These resources were designed for doctors, pharmacists and nurses in order to foster communication and collaboration to improve their patients’ medication use.

 

Deprescribing PPIs FAQ

This FAQ provides information on deprescribing proton-pump inhibitors (PPIs), as well as an overview of tools and resources available to facilitate safe and effective evidence-based deprescribing.


Pharmaceutical opinions

Do you think your patient could benefit from stopping their PPI? Not sure how to recommend deprescribing a PPI? This fillable form was created to help pharmacists advise the patient’s physician or nurse about safer medication use, and facilitate the conversation.






Patient brochures

Pharmaceutical opinions coupled with patient education brochures can help seniors safely deprescribe potentially harmful medications.

Check out this infographic summarizing the recent research. Over 40% of patients stopped potentially harmful medications following a combined approach involving the pharmacist and prescriber.




Deprescribing algorithms

Decisions around deprescribing can be very difficult. Few evidence-based guidelines exist to support safe deprescribing for specific classes of medication.

Researchers from the Bruyère Research Institute and the Ontario Pharmacy Research Collaboration developed evidence-based guidelines and algorithms to support safe and effective deprescribing.

Click below to access the Bruyère Research Institute proton-pump clinical practice guideline, deprescribing algorithm, and patient information resources:


Whiteboard video about deprescribing PPIs

The Canadian Deprescribing Network have created two brief, fun and informative whiteboard videos about deprescribing sedative-hypnotics and proton pump inhibitors. Each video runs for approximately 3 minutes and provides an overview of deprescribing, highlighting some useful evidence based resources for both prescribers and patients.

We need your help in evaluating how effective each of these videos are. To do this, you will be asked a series of questions before and after each video. Answers to the questions are provided in each video. Check out the short survey and video here.


Medication Therapy Services Clinic

If you are unsure whether deprescribing is an option for your patient or feel your patient would benefit from a more comprehensive medication assessment, the pharmacists at the Medication Therapy Services Clinic, or MTS Clinic, can help. The MTS Clinic is a “pharmacist-clinic” run by the School of Pharmacy at Memorial University. The clinic can provide a “deep dive” look into the reasons for medication use and provide tailored deprescribing recommendations for patients with more complex medication needs. They work with patients, their doctors/nurse practitioners and community pharmacists to ensure everyone is working from a shared care plan to support optimal medication use and health outcomes.


Choosing Wisely Canada toolkit on the appropriate use of PPIs

Bye-Bye, PPI
Proton pump inhibitors (PPIs) are often used inappropriately, without an indication, or for longer durations than recommended. This toolkit was created to support the implementation of interventions to reduce long-term prescription of PPIs where an indication is lacking. It can be used by physicians in community practice or by long-term care organizations to help achieve improvements in patient safety related to over-prescribing.


Memorial University podcast on proton-pump inhibitors

MUN Med Thread 6 - Proton Pump Inhibitors: The Lowdown on Stomach Acid

Listen to Dr. Justin Turner (Canadian Deprescribing Network and SaferMedsNL) discuss the safe use of proton pump inhibitors (PPIs) with Dr. Cathy Balsom (Clinical Pharmacist at the MTS Clinic) and Mike Chong (Drug Information Pharmacist at the School of Pharmacy).


Other deprescribing resources

 

Infographic summarizing the benefits of pharmacists and prescribers working together to deprescribe

Did you know that patient brochures coupled with pharmaceutical opinions helped seniors safely deprescribe a number of medications? Check out this infographic summarizing the study.


Postcard for health care professionals

(Click to enlarge or download, and see reverse side; size is 5 x 7 in)


Deprescribing fact sheet for health care professionals

  • How many seniors are on inappropriate medications?

  • How much do risky medications increase health care costs?

  • Who is more at risk: women or men?

For answers to these questions and more interesting facts, download these deprescribing infographics


MedStopper

Medstopper is a deprescribing web-based tool developed by a team of health professionals to help doctors and their patients look at a list of medications to decide if some should be stopped or changed. 

Beers Criteria

The 2015 Beers List of potentially inappropriate medications for older adults is one of the most frequently cited reference tools in the field of geriatrics. Click here for the printable Beers Criteria pocket guide.

STOPP/START Criteria

The STOPP/START Criteria helps clinicians screen older people's prescriptions and right treatment criteria. 

Additional reading

Abramowitz J, Thakkar P, Isa A, Truong A, Park C, Rosenfeld RM. Adverse Event Reporting for Proton Pump Inhibitor Therapy: An Overview of Systematic Reviews. Otolaryngol Head Neck Surg. 2016;155(4):547-554.

Benmassaoud A, McDonald EG, Lee TC. Potential harms of proton pump inhibitor therapy: rare adverse effects of commonly used drugs. CMAJ. 2015.

Canadian Association of Gastroenterology recommendation, 2017. Available: www.choosingwiselycanada.org/gastroenterology

Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, Rojas-Fernandez C, Walsh K, Welch V, Moayyedi P. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354-364.   

Juul-Hansen, P. and Rydning, A. (2011). Clinical and pathophysiological consequences of on-demand treatment with PPI in endoscopy-negative reflux disease. Is rebound hypersecretion of acid a problem? Scand J Gastroenterol 46(4): 398-405. 

Niklasson, A., Lindstrom, L., Simren, M., et al. (2010). Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am J Gastroenterol 105(7): 1531-1537.

Reimer, C., Sondergaard, B., Hilsted, L., et al. (2009). Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 137(1): 80-87, 87 e81.

Schoenfeld AJ, Grady D. Adverse Effects Associated With Proton Pump Inhibitors. JAMA Intern Med. 2016:1-3.