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    How effective are primary care pharmacists at running dyspepsia clinics for patients prescribed PPIs?

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    Publication date
    2018-09
    Author
    Petty, Duncan R.
    Allan, J.
    Dawson, R.
    Silcock, Jonathan
    Keyword
    Proton pump inhibitors
    Medication review
    Economic analysis
    Rights
    © 2018 Pharman. Reproduced with publishers permission.
    Peer-Reviewed
    Yes
    
    Metadata
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    Abstract
    Introduction As a consequence of the low cost and perceived safety, proton pump inhibitors (PPIs) are widely prescribed but they can cause longterm adverse effects and are often overprescribed. For most patients PPIs should not be continued long-term as patients can become dependent on PPIs and they are rarely stepped down/off treatment. We aimed to measure whether a dyspepsia review service could help patients on PPIs to step down/off treatment whilst still keeping them symptom free. Methods Pharmacists were provided with training on dyspepsia management. Four general practices were selected. Patients taking a PPI for more than two months were included. A list of exclusion criteria (e.g. active ulcers, newly initiated) was applied. Between six and eight dyspepsia review clinics were run at each site. Patients were booked into a 15-minute consultation. A concordance style consultation was held with clinicians providing information on dyspepsia management and exploring the patients’ ideas, concerns and expectations about stepping down or stepping off treatment. A follow-up audit was performed at four months to determine if patients had remained stepped down/off. An economic evaluation of clinic costs and drugs savings was performed. Results A total of 508 patients were invited to a review; 136 did not attend and 58 were excluded due to not meeting the inclusion criteria, leaving 314 patients reviewed for step-down/step-off. Successful step down/step off was achieved in 257 people (82% of those reviewed). The total cost savings of PPIs was £7,100. The additional cost of alginates was £1,207 giving a net saving on medicines of £5,893 per annum. Set-up costs were £1,194 and staff costs £3,524 to £5,156 giving total running costs, which vary dependent on the Agenda for Change (AfC) grade of pharmacist involved, of £4,720 - £6,351. Conclusion A dyspepsia review clinic is cost-neutral to run but, given that many patients are on polypharmacy, PPI step down might best be considered as part of a holistic medication review clinic.
    URI
    http://hdl.handle.net/10454/16681
    Version
    Published version.
    Citation
    Petty DR, Allan J, Dawson R, et al. (2018) How effective are primary care pharmacists at running dyspepsia clinics for patients prescribed PPIs? Journal of Medicines Optimisation. 4(2): 40-47.
    Link to publisher’s version
    https://www.pharman.co.uk/journals/medicine-optimisation-journal-archive
    Type
    Article
    Collections
    Life Sciences Publications

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