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With restrictions now imposed on standard dose PPIs, have education initiatives had any impact on prescribing?

Recently introduced restrictions on the prescribing of subsidised proton pump inhibitors have been supported by new Australian research showing that previous, education-based initiatives have done little to curb their use.

With concerns growing about long-term use, and overuse, of PPIs, previous efforts targeted at consumers and prescribers appear to have done little to restrict prescribing, or encourage use of lower-strength esomeprazole, say researchers from the University of New South Wales.  

They found that a year-long NPS MedicineWise-led education initiative had led to a 1.7% decline in monthly dispensing of standard strength PPIs. This corresponded to approximately 27941 fewer
than expected dispensings from May 2016 to June 2018. 

“Despite the promotion of stepping down or discontinuing PPI treatment in these initiatives, we did
not observe any changes in the rates of switching to lower PPI strengths or discontinuation of treatment,” the authors said.

“In fact, higher strength PPIs remained the dominant choice for Australians throughout the study period; low strength PPIs accounted for only 6% of PPI dispensing in the period following the initiatives”.

National educational initiatives targeting prescribers and patients have had a limited impact on improving quality use of PPIs, the authors said.

“It appears that educational initiatives working alone are unlikely to make the inroads required to curb overuse of PPIs; policy levers such as imposing tighter restrictions on subsidised use of PPIs in concert with education may be more effective”.

Restrictions on the prescribing of subsidised PPI formulations, effective from 1 May 2019 (after the study period), are intended to further promote the use of lower strength PPIs and to contain long-term treatment of higher strength PPIs to clinically appropriate cases,” the authors said.

“The effectiveness of these regulatory efforts remains to be assessed”.

The research was published in BMJ Quality & Safety.

 

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