Outcomes of a decision support prompt in community pharmacy-dispensing software to promote step-down of proton pump inhibitor therapy

Authors

  • Colin Curtain,

    1. Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
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  • Gregory M. Peterson,

    1. Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
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  • Peter Tenni,

    1. Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
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  • Ivan K. Bindoff,

    1. Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
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  • Mackenzie Williams

    1. Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
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Mr Colin Curtain BPharm MPS, Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia.
Tel.: + 61 3 6226 2190
Fax: + 61 3 6226 2870
E-mail: colin.curtain@utas.edu.au

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Computerized clinical decision support has been increasingly utilized in hospital and general-practice settings where it may improve prescribing practice. Little investigation has been undertaken using computerized decision support in the community pharmacy setting. Proton pump inhibitors are expensive and often prescribed in dosages above recommended guidelines.

WHAT THIS STUDY ADDS

• This study adds justification for the use of computerized decision support in community pharmacy. It highlights the promotion of improved prescribing of proton pump inhibitors through patient empowerment.

AIM To evaluate the effect of a computerized decision support prompt regarding high-dose proton pump inhibitor (PPI) therapy on prescribing and medication costs.

METHODS A prompt activated on dispensing high-dose esomeprazole or pantoprazole was implemented in 73 of 185 pharmacies. Anonymized prescription data and a patient survey were used to determine changes in prescribing and associated medication costs.

RESULTS The pharmacist-recorded PPI intervention rate per 100 high-dose PPI prescriptions was 1.67 for the PPI prompt group and 0.17 for the control group (P < 0.001). During the first 28 days of the trial, 196 interventions resulted in 34 instances of PPI step-down, with 28 of these occurring in PPI prompt pharmacies. Cost savings attributable to the prompt were AUD 7.98 (£4.95) per month per PPI prompt pharmacy compared with AUD 1.05 (£0.65) per control pharmacy.

CONCLUSION The use of electronic decision support prompts in community pharmacy practice can promote the quality use of medicines.

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