Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service: their effect and implications

Godman, Brian; Kurdi, Amanj; McCabe, Holly; MacBride-Stewart, Séan; Leporowski, Axel; Hurding, Simon; Bennie, Marion; Morton, Alec

doi:10.5639/gabij.2018.0704.030

Cited by 15 publications

(46 citation statements)

References 56 publications

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“…The usage and expenditure patterns for respiratory inhalers (Figures 1 and 2) did not follow the same patterns as seen with other common classes of medicines prescribed in ambulatory care in Scotland when medicines lose their patent such as antihypertensive medicines, PPIs, SSRIs and statins [42][43][44]53]. Consequently, we did not see appreciable reductions in inhaler expenditures as the constituent medicines lost their patents with the launch of newer inhalers replacing the older ones (Appendix 1A) and, as mentioned, price reductions with newer inhalers being more modest [42,43].…”

Section: Discussionmentioning

confidence: 84%

“…These multiple initiatives undertaken by Scottish Health Boards and NHS Scotland to influence physician prescribing were consolidated using the 4E methodology in line with previous studies: Education (guidelines and academic detailing interventions), Engineering (organizational/managerial interventions, e.g. prescribing indicators), Economics (financial incentives for prescribing) and Enforcement (enforced regulations by health authoritiesalthough not generally applying to Scotland) [42][43][44][60][61][62][63]. Examples of enforcement including compulsory INN prescribing in Lithuania, compulsory generic substitution in Sweden and restrictions on the prescribing of patented statins in Austria and Finland [64][65][66][67].…”

Section: Methodsmentioning

confidence: 99%

“…It is envisaged that the inhaler market will be very different from the typical oral markets where considerable savings can be made following generic availability as seen with the Proton Pump Inhibitors (PPIs), statins, and antihypertensives [42][43][44]. Firstly, there are known concerns with how well or not patients have used their inhalers in the past resulting in activities including patient education and actively involving patients with inhaler choices to help address this [33,[45][46][47][48][49][50].…”

Section: Introductionmentioning

confidence: 99%

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Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

McCabe

Godman

Kurdi

et al. 2019

Expert Review of Respiratory Medicine

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Background: There is an increasing prevalence of asthma and chronic obstructive pulmonary disease (COPD) worldwide, leading to increased inhaler use. However, there are concerns with inhaler compliance resulting in different patented inhalers and longer-acting formulations. As a result, inhalers are now among the highest expenditure items in ambulatory care in Scotland leading to multiple initiatives to keep within budget without compromising care. Method: This study assesses inhaler utilization and expenditure between 2001 and 2017 alongside health authority initiatives. Results: There was an increase by 137% in inhaler utilization between 2001 and 2017, and a twofold increase in expenditure, driven by the increasing use of patented combination inhalers to address concerns. This is very different to the oral markets where expenditure on proton pump inhibitors, statins, and antihypertensives have fallen considerably recently despite increased volumes due to the increasing use of low-cost generics. However, inhaler expenditure has started to fall with an increasing use of lower cost combinations and initiatives to reduce the steroid burden alongside monitoring patient care. Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care.

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Section: Discussionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

McCabe

Godman

Kurdi

et al. 2019

Expert Review of Respiratory Medicine

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“…In addition, PPIs have become the 8th therapeutic class on the prescription list in 2013. In Scotland, there was a threefold increase in PPI utilization between 2001 and 2017, however total expenditure on PPIs was 66.7% lower in 2017 compared to that in 2001 [4]. In the Netherlands, there was a threefold increase in PPI utilization between 2000 and 2010, whereas there imbursed expenditure fell by 58% in 2010, helped by increasing utilization of generic omeprazole at only 2% of the prepatent loss price in 2010 [5].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, PPIs overuse in the clinical setting is often the result of incorrect stress ulcer prophylaxis (SUP) in non-intensive care unit patients, and failure to discontinue this therapy before hospital discharge, even in the absence of a therapeutic indication. Despite their perceived safety and reasonable costs, overutilization of PPIs would pose significant health risks such as gastrointestinal discomfort, dyspepsia, elevated liver transaminase, allergic reactions, visual abnormalities, osteoporosis, hypomagnesemia, community-acquired pneumonia, as well as Clostridium difficile colitis [4, 13].…”

Section: Introductionmentioning

confidence: 99%

Awareness, attitude and behavior regarding proton pump inhibitor among medical staff in the Southwest of China

Luo

Fan

Bian

et al. 2019

BMC Health Serv Res

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BackgroundProton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drug in the world and there is a growing number of publications on correct versus incorrect use of PPIs worldwide. The knowledge of PPIs among the medical staff is essential for improving the rationality of PPI application. The present study aimed to investigate awareness, attitude and behavior toward PPI use among medical staff in the Southwest of China.MethodsThe present descriptive-analytical study was conducted on 900 medical staff from three professional groups (300 doctors, 300 nurses and 300 pharmacists) in China. The study data were collected through a self-designed questionnaire which included demographics, awareness, attitude and behavior toward PPI use. The study was carried out in 22 hospitals in Luzhou between February and June 2018.ResultsOf 900 surveys issued, 851valid questionnaires (295doctors, 268 nurses and 288 pharmacists) were returned. Of all respondents, 33.25% were men and 66.75% were women. The score related to PPI awareness score of medical staff was low (59.47 ± 15.75). The level of awareness of pharmacist was significantly higher than that of doctors and nurses (P < 0.01), which was related to gender, age, occupation, educational level, professional title, hospital nature and hospital grade. Similarly, on the attitude towards PPI use, the pharmacists scored also significantly higher than doctors and the nurses (P < 0.01). Three hundred eighty-one of 851 medical staff had used PPI in the past 1 year, of which omeprazole was the most widely used. Among doctors, nurses and pharmacists, the usage rate of PPI was 50.85, 42.16, 40.97%, respectively. The use frequency was related to occupation and professional title. The score about the behavior toward PPIs of the nurses was also significantly lower than that of doctors and pharmacists (P < 0.01).ConclusionsThe study indicated that the medical staff lack of awareness concerning rational use of PPI in China, especially nurse. Thus, it is necessary to call for action on the improvement of PPI awareness and medication-taking behaviors to reduce PPI overuse and to promote the rationality of PPI application.

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Drug Utilisation Patterns of Alternatives to Ranitidine-Containing Medicines in Patients Treated with Ranitidine: A Network Analysis of Data from Six European National Databases

Arinze,

de Ridder,

Vojinovic

et al. 2023

Drug Saf

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Introduction Ranitidine, a histamine H 2 -receptor antagonist (H 2 RA), is indicated in the management of gastric acid-related disorders. In 2020, the European Medicines Agency (EMA) recommended suspension of all ranitidine-containing medicines in the European Union (EU) due to the presence of N -nitrosodimethylamine (NDMA) impurities, which were considered to be carcinogenic. The aim of this study was to investigate the impact of regulatory intervention on use patterns of ranitidine-containing medicines and their therapeutic alternatives. Objectives The aim was to study drug utilisation patterns of ranitidine and report discernible trends in treatment discontinuation and switching to alternative medications. Methods This retrospective, population-based cohort study was conducted using primary care records from six European countries between 2017 and 2023. To explore drug utilisation patterns, we calculated (1) incident use of ranitidine, other H 2 RAs, and other alternative drugs for the treatment of gastric ulcer and/or gastric bleeding; (2) ranitidine discontinuation; and (3) switching from ranitidine to alternative drugs (H 2 RAs, proton-pump inhibitors [PPIs], and other medicinal products for acid-related disorders). Results During the study period, 385,273 new ranitidine users were observed, with most users being female and aged 18–74 years. Ranitidine was the most commonly prescribed H 2 RA in the pre-referral period (September 2017–August 2019), with incidence rates between 0.8 and 9.0/1000 person years (PY). A steep decline to 0.3–3.8/1000 PY was observed in the referral period (September 2019–March 2020), eventually dropping to 0.0–0.4/1000 PY in the post-referral period (April 2020–March 2022). Switching from ranitidine to alternative drugs increased in the post-referral period, with the majority of patients switching to PPIs. Discontinuation of ranitidine use ranged from 270 to 380/1000 users in 2017 and decreased over time. Conclusions Ranitidine was commonly used prior to referral, but it was subsequently discontinued and replaced primarily with PPIs. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01354-9.

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Ongoing activities to influence the prescribing of proton pump inhibitors within the Scottish National Health Service: their effect and implications

Cited by 15 publications

References 56 publications

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

Awareness, attitude and behavior regarding proton pump inhibitor among medical staff in the Southwest of China

Drug Utilisation Patterns of Alternatives to Ranitidine-Containing Medicines in Patients Treated with Ranitidine: A Network Analysis of Data from Six European National Databases

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