title: A health insurance company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.
abstract: BACKGROUND
  A health insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs).
  
  
  OBJECTIVE
  To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription.
  
  
  METHODS
  A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis.
  
  
  RESULTS
  At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively.
  
  
  CONCLUSIONS
  This health insurance company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. h.m.smeets@umcutrecht.nl
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Smeets
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Paul C M
authors.initials: PC
authors.lastname: van Dijk
authors.forename: Arnold P M
authors.initials: AP
authors.lastname: van der Lee
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D012923:Social Class; D013689:Telephone
chemical_list: D000863:Antacids