title: Glad you brought it up: a patient-centred programme to reduce proton-pump inhibitor prescribing in general medical practice.
abstract: BACKGROUND
  Many patients unnecessarily receive proton-pump inhibitor (PPI) drugs long term with significant financial and safety implications. Educating, empowering and supporting patients to self-manage their symptoms can lead to significant and sustained reductions in PPI  prescribing. We aimed to implement a programme to reduce inappropriate PPI prescribing.
  
  
  METHODS
  Eligible patients in one general medical practice in rural Scotland were invited for participation between November 2008 and February 2010. Patients attended special nurse advisor clinics,  completed dyspepsia questionnaires, received information, formulated self-management plans and were offered flexible support.
  
  
  RESULTS
  Of the study population, 437/2883 (15%) were prescribed PPIs. Of these, 166 (38%) were judged eligible for participation. After 12 months, 138/157  (83%) had reduced or stopped their PPIs, while 19/157 (11%) had reverted. The estimated annual net saving in the prescribing budget was ?3180.67. Self-reported understanding of symptom self-management increased from 6/20 (30%) to 18/20 (90%) patients after participation in the programme.
  
  
  CONCLUSIONS
  A patient-centred programme delivered by a specialist nurse significantly reduced PPI prescribing with financial and potential therapeutic benefits. The vast majority of eligible patients were able to 'step down and off' or 'step off' PPI use after 12 months without any  complications or deteriorating symptom control. Further research with larger cohorts of practices and patients is needed to develop a feasible, acceptable and effective programme if similar benefits are to be achieved for primary care in general.
authors: Kingshill Medical Practice, Forth, Lanark ML11 8AJ, UK. jill.murie@nhs.net
authors: Jill
authors: J
authors: Murie
authors: Jane
authors: J
authors: Allen
authors: Ray
authors: R
authors: Simmonds
authors: Carl
authors: C
authors: de Wet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration*; D018802:Patient-Centered Care; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012606:Scotland; D012648:Self Care; D011795:Surveys and Questionnaires
chemical_list: D054328:Proton Pump Inhibitors