Proton pump inhibitors: compliance with a mandated step-up program

Objective — To assess compliance with a step-up approach to proton pump inhibitor (PPI) therapy before implementation of a new provincial policy to promote histamine-type 2 receptor antagonist (H2RA) use before PPI therapy.

Design — Population-based, retrospective, open cohort study using prescribing and medical procedure data from January 1, 1995, to April 30, 1999.

Setting — Health administration databases for the universal health care system in Ontario.

Participants — Approximately 1.4 million residents of Ontario older than 65 years.

Main Outcome Measures — Proportion of patients who received a trial of H2RA therapy or gastrointestinal diagnostic testing 12 months before starting PPI therapy in 1996.

Results — Among the 25,870 patients who met study criteria in 1996, about 63% had received H2RAs 12 months before starting PPI therapy and 73% had had a trial of H2RAs or gastrointestinal diagnostic testing. Repeat analysis for January through April 1999, following the new policy implementation, showed that about 72% of patients had had a trial of H2RAs within 12 months of starting PPI therapy.

Conclusion — A modest gain (9%) in compliance with using H2RA therapy within 12 months before starting PPI therapy was seen following introduction of the step-up intervention. In future, costs and benefits of potential interventions should be carefully considered before implementing new policies.