Pharmacist-led educational intervention for rational prescribing and deprescribing of proton pump inhibitors in cancer patients: A quasi-experimental study from Pakistan
Haider Hikman, Muhammad Junaid Hassan Sharif, Qasim Khan, Omar Akhlaq Bhutta, Ghulam Mujtaba, Sajjad Ullah, Muhammad AshfaqPurpose
Proton pump inhibitors (PPIs) are often overprescribed in cancer care, leading to unnecessary side effects and increasing healthcare costs. Pharmacists can optimize and improve the rational prescribing of PPIs particularly in low/middle income countries, where such data is limited. We aimed to evaluate how a pharmacist-led education program affects PPIs rational prescribing and deprescribing in cancer patients through adhering to American Gastroenterological Association (AGA) guidelines, documentation of indication, and reducing costs.
Methods
This quasi-experimental study was conducted at a tertiary care cancer hospital in Peshawar, Pakistan from November 2024 to January 2025. Intervention included physician education via CME sessions and weekly AGA guidelines pamphlet. Data related to patient age, type of cancer, PPI prescriptions, indications for use, documentation, other co-prescribed medicines, and costs were collected. Outcomes included guidelines adherence in terms of changes in PPI prescribing, inappropriate PPI use, and the total costs of therapy.
Results
A total of 400 prescriptions (200 pre- and 200 -post intervention) were analyzed. Inappropriate use without proper indication decreased from 34.3% to 14%. Long-term use without a valid reason also declined from 7.3% to 1.8%. The average cost of treatment dropped from PKR 530 ± 428.6 to 336.4 ± 250.8, with p < 0.001. Significant improvements in adherence to multiple AGA Best Practice Advise (BPA) categories were observed, especially in deprescribing PPIs without definitive indications and step-down dosing. The documentation of indications for PPI use improved from 39.3% to 60.7%, with p < 0.001.
Conclusion
Pharmacist-led interventions greatly improved rational PPIs prescribing, enhanced documentation, reduced inappropriate PPI use, and reduced therapy costs in cancer patients. These results support the pharmacist's integration into oncology healthcare team to improve medicine safety, rational use and resource utilization.