Effectiveness of a Collaborative Deprescribing Intervention of Proton Pump Inhibitors on Community-Dwelling Older Adults: The C-SENIoR Pragmatic Non-randomised Controlled Trial
Abstract
Background: Proton pump inhibitors (PPIs) are commonly used and often prescribed inappropriately, which increases the risk of adverse events. Deprescribing is a health professional-supervised intervention aimed at reducing or discontinuing medications that may cause harm or no longer provide benefits.
Objective: To evaluate the effectiveness of a collaborative intervention involving community pharmacists and general practitioners in deprescribing inappropriate PPIs (ATC/WHO A02BC) among community-dwelling older adults (aged ≥ 65 years).
Methods: This was a pragmatic, multicentre, non-randomised two-arm-controlled trial with 6-month follow-up in Portuguese primary care, involving community pharmacies and family health units (FHUs) to deprescribe long-term PPIs (> 8 weeks). The intervention comprised a pharmacy-based patient awareness and education approach, followed by a clinical assessment by general practitioners to assess inappropriate use and initiate the deprescribing process, along with pharmacy-based follow-up to monitor the withdrawal process. The comparator was usual care. The primary outcome was successful deprescribing, defined as the discontinuation or dose reduction of any PPI at 3 and 6 months. Secondary measurements included clinical and drug-specific outcomes. An intention-to-treat analysis was performed.
Results: The study included 166 patients (mean age 74.2 years (SD 6.0 years), 59.0% female) who had been using PPIs for an average of 10.6 years (SD 7.3…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 166 participants or records.
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