PT  - JOURNAL ARTICLE
AU  - Cathal Coyle
AU  - Russell Symonds
AU  - Jane Allan
AU  - Sarah Dawson
AU  - Sheldon Russell
AU  - Adam Smith
AU  - Colin Daff
AU  - Helen Kotze
TI  - Sustained proton pump inhibitor deprescribing among dyspeptic patients in general practice: a return to self-management through a programme of education and alginate rescue therapy. A prospective interventional study
AID  - 10.3399/bjgpopen19X101651
DP  - 2019 Jul 10
TA  - BJGP Open
PG  - bjgpopen19X101651
4099  - http://bjgpopen.org/content/early/2019/07/11/bjgpopen19X101651.short
4100  - http://bjgpopen.org/content/early/2019/07/11/bjgpopen19X101651.full
AB  - Background Dyspepsia guidelines recommend that patients treated with proton pump inhibitors (PPIs) should step down to the lowest effective dose or return to self-care, but rebound hyperacidity can make this difficult. Many patients continue on PPIs in the long term, which may lead to safety and financial implications.Aim To determine if a nurse-led educational support programme and rescue therapy for rebound symptoms can help patients achieve a sustained reduction in PPI use.Design & setting A prospective interventional study was conducted at 26 surgeries across the UK.Method Adult patients, treated with PPIs for ≥2 consecutive months with an active repeat prescription, were invited to a 20-minute dyspepsia clinic appointment with a trained nurse adviser. An action plan to reduce and/or stop their PPI usage was agreed and alginate supplied for the self-management of rebound symptoms. After 12 months, PPI status was reviewed and prescribing cost savings calculated.Results After 12 months, 75.1% of 6249 eligible patients stepped down or off PPIs (35.3% stepped off; 5.0% stepped down then off; 34.8% stepped down only), while 8.7% of patients had reverted to their original PPI dose. PPI prescriptions fell from 89 915 to 45 880 and alginate prescriptions increased from 2405 to 6670. An average of 1.7 bottles (500 ml each) of alginate were used per patient who stepped down or off. Estimated annual cost-saving on prescriptions was £31 716.30.Conclusion A programme of education and short-term rebound symptom management helped the majority of patients to successfully step down or off PPIs, significantly reducing the potential risks associated with chronic therapy.