A practice-based approach for converting from proton pump inhibitors to less costly therapy.
BACKGROUND
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.


METHODS
Before-after study.


METHODS
Portland Veterans Affairs Primary Care Clinics.


METHODS
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.


METHODS
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.
Lucas
L M
LM
Department of Veterans Affairs Medical Center, Oregon Health Sciences University, Portland, USA. Linda.Lucas@med.va.gov
Gerrity
M S
MS
Anderson
T
T
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D016527:Drug Costs / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005572:Formularies, Hospital as Topic; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000191:economics; D006635:Histamine H2 Antagonists / Q000191:economics* / Q000627:therapeutic use*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D009922:Oregon; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics*; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000191:economics*; D011899:Ranitidine / Q000191:economics / Q000627:therapeutic use
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D064747:Lansoprazole; D011899:Ranitidine; D009853:Omeprazole