Lansoprazole overutilization: methods for step-down therapy.
OBJECTIVE
To identify the documented indications for long-term therapy with lansoprazole 30 mg twice daily at the Veterans Affairs Pittsburgh Healthcare System, assess compliance with appropriate use criteria, evaluate patients eligible for step-down therapy, and recommend appropriate step-down therapy in order to improve patient care, decrease overprescribing, and reduce medication costs.


METHODS
Prospective intervention.


METHODS
The records of all patients with prescriptions for lansoprazole 30 mg twice daily as of June 2000 were reviewed. Patients were interviewed to assess medication compliance and symptom control and to provide education on lifestyle modifications. Interventions with the providers were completed to encourage step-down therapy in appropriate patients.


RESULTS
Two hundred forty-eight patients with active prescriptions for twice-daily lansoprazole were reviewed. Of these patients, 66% (n = 163) did not have an indication compliant with the medical center's guidelines for use of lansoprazole 30 mg twice daily. Of these, 88% (n = 143) had no documented attempt at step-down therapy and 49% (n = 80) had no documented gastrointestinal workup. Interventions for step-down therapy were recommended for 48% (n = 120) of the 248 patients. Forty-six percent (n = 60) of recommendations were accepted, resulting in a cost savings of dollars 85000 per year.


CONCLUSIONS
A high rate of clinician noncompliance with the guidelines for appropriate use of lansoprazole 30 mg twice daily was found. These prescribing patterns resulted in significant cost concerns. Our review and interventions led to step-down therapy for almost half of the patients receiving twice-daily lansoprazole. This review of patient records and intervention with primary care providers resulted in cost reduction and offered an opportunity to educate patients on beneficial lifestyle modifications.
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Penn 15240, USA.
Cynthia J
CJ
Pohland
Stephanie A
SA
Scavnicky
Steve S
SS
Lasky
Chester B
CB
Good
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D017723:Drug Utilization Review; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005572:Formularies, Hospital as Topic; D005744:Gastric Acid / Q000378:metabolism; D005759:Gastroenteritis / Q000188:drug therapy; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006300:Health Services Misuse; D006302:Health Services Research; D006787:Hospitals, Veterans; D006801:Humans; D064747:Lansoprazole; D008485:Medical Audit; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use*; D010414:Pennsylvania; D011446:Prospective Studies; D054328:Proton Pump Inhibitors
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole