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


METHODS
Population-based, retrospective, open cohort study using prescribing and medical procedure data from January 1, 1995, to April 30, 1999.


METHODS
Health administration databases for the universal health care system in Ontario.


METHODS
Approximately 1.4 million residents of Ontario older than 65 years.


METHODS
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.


CONCLUSIONS
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.
Institute for Clinical Evaluative Sciences, Toronto, Ont.
M M
MM
Mamdani
K
K
Tu
L
L
Jaakkimainen
A
A
Bica
J
J
Hux
D000368:Aged; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004415:Dyspepsia / Q000188:drug therapy*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy; D006635:Histamine H2 Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009313:National Health Programs; D009864:Ontario; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors