Jones M I, Greenfield S M, Jowett S, Bradley C P, Seal R
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Fam Pract. 2001 Jun;18(3):333-8. doi: 10.1093/fampra/18.3.333.
There has been a rapid increase in proton pump inhibitor (PPI) prescribing in recent years, and controlling the cost and improving the quality of prescribing is an issue of concern to many GPS:
Our aim was to compare GPs' usage of different PPIs and explore how GPs' PPI prescribing changes following the introduction of a cheaper competitor.
PPI prescribing data (PACT) for 53 GPs, who were selected as regular users of a teaching hospital, were monitored from January 1995 to December 1997. The GPs were located in two adjoining health districts and had been interviewed about influences on their decisions to begin prescribing lansoprazole. The PPI prescribing data were collected for the teaching hospital and the general hospital in the adjoining district.
Complete prescribing data were available for 50 GPS: Total PPI prescribing increased throughout the study due mainly to increasing use of the new PPIS: Use of the new PPIs increased from 6 to 24% over 3 years. The proportion of maintenance doses prescribed increased from 3 to 12%. There was a 23-fold difference in total PPI prescribing and an 87-fold difference in lansoprazole prescribing between the highest and lowest prescribers. The uptake of pantoprazole was slower than that of lansoprazole. A rapid increase in the use of lansoprazole by the GPs followed an increase in use in the teaching hospital.
Hospital prescribing was an important influence on the choice of PPI used by GPS: The wide variation in PPI prescribing suggests that there is scope for improvement in the quality and cost of PPI prescribing.
近年来质子泵抑制剂（PPI）的处方量迅速增加，控制成本和提高处方质量是许多全科医生关注的问题。
我们的目的是比较全科医生对不同PPI的使用情况，并探讨在引入更便宜的竞争产品后，全科医生的PPI处方是如何变化的。
对53名被选为教学医院常规使用者的全科医生的PPI处方数据（PACT）进行监测，时间从1995年1月至1997年12月。这些全科医生位于两个相邻的健康区，曾就影响他们开始处方兰索拉唑的决定因素接受过访谈。收集了教学医院和相邻区综合医院的PPI处方数据。
50名全科医生有完整的处方数据：在整个研究过程中，PPI总处方量增加，主要原因是新PPI的使用增加：新PPI的使用在3年内从6%增加到24%。维持剂量处方的比例从3%增加到12%。最高和最低处方者之间的PPI总处方量相差23倍，兰索拉唑处方量相差87倍。泮托拉唑的采用速度比兰索拉唑慢。全科医生对兰索拉唑的使用随着教学医院使用量的增加而迅速增加。
医院处方对全科医生使用PPI的选择有重要影响：PPI处方的广泛差异表明，PPI处方的质量和成本有改进空间。
