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Long-term effects of a multifaceted intervention to encourage the choice of the oral route for proton pump inhibitors: an interrupted time-series analysis
  1. I Colombet1,2,3,
  2. B Sabatier4,
  3. F Gillaizeau1,2,3,
  4. P Prognon4,
  5. D Begué4,5,
  6. P Durieux1,2,3
  1. 1
    INSERM, UMR_S 872, Paris, France
  2. 2
    School of medicine, Université Paris Descartes, Paris, France
  3. 3
    APHP, Georges Pompidou European Hospital, Paris, France
  4. 4
    Pharmacy Department, APHP, Georges Pompidou European Hospital, Paris, France
  5. 5
    School of Pharmacy, Université Paris Descartes, Paris, France
  1. Dr I Colombet, Département d’Informatique Hospitalière et Santé Publique, Hôpital Européen Georges Pompidou, 20–40 rue Leblanc, 75908 Paris cedex 15, France; isabelle.colombet{at}


Problem: Drugs are often given intravenously even when the patient is able to swallow and when an oral form would be more cost-effective.

Design: Evaluation of the impact of a multifaceted intervention on the early switch from intravenous to oral administration of proton pump inhibitors (PPI) in a hospital setting. The interrupted time series of intravenous PPI consumption was analysed.

Background and setting: At a French University Hospital, the Drug Committee, composed of multidisciplinary pharmacy and medical staff, addressed the issue of increasing consumption of intravenous PPI drugs (May 2003).

Strategy for change: Letters to department heads, academic analyses from members of the Drug Committee, paper reminders at the point of care and audit-feedbacks by pharmacists. Monitoring of consumption and repeated reminder letters were planned.

Effect of change: The consumption of PPI was stable before the first intervention (mean level: 954 units/month). An immediate decrease occurred after the first Drug Committee letter (30% relative reduction, 95% CI −16% to −46%; p<0.001) with a significant trend change during the first multifaceted intervention (−24 units/month, 95% CI −42 to −7; p = 0.007). After the end of the outreach visits (July 2004), the consumptions increased (+32 units/month, 95% CI: 14 to 50, p<0.001). The second intervention had no significant impact.

Lessons learnt: A complex intervention (audit, feedbacks, outreach visits) had an effect on practice. It was not sustained even after a less resource-intensive intervention. Other types of interventions are needed that could be continuously implemented to improve ordering practices long term.

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  • Competing interests: None.