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Original research
Passing the acid test? Evaluating the impact of national education initiatives to reduce proton pump inhibitor use in Australia
  1. Claudia Bruno1,
  2. Sallie-Anne Pearson1,
  3. Benjamin Daniels1,
  4. Nicholas A Buckley2,
  5. Andrea Schaffer1,
  6. Helga Zoega1,3
  1. 1 Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
  2. 2 School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Faculty of Medicine, Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  1. Correspondence to Claudia Bruno, Medicine Policy Research Unit, Centre for Big Data Research in Health, Kensington NSW 2052, Australia; c.bruno{at}unsw.edu.au

Abstract

Background Proton pump inhibitor (PPI) use is widespread. There have been increasing concerns about overuse of high-dose PPIs for durations longer than clinically necessary.

Objective To evaluate the impact of national education initiatives on reducing PPI use in Australia.

Design Population-based, controlled interrupted time series analysis of PPI dispensing claims data for Australian adults from July 2012 to June 2018; we used statin dispensing as a control.

Interventions A year-long educational initiative led by NPS MedicineWise (previously the National Prescribing Service) from April 2015. Simultaneously, Choosing Wisely released recommendations in April 2015 and May 2016. Both promoted review of prolonged PPI use and encouraged stepping down or ceasing treatment, where appropriate.

Measurements We examined monthly changes in PPI (and statin) dispensing (stratified by high, standard and low tablet strength), rates of switching from higher to lower strength PPIs and rates of PPI (and statin) discontinuation.

Results We observed 12 040 021 PPI dispensings to 579 594 people. We observed a sustained −1.7% (95% CI: −2.7 to −0.7%) decline in monthly dispensing of standard strength PPIs following the initiatives until the end of the study period. There were no significant changes in high or low strength PPI (or statin) dispensings, switching to lower strength PPIs, or PPI (and statin) treatment discontinuation.

Conclusion Our findings suggest that these educational initiatives alone were insufficient in curbing overuse of PPIs on a national level. Concerted efforts with policy levers such as imposing tighter restrictions on subsidised use of PPIs may be more effective. Noting low strength esomeprazole is not publicly subsidised in Australia, availability of these preparations may also facilitate more appropriate practice

  • pharmacoepidemiology
  • health services research
  • healthcare quality improvement
  • health policy
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2019-009897

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    Footnotes

    • Presented at 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, August 24-28, 2019, Philadelphia, PA, USA.

    • Correction notice This article has been corrected since it was published. The order of two co-authors has changed ie, Sallie-Anne Pearson as the second author and Benjamin Daniels as the third author.

    • Contributors All authors contributed to the study concept and design. SAP and HZ acquired the data. CB analysed the data with input from AS and BD. CB drafted the manuscript with the supervision of HZ and SAP. NB provided clinical insight throughout. All of the authors critically revised the manuscript for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

    • Funding This research is supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines and Ageing (ID: 1060407) and a Cooperative Research Centre Project (CRC-P) Grant from the Australian Government Department of Industry, Innovation and Science (ID: CRC-P-439). Dr Zoega was supported by a Scientia Fellowship from UNSW Sydney. Dr Schaffer was supported by a NHMRC Early Career Fellowship (#1158763).

    • Disclaimer SAP is a member of the Drug Utilisation Sub Committee of the Pharmaceutical Benefits Advisory Committee. The views expressed in this paper do not represent those of the Committee.

    • Competing interests None declared.

    • Patient consent for publication Not required. Individual consent for the release of these data has been waived according to the Australian Privacy Act of 1988.

    • Ethics approval Our study was approved by the NSW Population and Health Services Research Ethics Committee (Approval Number: 2013/11/494).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.

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