OBJECTIVES: This study aimed to evaluate the effectiveness of a pharmacist-led intervention in decreasing the overuse of stress ulcer prophylaxis (SUP) compared with the usual care for adult patients in Chinese ICUs.
DESIGN: Pragmatic, multicenter, stepped-wedge, cluster-randomized controlled trial.
SETTING: Twenty-six ICUs in China from October 2022 to March 2023.
PATIENTS: We enrolled 2199 patients 18 years old or older who were newly admitted to the participating ICUs.
INTERVENTIONS: Using the Medical Research Council framework for developing and evaluating complex intervention measures, a multidisciplinary team (Scenarios, Improving and Refining Interventions, Constructing, Refining and Testing Research Theories, Incorporating Stakeholders, Identifying Important Uncertainties, and Economics Considerations) designed a multifaceted intervention.
MEASUREMENTS AND MAIN RESULTS: The primary outcomes were the proportion of patients receiving SUP and that with overt gastrointestinal bleeding. We conducted intention-to-treat analyses using generalized linear mixed models to adjust for potential confounders (age, sex, and acute physiology and chronic health evaluation II score) with random effects for the site. The proportion of patients receiving SUP in the intervention group was lower than that in the control group (45.5% vs. 49.5%; odds ratio [OR], 0.81; 95% CI, 0.68-0.96; p = 0.017). The proportion of patients with overt gastrointestinal bleeding was similar (3.7% vs. 4.0%; OR, 1.05; 95% CI, 0.65-2.85; p = 0.81).
CONCLUSIONS: The pharmacist-led intervention reduced the proportion of patients receiving SUP in the ICUs, without significantly affecting the proportion of patients with overt gastrointestinal bleeding. These findings will help guide ICU medical decision-making.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Intensivist/Critical Care |
I would have liked a better explanation of the criteria the pharmacist used to decide for whom to recommend SUP.
This is an open clustered randomized study. The intervention was the presence of pharmacists with the ICU team to help with clinical decisions about prophylactic acid suppression therapy. The goal of the study was to show whether pharmacists can lower the rates of prophylactic acid suppression, mostly in low-risk patients for upper gastrointestinal bleed. The study indeed proved that the rates of acid suppression was lower with the presence of the ICU pharmacists, while the rate of UGIB did not differ. The study was well done and well structured and included 27 different ICUs. The limitation of this study was that it was an open study with the clinicians aware of the interventions. This awareness might result in some bias in treatment. Overall, the finding is very relevant to practicing clinicians in the ICU.
Reduces the unnecessary use of the drug in ICU settings.
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