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2022-10-25
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Copyright (c) 2022 Sonia Bhardwaj, Stephanie Garvin, Sierra Kuehl, Johanna Van Epps, Frederick Dunkerson, Molly Lehmann, Stephanie Gruber, Mara Kieser, Qianqian Zhao, Edward Christopher Portillo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
Incorporation of Student Pharmacists into a Proton Pump Inhibitor Deprescribing Telehealth Program for Rural Veterans
Sonia Bhardwaj
University of Wisconsin-Madison School of Pharmacy
Stephanie Garvin
University of Wisconsin-Madison School of Pharmacy
Sierra Kuehl
University of Wisconsin-Madison School of Pharmacy
Johanna Van Epps
University of Wisconsin-Madison School of Pharmacy
Frederick Dunkerson
William S. Middleton Memorial Veterans Hospital, Madison, WI
Molly Lehmann
William S. Middleton Memorial Veterans Hospital, Madison, WI
Stephanie Gruber
William S. Middleton Memorial Veterans Hospital, Madison, WI
Mara Kieser
University of Wisconsin-Madison School of Pharmacy
Qianqian Zhao
University of Wisconsin-Madison School of Pharmacy
Edward Christopher Portillo
University of Wisconsin-Madison School of Pharmacy
DOI: https://doi.org/10.24926/iip.v13i3.4500
Keywords: student pharmacist, proton pump inhibitors, deprescribing, telehealth, rural Veterans
Abstract
Background: Proton pump inhibitors (PPIs) are among the most widely prescribed class of medications in the United States. Although effective in the treatment of acid related disease, inappropriate PPI use is prevalent, and long-term PPI use has been associated with adverse effects.
Objectives: This evaluation explores the novelty of a student-pharmacist directed PPI deprescribing telehealth program with the goals of (1) determining whether PPIs are appropriately prescribed in Veterans via remote student-led chart reviews, (2) identifying if a gap exists between urban and rural Veterans prescribed a PPI, and (3) assessing the feasibility of integrating student pharmacists into the PPI deprescribing process utilizing telehealth visits through a pilot study.
Methods: Student pharmacists evaluated PPI appropriateness in Veterans at the William S. Middleton Veterans Hospital. Students collected data via remote chart reviews, compared appropriateness of PPI therapy in rural versus urban Veterans, and conducted a deprescribing pilot call study in rural Veterans with inappropriate PPI indications. Clinical decision-making was agreed upon in collaboration with pharmacist preceptors, however all means of communication with Veterans was performed by student pharmacists.
Results: 51% of Veterans were found to have an inappropriate indication for their PPI, though comparison of inappropriate PPI use in rural versus urban Veterans was not statistically significant (n=170, p-value 0.34). 83% of Veterans agreed to proceed with PPI deprescribing and 71% of Veterans ended the pilot study with at least some degree of PPI dose reduction (n=33).
Conclusion: Inappropriate PPI use among rural and urban Veterans is prevalent, however a significant difference was not observed between the two cohorts. Student pharmacists are capable of successful telehealth deprescribing interventions in collaboration with pharmacists.
