Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review

<p>Abstract</p> <p>Background</p> <p>Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD).</p> <p>Methods</p> <p>A systematic review of intervention studies with a design according to research quality criteria and outcomes related to the effect of reduction of ASD medication retrieved from Medline, Embase and the Cochrane Library. Outcome measures were the strategy of intervention, quality of methodology and results of treatment to differences of ASD prescriptions and costs.</p> <p>Results</p> <p>The intervention varied from a single passive method to multiple active interactions with GPs. Reports of study quality had shortcomings on subjects of data-analysis. Not all outcomes were calculated but if so rction of prescriptions varied from 8% up to 40% and the cost effectiveness was in some cases negative and in others positive. Few studies demonstrated good effects from the interventions to reduce ASD.</p> <p>Conclusion</p> <p>Poor quality of some studies is limiting the evidence for effective interventions. Also it is difficult to compare cost-effectiveness between studies. However, RCT studies demonstrate that active interventions are required to reduce ASD volume. Larger multi-intervention studies are necessary to evaluate the most successful intervention instruments.</p

Long-term management of GERD in the elderly with pantoprazole

The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD

Meta-analysis: the influence of pre-treatment with a proton pump inhibitor on Helicobacter pylori eradication.

Contains fulltext : 48800.pdf (publisher's version ) (Closed access)BACKGROUND: There is much debate about the influence of pre-treatment with a proton pump inhibitor on Helicobacter pylori eradication. The few studies investigating the influence of pre-treatment on triple and quadruple therapies did not find differences in eradication rates. However, the high eradication rates make it difficult to study factors associated with therapy failure in small populations. In order to overcome this problem we performed a meta-analysis. METHODS: The literature was searched in order to identify randomized clinical trials comparing modern triple/quadruple therapies for H. pylori eradication without pre-treatment with a proton pump inhibitor with exactly the same regimen with pre-treatment. The overall risk difference (with - without pre-treatment) was calculated by pooling the risk differences of the individual studies weighted by the inverse of their variances. RESULTS: Nine studies, investigating a total of 773 patients, were identified. There was considerable variation regarding therapy regimen and duration. Pooled eradication rates were 81.3% (312 of 384) for patients with pre-treatment and 81.2% (316 of 389) for patients without pre-treatment. The (weighted) overall risk difference was 0.1% (95% CI: -5%; 5%). CONCLUSION: Pre-treatment with a proton pump inhibitor does not influence H. pylori eradication

Use of prescribed and non-prescribed medication for dyspepsia.

Contains fulltext : 59130.pdf (publisher's version ) (Open Access)OBJECTIVE: To explore patient factors related to the use of prescribed and non-prescribed drugs for dyspepsia in The Netherlands. DESIGN: Patient survey study. SETTING AND SUBJECTS: Questionnaires sent to patients who had a prescription for dyspepsia medication from their general practitioner. MAIN OUTCOME MEASURES: Patient factors related to the on-demand use of prescribed medication and the use of non-prescribed medication for dyspepsia. RESULTS: 74% of the (n=518) patients had been receiving prescribed medication for dyspepsia for more than one year. A quarter of the patients were using the prescribed medication "on demand" instead of adhering to the instructions on the prescription. PPI prescriptions reduced the probability of using the medication on demand, compared with other prescribed drugs (OR 0.39). Some 19% of the patients were using non-prescribed drugs for dyspepsia. More of the patients who had visited their general practitioner in the previous 12 months were using their drugs on demand (OR 2.27) and were using non-prescribed drugs (OR 2.40) than the patients who had not visited their GP. CONCLUSION: Clear information for patients on how to use their medication for dyspepsia may contribute to decreasing unnecessary drug use. Communication about (in)appropriate use of drugs "on demand", non-prescribed drugs, and health education should be addressed to all patient groups. Further studies on these topics should aim to improve medical care based on shared decision-making for patients with dyspepsia