Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2001 Mar;47:531–535.

Proton pump inhibitors. Compliance with a mandated step-up program.

M M Mamdani 1, K Tu 1, L Jaakkimainen 1, A Bica 1, J Hux 1
PMCID: PMC2018396  PMID: 11281086

Abstract

OBJECTIVE: To assess compliance with a step-up approach to proton pump inhibitor (PPI) therapy before implementation of a new provincial policy to promote histamine-type 2 receptor antagonist (H2RA) use before PPI therapy. DESIGN: Population-based, retrospective, open cohort study using prescribing and medical procedure data from January 1, 1995, to April 30, 1999. SETTING: Health administration databases for the universal health care system in Ontario. PARTICIPANTS: Approximately 1.4 million residents of Ontario older than 65 years. MAIN OUTCOME MEASURES: Proportion of patients who received a trial of H2RA therapy or gastrointestinal diagnostic testing 12 months before starting PPI therapy in 1996. RESULTS: Among the 25,870 patients who met study criteria in 1996, about 63% had received H2RAs 12 months before starting PPI therapy and 73% had had a trial of H2RAs or gastrointestinal diagnostic testing. Repeat analysis for January through April 1999, following the new policy implementation, showed that about 72% of patients had had a trial of H2RAs within 12 months of starting PPI therapy. CONCLUSION: A modest gain (9%) in compliance with using H2RA therapy within 12 months before starting PPI therapy was seen following introduction of the step-up intervention. In future, costs and benefits of potential interventions should be carefully considered before implementing new policies.

Full Text

The Full Text of this article is available as a PDF (46.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bardhan K. D., Müller-Lissner S., Bigard M. A., Bianchi Porro G., Ponce J., Hosie J., Scott M., Weir D. G., Gillon K. R., Peacock R. A. Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine. The European Study Group. BMJ. 1999 Feb 20;318(7182):502–507. doi: 10.1136/bmj.318.7182.502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bashford J. N., Norwood J., Chapman S. R. Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. BMJ. 1998 Aug 15;317(7156):452–456. doi: 10.1136/bmj.317.7156.452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bateman D. N. Proton-pump inhibitors: three of a kind? Lancet. 1997 Jun 7;349(9066):1637–1638. doi: 10.1016/s0140-6736(05)62629-3. [DOI] [PubMed] [Google Scholar]
  4. Eggleston A., Wigerinck A., Huijghebaert S., Dubois D., Haycox A. Cost effectiveness of treatment for gastro-oesophageal reflux disease in clinical practice: a clinical database analysis. Gut. 1998 Jan;42(1):13–16. doi: 10.1136/gut.42.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Harris R. A., Kuppermann M., Richter J. E. Proton pump inhibitors or histamine-2 receptor antagonists for the prevention of recurrences of erosive reflux esophagitis: a cost-effectiveness analysis. Am J Gastroenterol. 1997 Dec;92(12):2179–2187. [PubMed] [Google Scholar]
  6. Hillman A. L. Economic analysis of alternative treatments for persistent gastro-oesophageal reflux disease. Scand J Gastroenterol Suppl. 1994;201:98–102. doi: 10.3109/00365529409105374. [DOI] [PubMed] [Google Scholar]
  7. Kudenchuk P. J., Maynard C., Martin J. S., Wirkus M., Weaver W. D. Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the Myocardial Infarction Triage and Intervention Registry) Am J Cardiol. 1996 Jul 1;78(1):9–14. doi: 10.1016/s0002-9149(96)00218-4. [DOI] [PubMed] [Google Scholar]
  8. McBride J. E., Pater J. L., Dorland J. L., Lam Y. M. Extent and variation of omeprazole prescribing in an elderly population of Ontario. Ann Pharmacother. 1997 Apr;31(4):411–416. doi: 10.1177/106002809703100404. [DOI] [PubMed] [Google Scholar]
  9. McManus P., Marley J., Birkett D. J., Lindner J. Compliance with restrictions on the subsidized use of proton pump inhibitors in Australia. Br J Clin Pharmacol. 1998 Oct;46(4):409–411. doi: 10.1046/j.1365-2125.1998.00791.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Roberts S. J., Bateman D. N. Prescribing of antacids and ulcer-healing drugs in primary care in the north of England. Aliment Pharmacol Ther. 1995 Apr;9(2):137–143. doi: 10.1111/j.1365-2036.1995.tb00362.x. [DOI] [PubMed] [Google Scholar]
  11. Talley N. J., O'Keefe E. A., Zinsmeister A. R., Melton L. J., 3rd Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology. 1992 Mar;102(3):895–901. doi: 10.1016/0016-5085(92)90175-x. [DOI] [PubMed] [Google Scholar]
  12. Walan A., Eriksson S. Long-term consequences with regard to clinical outcome and cost-effectiveness of episodic treatment with omeprazole or ranitidine for healing of duodenal ulcer. Scand J Gastroenterol Suppl. 1994;201:91–97. doi: 10.3109/00365529409105373. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES