
Canadian Deprescribing Network (CaDeN)
- Do I still need this medication? PPI Handout for patients (http://www.criugm.qc.ca/fichier/pdf/PPI-EN-Men.pdf)
Deprescrbing.org
- PPI Deprescribing Algorithm (https://deprescribing.org/wp-content/uploads/2018/08/ppi-deprescribing-algorithm_2018_En.pdf)
- Corresponding guideline https://www.cfp.ca/content/63/5/354
More information about PPIs in TI Letters:
[99] Comparative effectiveness of proton pump inhibitors
[111] Deprescribing Proton Pump Inhibitors
[118] Trends in utilization of proton pump inhibitors in British Columbia
[126] Serious harms with long-term PPI use in older adults
Sample PPI Deprescribing Letter (Courtesy of Hafeez Dossa)
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