PMID- 11769299
OWN - NLM
STAT- MEDLINE
DCOM- 20020110
LR  - 20181130
IS  - 1099-8128 (Print)
IS  - 1099-8128 (Linking)
VI  - 4
IP  - 6
DP  - 2001 Nov-Dec
TI  - A practice-based approach for converting from proton pump inhibitors to less 
      costly therapy.
PG  - 263-70
AB  - CONTEXT: Projected cost for lansoprazole, the formulary proton pump inhibitor 
      (PPI) at our institution, was $1.8 million in 1999. While some patients require 
      PPI therapy, many could control their symptoms with a histamine H2-receptor 
      antagonist blocker (H2 blocker) at a much lower cost. OBJECTIVE: To evaluate a 
      practice-based approach to converting patients from PPIs to H2 blockers. DESIGN: 
      Before-after study. SETTING: Portland Veterans Affairs Primary Care Clinics. 
      INTERVENTION: We developed guidelines and educated clinicians about the use of 
      PPIs and H2 blockers. To help physicians convert appropriate patients from PPIs 
      to H2 blockers, we gave them a list of their patients receiving PPIs, form 
      letters for patients explaining the conversion, and structured prescription 
      forms. Patient lists and e-mail reminders, as well as feedback on institutional 
      performance, were sent to clinicians during the intervention period. OUTCOME 
      MEASURES: Number of PPI and H2 prescriptions per enrollee and pharmacy costs. 
      RESULTS: The average number of PPI prescriptions per enrollee at our institution 
      decreased from 0.39 in the 9 months before the intervention to 0.27 in the 9 
      months after the intervention. The associated pharmacy costs decreased from an 
      average of $43 to $28 per enrollee per quarter, a difference of $15 or a savings 
      of $80,000 per quarter. Accounting for the decrease in medication prices during 
      the study, this difference was $11 per patient per quarter, corresponding to a 
      savings of about $60,000 per quarter. With respect to the conversion process, 
      more than 70% of clinicians felt the intervention had a big impact on how they 
      prescribed PPIs and H2 blockers. Eighty-two percent of clinicians converted 
      patients from PPIs to H2 blockers during clinic time; 56% did so during 
      administrative time. Overall, more clinicians considered the intervention to be 
      helpful rather than a hassle. CONCLUSIONS: The number of PPI prescriptions 
      decreased during the intervention and was sustained at least three quarters 
      afterward. This low-intensity, practice-based intervention may serve as a model 
      for other health care systems.
FAU - Lucas, L M
AU  - Lucas LM
AD  - Department of Veterans Affairs Medical Center, Oregon Health Sciences University, 
      Portland, USA. Linda.Lucas@med.va.gov
FAU - Gerrity, M S
AU  - Gerrity MS
FAU - Anderson, T
AU  - Anderson T
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Eff Clin Pract
JT  - Effective clinical practice : ECP
JID - 9815774
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Proton Pumps)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - 884KT10YB7 (Ranitidine)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles
MH  - Anti-Ulcer Agents/economics/therapeutic use
MH  - Cost Savings
MH  - Drug Costs/*statistics & numerical data
MH  - Drug Prescriptions/*economics
MH  - Drug Utilization/*statistics & numerical data
MH  - *Formularies, Hospital as Topic
MH  - Gastroesophageal Reflux/*drug therapy/economics
MH  - Histamine H2 Antagonists/*economics/*therapeutic use
MH  - Hospitals, Veterans/economics
MH  - Humans
MH  - Lansoprazole
MH  - Omeprazole/*analogs & derivatives/economics/therapeutic use
MH  - Oregon
MH  - Pharmacy Service, Hospital/economics/statistics & numerical data
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Primary Health Care/*economics
MH  - *Proton Pump Inhibitors
MH  - Proton Pumps/*economics
MH  - Ranitidine/economics/therapeutic use
EDAT- 2002/01/05 10:00
MHDA- 2002/01/11 10:01
CRDT- 2002/01/05 10:00
PHST- 2002/01/05 10:00 [pubmed]
PHST- 2002/01/11 10:01 [medline]
PHST- 2002/01/05 10:00 [entrez]
PST - ppublish
SO  - Eff Clin Pract. 2001 Nov-Dec;4(6):263-70.