Abstract

Objectives: Proton pump inhibitors (PPIs) are among the drugs most commonly prescribed in our setting. The objective of the intervention was to assess whether a letter sent by post is more effective in achieving a reduction/cessation of long-term high-doses of PPI use than usual practice.

Methods: This was a randomised intervention study, with before-and-after outcome measures and a control group, in patients who had an active prescription for PPIs at high doses for at least 6 months. The intervention consisted of sending patients an informative letter by post, in which their doctor invited them to seek an appointment for a medication review. Control group patients did not receive such a letter, and they were treated as usual. The main outcome variable was the number of active prescriptions of each PPI dose (high dose/standard dose/treatment cessation) at 6 months after the intervention.

Results: Six months after the intervention, 8% of control group patients and 16.4% of intervention group patients were not on any PPIs. Additionally, among those with active prescriptions for PPIs, 6% of controls and 20% of intervention group patients had reduced their intake to the standard dose. Overall, cessation/reduction in the intervention group was higher than in the control group, 36.4% vs 14%, the difference being significant (22.4%; 95% CI: 14.1 to 30.7).

Conclusion: Sending a letter by post to patients who had been on high-dose PPI therapy for at least 6 months was found to be more effective for treatment cessation and/or dose reduction than usual practice.

Keywords: Proton Pump Inhibitors; Drugs; Spain

References

1. “Inhibidores de la Bomba de protones: Recomendaciones de Uso”. Departamento de Salud (2016).
2. Utilización de medicamentos antiulcerosos en España durante el periodo 2000-2012. Informe de utilización de medicamentos U/AUL/V1/15012014. Agencia Española de Medicamentos y Productos Sanitarios.
3. García del Pozo J. “Estudio de utilización de antiulcerosos en España (2000-2008)”. Información terapeútica del Sistema Nacional de Salud 33 (2009): 49-54.
4. Pollock K and Grime J. “Strategies for reducing the prescribing of proton pump inhibitors (PPIs): patient self-regulation of treatment may be an under-exploited resource”. Social Science and Medicine 51 (2000): 1827-1839.
5. Haastrup P., et al. “Strategies for discontinuation of proton pump inhibitors: a systematic review”. Family Practice 6 (2014): 625-630.
6. Department of Health, Basque Government. Manual de evaluación. Anexo II Contrato Programa 2018. OSIs. Versión 11 de abril de 2018. Dirección de Aseguramiento y Contratación Sanitaria (2018).
7. Tenni P and Dunbabin D. “A guide to deprescribing for better health outcomes: Proton pump inhibitors” (2016).
8. Farrel B., et al. “Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline”. Canadian Family Physician 63 (2017): 354-364.
9. Therapeutics Initiative. “Evidence based drug therapy. Deprescribing proton pump inhibitors”. Therapeutics Letter 111 (2018): 1-2.
10. Omeprazoles los justos. i-botika 25 (2016).
11. Omeprazoles, quizá sea el momento de dejarlos. i-botika 27 (2016).
12. Valverde Bilbao E., et al. “Intervención para optimizar el uso adecuado de inhibidores de la bomba de protons”. Libro de comunicaciones X Jornada de Seguridad del Paciente en Atención Primaria (2017).
13. Holmström I and Röing M. “The relation between patient-centeredness and patient empowerment: A discussion on concepts”. Patient Education and Counseling 79 (2010): 167-172.
14. Ciapponi A. “Toma de decisions compartidas” 15.1 (2012): 2-4.
15. Funnell MM. “Patient empowerment: What does it really mean?” Patient Education and Counselling 99 (2016): 1921-1922.
16. Cormack MA., et al. “Evaluation of an easy, cost-effective strategy for cutting benzodiazepine use in general practice”. British Journal of General Practice 44 (1994): 5-8.
17. Heather N., et al. “Randomised controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention”. Addiction Research and Theory2 (2004): 141-154.
18. Gorgels WJ., et al. “Discontinuation of long-term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study”. Drug and Alcohol Dependence 78 (2005): 49-56.
19. Krol N., et al. “Patient-directed strategy to reduce prescribing for patients with dyspepsia in general practice: a randomized trial”. Alimentary Pharmacology and Therapeutics 19 (2004): 917-922.
20. Kim J., et al. “Strategies for effective discontinuation of proton pump inhibitors”. Current Gastroenterology Reports 6 (2018): 27.

Citation

Citation: Elena Valverde Bilbao., et al. “Intervention by Post for Reducing the Chronic Use of High Doses of Proton Pump Inhibitors".Acta Scientific Nutritional Health 4.8 (2020): 03-08.

Copyright

Copyright: © 2020 Elena Valverde Bilbao., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.