PMID- 11128270
OWN - NLM
STAT- MEDLINE
DCOM- 20010208
LR  - 20190726
IS  - 0277-9536 (Print)
IS  - 0277-9536 (Linking)
VI  - 51
IP  - 12
DP  - 2000 Dec
TI  - Strategies for reducing the prescribing of proton pump inhibitors (PPIs): patient 
      self-regulation of treatment may be an under-exploited resource.
PG  - 1827-39
AB  - Escalating costs of proton pump inhibitor (PPI) prescribing are a source of 
      increasing concern. To reduce costs, GPs in the UK have been coming under 
      pressure to restrict PPI prescribing in primary care, e.g. by raising the 
      prescribing threshold for new patients, and encouraging established patients to 
      accept a reduced dose, if not stop taking PPIs altogether. The need to reduce 
      prescribing costs impacts on patients by redefining, i.e. reducing, the 
      boundaries of clinical need for which PPI prescribing is deemed appropriate. This 
      may be rationalised by the assumptions that much existing prescribing is 
      inappropriate, is applied to relatively minor and trivial afflictions, and that 
      patients put pressure on their doctors to initiate prescribing of PPIs, after 
      which they are very reluctant to give them up. The research involved extended 
      interviews to elicit GP and patient views and experience of PPI prescribing. A 
      particular focus was a comparison of the views of patients and GPs, and the 
      understanding and articulation of the patient perspective on PPIs, which has been 
      largely absent from the discussion to date. The research identified six distinct 
      strategies used by GPs in their efforts to reduce PPI prescribing. Contrary to 
      what GPs often assumed to be the case, patients were generally quite receptive to 
      changes to their medication, provided they had the security of knowing that their 
      original prescription would be restored if necessary. Most doctors assessed their 
      rationing strategies as having some impact, but acknowledged the difficulties in 
      achieving a significant and sustained reduction in PPIs. In the study sample 
      nearly half of the patients who had experienced a prescribing switch or step down 
      had drifted back to their former brand, and, especially, higher dose. However, 
      far from being overly and unreflectively dependent on PPIs, patients were often 
      keen to reduce their medicine taking to a minimum. A number of respondents had 
      taken the initiative in experimenting to find the lowest effective dose of PPIs 
      required to control their symptoms. GPs varied in their attitudes to this form of 
      treatment self-management, but less than half actively encouraged patients to 
      regulate their treatment in this way. Our findings suggest that there is 
      considerable scope for encouraging patients to self-regulate with PPIs, and that 
      many patients would be willing to do this if the practice was sanctioned by their 
      doctors. The anticipated benefits of increased self-regulation include an overall 
      reduction in PPI prescribing and associated costs, and an increase in patient 
      autonomy and control which is in line with the concordance model of the ideal 
      relationship between patients and doctors.
FAU - Pollock, K
AU  - Pollock K
AD  - Department of Medicines Management, Keele University, Staffs, UK. 
      k.pollock@keele.ac.uk
FAU - Grime, J
AU  - Grime J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Soc Sci Med
JT  - Social science & medicine (1982)
JID - 8303205
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 80061L1WGD (Cimetidine)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Ulcer Agents/*administration & dosage
MH  - Cimetidine
MH  - Drug Utilization/*economics
MH  - Economics, Pharmaceutical
MH  - England
MH  - Family Practice
MH  - Humans
MH  - Middle Aged
MH  - Omeprazole
MH  - *Patients
MH  - *Physician-Patient Relations
MH  - *Practice Patterns, Physicians'/economics
MH  - *Proton Pump Inhibitors
EDAT- 2000/12/29 11:00
MHDA- 2001/03/03 10:01
CRDT- 2000/12/29 11:00
PHST- 2000/12/29 11:00 [pubmed]
PHST- 2001/03/03 10:01 [medline]
PHST- 2000/12/29 11:00 [entrez]
AID - S0277953600001143 [pii]
AID - 10.1016/s0277-9536(00)00114-3 [doi]
PST - ppublish
SO  - Soc Sci Med. 2000 Dec;51(12):1827-39. doi: 10.1016/s0277-9536(00)00114-3.