Evidence map›Paper›PMID 31641029›Full record

Observational studyBMJ quality & safety2020

Passing the acid test? Evaluating the impact of national education initiatives to reduce proton pump inhibitor use in Australia.

Claudia Bruno, Sallie-Anne Pearson, Benjamin Daniels, Nicholas A Buckley, Andrea Schaffer, Helga Zoega

Abstract readObservational Study
In one paragraph

Observational study in BMJ quality & safety, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Claudia BrunoCentre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia c.bruno@unsw.edu.au.ORCID 0000-0001-7789-3415
Sallie-Anne PearsonCentre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0001-7137-6855
Benjamin DanielsCentre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0001-8617-6055
Nicholas A BuckleySchool of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-6326-4711
Andrea SchafferCentre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-3701-4997
Helga ZoegaCentre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0003-0761-9028

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProton pump inhibitor (PPI) use is widespread. There have been increasing concerns about overuse of high-dose PPIs for durations longer than clinically necessary.

objectiveTo evaluate the impact of national education initiatives on reducing PPI use in Australia.

designPopulation-based, controlled interrupted time series analysis of PPI dispensing claims data for Australian adults from July 2012 to June 2018; we used statin dispensing as a control.

interventionsA year-long educational initiative led by NPS MedicineWise (previously the National Prescribing Service) from April 2015. Simultaneously, Choosing Wisely released recommendations in April 2015 and May 2016. Both promoted review of prolonged PPI use and encouraged stepping down or ceasing treatment, where appropriate. MEASUREMENTS: We examined monthly changes in PPI (and statin) dispensing (stratified by high, standard and low tablet strength), rates of switching from higher to lower strength PPIs and rates of PPI (and statin) discontinuation.

resultsWe observed 12 040 021 PPI dispensings to 579 594 people. We observed a sustained -1.7% (95% CI: -2.7 to -0.7%) decline in monthly dispensing of standard strength PPIs following the initiatives until the end of the study period. There were no significant changes in high or low strength PPI (or statin) dispensings, switching to lower strength PPIs, or PPI (and statin) treatment discontinuation.

conclusionOur findings suggest that these educational initiatives alone were insufficient in curbing overuse of PPIs on a national level. Concerted efforts with policy levers such as imposing tighter restrictions on subsidised use of PPIs may be more effective. Noting low strength esomeprazole is not publicly subsidised in Australia, availability of these preparations may also facilitate more appropriate practice.

Indexed as

Program EvaluationAustraliaDrug PrescriptionsDrug UtilizationFemaleGuidelines as TopicHumansHydroxymethylglutaryl-CoA Reductase InhibitorsInterrupted Time Series AnalysisMaleMedical OverusePractice Patterns, Physicians'Proton Pump InhibitorsRetrospective StudiesHydroxymethylglutaryl-CoA Reductase InhibitorsProton Pump Inhibitorshealthcare quality improvementhealth policyhealth services researchpharmacoepidemiology

Identifiers

PMID31641029
PMCPMC7241967

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.