Proton pump inhibitors (PPIs) are a class of medications used to treat common gastrointestinal (GI) conditions.
Need for Recommendations
PPIs are commonly prescribed and widely used in Canada, with 12.4 million PPI prescriptions dispensed in 2004. However, questions exist about whether PPIs are being prescribed and used appropriately. Both over- and under-usage of PPIs have been reported, and costs associated with inappropriate prescribing and use may be considerable. To optimize the prescribing and use of PPIs in Canada, the evidence needed to be examined and the results communicated effectively to policy- makers, prescribers, and consumers.
CADTH was directed by the federal, provincial, and territorial (F/P/T) governments to focus on the optimal use of PPIs in Canada. CADTH conducted this project under its former Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) program. CADTH undertook a multi-step process 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.
The CADTH PPI project has resulted in:
- 52 evidence-based statements
- 28 relating to gastroesophageal reflux disease (GERD)
- 6 relating to dyspepsia
- 18 relating to peptic ulcer disease (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 in PPI prescribing and use, and a framework to assist in their evaluation
- nine Optimal Therapy Reports on PPIs.
- 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.
Through the uptake and adoption of the CADTH PPI key findings:
- Health outcomes can be improved
- Limited health care resources can be targeted more effectively.
CADTH addressed the use of PPIs for the management of GERD, dyspepsia, PUD, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drug-associated ulcer.
The Canadian Agency for Drugs and Technologies in Health (CADTH) assists health care providers, decision- makers, and consumers with the local implementation of optimal drug therapy, including the use of proton pump inhibitors (PPIs) — a class of medications used to treat common gastrointestinal (GI) conditions. We do this by offering intervention tools based on our evidence-based clinical and cost-effectiveness information (detailed in our Optimal Therapy Reports), which you can access to help implement optimal PPI therapy in your area. Contact us if you would like our assistance in tailoring any of these tools to meet your unique needs.
To help decision-makers evaluate optimal therapy initiatives, CADTH has also developed a series of generic tools that can be applied across health topics. These generic tools including an audit and feedback guide, an evaluation framework, and academic detailing templates.
- Project Highlights Brochure – highlights of the clinical and economic evidence from the COMPUS PPI project.
- Optimal Therapy Newsletter (formerly referred to as the Academic Detailing Newsletter) - summary of key clinical messages on optimal PPI prescribing and use for gastroesophageal reflux disease, dyspepsia, and non-steroidal anti-inflammatory drug (NSAID)-induced ulcer.
- Quick Reference Prescribing Aid - contains key messages and comparative PPI cost information.
- Alternate Prescription Pad - provides suggested lifestyle modifications and basic management strategies for GI conditions.
- Alternatives to Proton Pump Inhibitors – provides suggested lifestyle modifications and basic management strategies for GI conditions in an easy-to-print, one-page handout.
- COMPUS/RxFiles Pearls Document - detailed evidence and messaging "PEARLS".
- Didactic Presentation for Pharmacists - continuing medical education providers may use these presentation slides, in part or in whole, for education on the optimal prescribing and use of PPIs.
- Didactic Presentation for Physicians - continuing medical education providers may use these presentation slides, in part or in whole, for education on the optimal prescribing and use of PPIs.
- Presentation for Pharmacists together with Interactive Case Studies - designed for continuing medical education providers for small education sessions on the optimal prescribing and use of PPIs; includes case studies.
- Interactive Presentation for Physicians with Case Studies - designed for continuing medical education providers for small education sessions on the optimal prescribing and use of PPIs; includes case studies.
- Physician Self-Audit Tool – designed to allow physicians to prospectively or retrospectively audit their PPI prescribing practices.
- Upskilling Document - provides relevant reference material to qualified interventionists (i.e., continuing medical education providers, academic detailers).
- Short and Long Surveys
- Evaluation of Materials: Physician/Pharmacist
- Evaluation of Materials: Organizations
- Physician Didactic Sessions: Participant
- Physician Didactic Sessions: Presenter
- Pharmacist Didactic Sessions: Participant
- Pharmacist Didactic Sessions: Presenter
- Physician Interactive Sessions: Presenter
- Pharmacist Interactive Sessions: Participant
- Academic Detailing: Physician experience
- Academic Detailing: Detailer experience
Represents current activity
in project process
To assist health care providers, policy-makers, and consumers in making well-informed decisions about the prescribing and use of proton pump inhibitors, our completed research and resulting recommendations are available in a series of Optimal Therapy Reports that provide:
- evidence-based clinical statements and cost-effectiveness statements
- a clear picture of current practice and current utilization in Canada
- an analysis of the quantity of proton pump inhibitor agents prescribed, including market share and cost information
- an outline of gaps between current prescribing and use.
- Project in Brief (one-page synopsis of clinical reports)
- Executive Summary (three-page synopsis of clinical reports)
- Overview Report (25 page synopsis of clinical reports)
- Canadian Agency for Drugs and Technologies in Health. Evidence for PPI use in gastroesophageal reflux disease, dyspepsia and peptic ulcer disease: scientific report. Optimal Therapy Report - COMPUS 2007;1(2).
- Canadian Agency for Drugs and Technologies in Health. Economic models and conclusions for the treatment of dyspepsia; and gastroesophageal reflux disease - related heartburn and the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal complications. Optimal Therapy Report - COMPUS 2007;1(3).
- Canadian Agency for Drugs and Technologies in Health. Interventions for appropriate prescribing of proton pump inhibitors: a literature review. Optimal Therapy Report - COMPUS 2007;1(4).
- Canadian Agency for Drugs and Technologies in Health. Current practice analysis report for the prescribing and use of proton pump inhibitors. Optimal Therapy Report - COMPUS 2007;1(5).
- Canadian Agency for Drugs and Technologies in Health. Gap analysis report for the prescribing and use of proton pump inhibitors. Optimal Therapy Report - COMPUS 2007;1(6).
- Canadian Agency for Drugs and Technologies in Health. Selection of interventions report: PPI project. Optimal Therapy Report - COMPUS 2007;1(7).