NPS MedicineWise 全科医生教育项目和澳大利亚明智选择推荐对质子泵抑制剂在澳大利亚处方的影响。

Impact of NPS MedicineWise general practitioner education programs and Choosing Wisely Australia recommendations on prescribing of proton pump inhibitors in Australia.

机构信息

NPS MedicineWise, Level 7, 418A Elizabeth Street, Surry Hills, NSW, 2010, Australia.

Medicines Policy Research Centre, Centre for Big Data Research in Health, University of New South Wales, Lowy Cancer Research Building, Kensington, NSW, 2052, Australia.

出版信息

BMC Fam Pract. 2020 May 9;21(1):85. doi: 10.1186/s12875-020-01158-1.

DOI:10.1186/s12875-020-01158-1

PMID:32386520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7211331/

Abstract

BACKGROUND

This study evaluated the impact of multifaceted NPS MedicineWise programs that targeted all general practitioners (GPs) in Australia in 2009 and 2015 with the aim of reducing unnecessary prescribing of proton pump inhibitors (PPIs) and encouraged stepping down to a lower strength PPI or to discontinue treatment. The 2015 intervention coincided with the release of Choosing Wisely Australia recommendations from the Royal Australian College of General Practitioners (RACGP).

METHODS

Outcome measures included monthly dispensing rates of different strength PPIs prescribed by GPs to concessional patients in Australia. All PPIs were categorized according to the May 2019 revised classifications for standard and low strength PPIs except for esomeprazole 40 mg which was classified as a standard strength and esomeprazole 20 mg as low strength for this analysis. Time series analyses was conducted of the dispensing rates of PPI prescriptions for concessional patients between January 2006 and June 2016 using the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) databases in Australia. Participants were GPs with dispensed PPI prescriptions to concessional patients between January 2006 and June 2016.

RESULTS

Following the 2009 NPS MedicineWise program we observed a 6.7% reduction in the expected dispensing rate of standard strength PPIs for concessional patients between April 2006 and March 2015, and an 8.6% reduction between April 2009 and June 2016 following the 2015 program launch. We observed a significant increase of 5.6% in the dispensing rate of low strength PPIs for concessional patients between April 2009 and March 2015, and no significant change in trend following the 2015 program.

CONCLUSIONS

The NPS MedicineWise programs were associated with reductions in the dispensing rate of standard strength PPIs by June 2016 and an increase in the dispensing rate of low-strength PPIs by March 2015 although this trend did not continue following the 2015 program. This suggests that GPs are stepping down patients to lower strength PPIs following the educational programs. However, lower strength PPIs are still not the majority of PPIs dispensed in Australian and regular interventions to sustain and improve PPI management by GPs may be warranted.

摘要

背景

本研究评估了 2009 年和 2015 年针对所有全科医生（GP）开展的多方面 NPS 明智用药计划的影响，旨在减少质子泵抑制剂（PPI）的不必要处方，并鼓励降低 PPI 强度或停止治疗。2015 年的干预恰逢澳大利亚皇家全科医师学院（RACGP）发布明智用药澳大利亚选择建议。

方法

结果测量包括澳大利亚优惠患者每月由 GP 开处不同强度 PPI 的配药率。除埃索美拉唑 40mg 被归类为标准强度和埃索美拉唑 20mg 被归类为低强度外，所有 PPI 均根据 2019 年 5 月修订的标准和低强度 PPI 分类进行分类，用于本分析。使用澳大利亚药品福利计划（PBS）和医疗保险福利计划（MBS）数据库对 2006 年 1 月至 2016 年 6 月期间优惠患者 PPI 处方的配药率进行了时间序列分析。参与者为 2006 年 1 月至 2016 年 6 月期间为优惠患者开具 PPI 处方的 GP。

结果

在 2009 年 NPS 明智用药计划之后，我们观察到优惠患者标准强度 PPI 的预期配药率从 2006 年 4 月到 2015 年 3 月下降了 6.7%，而在 2015 年计划启动后，从 2009 年 4 月到 2016 年 6 月下降了 8.6%。我们观察到优惠患者低强度 PPI 的配药率在 2009 年 4 月至 2015 年 3 月之间显著增加了 5.6%，但在 2015 年计划之后，趋势没有明显变化。

结论

NPS 明智用药计划与 2016 年 6 月前标准强度 PPI 的配药率下降以及 2015 年 3 月前低强度 PPI 的配药率增加有关，尽管在 2015 年计划之后这一趋势并未持续。这表明，在教育计划之后，GP 正在将患者降级到低强度 PPI。然而，澳大利亚开具的 PPI 中仍以低强度 PPI 为主，可能需要定期干预以维持和改善 GP 对 PPI 的管理。