Proton Pump Inhibitor Therapy

Medication
Proton pump inhibitors (PPIs) are a class of medications used totreat common gastrointestinal (GI) conditions.

Issue
PPIs are commonly prescribed and widely used in Canada, with12.4 million PPI prescriptions dispensed in 2004. However, questions existabout whether PPIs are being prescribed and used appropriately. Both over- andunder-usage of PPIs have been reported, and costs associated with inappropriateprescribing and use may be considerable. To optimize the prescribing and use ofPPIs in Canada, the evidence needed to be examined and theresults communicated effectively to policy makers, prescribers, and consumers.

Condition
COMPUS addressed the use of PPIs for the management of gastroesophageal refluxdisease (GERD), dyspepsia, peptic ulcer disease (PUD), H. pylori infection, and nonsteroidalanti-inflammatory drug-associated ulcer.

Methods
COMPUS was directed by the federal, provincial, and territorial(F/P/T) governments to focus on the optimal use of PPIs in Canada. Amulti-step process was undertaken by COMPUS to:

• identify, summarize, and evaluate the clinical evidence in the form of evidence-based statements
• produce reliable economic evidence
• understand the current practice, in Canada, related to PPI prescribing and use
• identify gaps in practice, highlighting areas where current practice differs from the evidence
• develop key messages based on the evidence-based statements to address the gaps in practice
• select interventions to support the key messages and effect change in the prescribing and use of PPIs
• develop intervention tools for implementation
• develop an evaluation framework.

Results
The COMPUS PPI project has resulted in:

• 56 evidence-based statements
  • 28 relating to GERD
  • six relating to dyspepsia
  • 18 relating to PUD
• three key gaps in current PPI prescribing and use as compared with the evidence
• three primary, and eight additional, key messages important to policy makers and prescribers
• twelve intervention tools ready for implementation to effect change inPPI prescribing and use and a framework to assist in their evaluation
• nine Optimal Therapy Reports on PPIs.

Key Messages

• All PPIs are equally efficacious in the initial treatment of GERD, dyspepsia, and other common GI conditions.
• Doubling the standard daily doses of PPIs, as initial therapy, is no better than standard daily-dose therapy.
• PPIs are not efficacious in treating cough, asthma, or laryngeal symptoms associated with GERD.

Key Outcomes
Through the uptake and adoption of the COMPUS PPI key findings:

• Health outcomes can be improved
• Limited health care resources can be targeted more effectively.