Reeve E, Andrews J, Wiese M, et al. Feasibility of a Patient-Centered Deprescribing Process to Reduce Inappropriate Use of Proton Pump Inhibitors. Annals of Pharmacotherapy 2015;49(1):29-38
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/25385826
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 6 enrolled, 6 completed
Age: 70 ± 14 years Sex: 2 female, 4 male Participants with dementia: No Inclusion criteria: · Current prescription for a proton pump inhibitor (regardless of indication, dose, frequency, and duration of use) Exclusion criteria: · Documented clinically significant dementia without a carer present · Insufficient English language skills without a translator present · Age less than 18 years Concomitant medicines: 14 ± 6 medicines Country: Australia Setting: Community – “outpatients attending the Multidisciplinary Ambulatory Consulting Service (MACS) at three different sites across South Australia (Royal Adelaide Hospital, Elizabeth General Practice Plus and |
| Interventions | Medicine: Proton pump inhibitors
Withdrawal schedule: “Halving the dose every two weeks and reduction to as-needed use if the participant remained symptom-free on the low-dose.” |
| Outcomes | Proton pump inhibitor use
Adverse drug withdrawal effects |
| Dates | Dates: June 2012 to June 2013
Follow-up duration: Six months |
| Funding sources | The author(s) received no financial support for the research, authorship, and/or publication of this article. |
| Notes | “The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ER is a recipient of an Australian Postgraduate Award Ph.D.scholarship during which time this research was conducted. All other authors declare no support from any organization for the submitted work. ER has served as a speaker for Australian Association of Consultant Pharmacists and has received research funding from the Society of Hospital Pharmacists Australia Celegene Information Technology in Hospital grant for an unrelated study. JMA has delivered paid medical education lectures for AstraZeneca and Nycomed.” |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Not a randomized study |
| Allocation concealment (selection bias) | High risk | No concurrent control group – not concealed |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Open study |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | Open study |
| Incomplete outcome data (attrition bias) | 1 out of 5 | The data for all participants is reported. |
| Selective reporting (reporting bias) | 1 out of 5 | There was no prior protocol published, but the methods match the results. Specific outcome measures not in method. |
| Confounding (non-randomized) | 5 out of 5 | There is no control group as it is a before-and-after study. |
| Other bias | Low risk | |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of the average older adults attending a specialized clinic |
| Selection of the non-exposed cohort | No concurrent control group
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| Ascertainment of exposure | Ascertainment of exposure: structured interview
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| Demonstration that outcome of interest was not present at start of study | Demonstrated that outcome of interest was not present at start of study | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controlled for proton pump withdrawal |
| Outcome bias | Assessment of outcome | Assessment of outcome: self-control |
| Was follow-up long enough for outcomes to occur
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Follow-up was long enough for outcomes to occur
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| Adequacy of follow-up of cohorts | Complete follow-up – all subjects accounted for | |
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