Targeting doctors won't reduce ulcer drug overuse

NEW YORK (Reuters Health) - Education efforts directed at doctors won't prevent overuse of popular ulcer drugs, a new study from the Netherlands shows.

Future efforts might be more successful if they focus on patients as well as physicians, the study's authors conclude.

Dr. Hugo M. Smeets of University Medical Center in Utrecht and his colleagues were trying to tackle excessive long-term use of acid-suppressing drugs, especially proton pump inhibitors, which include Prilosec and Prevacid.

While these medications offer "prompt and effective" relief of heartburn and other stomach-acid related symptoms, there's evidence too many people are taking them long-term, Smeets and his team explain in the Archives of Internal Medicine.

For most conditions for which these drugs are used, such as gastrointestinal reflux disease (GERD), patients will get symptom relief by taking the medications for a week or two as needed, the researchers explain. But more than a third of patients who take these drugs receive more than 180 daily doses each year. What's more, the researchers say, frequent and long-term use of these medications may carry risks such as lung and stomach infections and the bone-thinning disease osteoporosis.

To investigate whether targeting primary care physicians might help reduce consumption of these drugs, Smeets and his team randomly assigned 112 physician groups, including 993 primary care doctors treating nearly a million patients, to an insurance company-initiated intervention to reduce acid suppressing drug use or to a control group who received no intervention.

Doctors in the intervention group received professional guidelines on the use of acid-suppressing drugs, a list of strategies for getting patients off these treatments, handouts to give their patients on proper use of the medications, a list of their patients taking acid-suppressing drugs long-term, and payment for up to three extra consultations per patient as needed.

About 2 percent of patients in the study were long-term acid-suppressing drug users.

Over the six-month study, 14 percent of patients in both the intervention and control groups cut their use of acid-suppressing drugs by more than half. There were no differences between the two groups in changes of volume of prescriptions per patient.

"In clinical practice, it is difficult to limit patients in their acid-suppressing drug consumption," Smeets and his colleagues note. This is both because patients feel the drugs are effective for treating their symptoms, and because they experience a "rebound" return of symptoms once they stop taking the pills, the researchers explain.

The problem with the program evaluated in the new study, the researchers say, is that it didn't do enough to help doctors with the challenges they face in trying to change prescription patterns for a medication that's effective, and with which patients are satisfied.

"In the case of acid suppressing drug prescription, it is likely that both the prescribing physician and the patient need to be convinced of the benefits of reduction of antacid drug use," they conclude.

"More research is needed to find out how this can be achieved," they say.

SOURCE: link.reuters.com/pyd69m Archives of Internal Medicine, July 26, 2010.