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PPI prescribing variation costs millions

The British Gastroenterology Society annual meeting last month was told GP prescribing of proton pump inhibitors can vary six-fold and communication was poor – Rob Finch reports

Wide variations in prescribing of proton pump inhibitors could be costing the NHS millions of pounds a year, according to latest research.

Studies presented at the British Gastroenterology Society annual meeting last month showed a six-fold variation in GP prescribing of PPIs and poor levels of communication between hospitals and practices regarding duration and reason for treatment.

The GPC said the variations were probably due to some GPs being in the habit of using older drugs that were not as effective and called on the Government to meet the soaring cost of PPIs.

The first study looked at GP notes of 46,933 patients in eight practices in the North-East. Across all eight practices the prescribing rates varied from 0.6 per cent of patients on a PPI to 3.6 per cent.

The results also showed 60 per cent of patients on the drugs had received further investigation with endoscopy while 30 per cent had received no further investigation.

Study co-author Professor Pali Hungin, a GP and dean of medicine at the University of Durham, said the variations were probably down to individual prescribing and referral behaviour of GPs rather than any demographic characteristics of the GPs or practices.

The second study presented at the conference found 30 per cent of patients were being prescribed PPIs in secondary care with 'no clear indication'.

Moreover, the hospitals failed to communicate with GPs the indication for treatment and the duration of treatment was stated in just 17 per cent of cases.

Latest prescribing figures show PPIs cost the NHS £403 million in 2002, up 23 per cent from 2000, making them the most prescribed class of drug after statins.

Dr Peter Fellows, chair of the GPC prescribing sub-committee, said the variation in prescribing was 'wide' but added GPs should not be put off prescribing them for cost reasons as they reduced the need for surgery.

Dr Fellows, a GP in Lydney, Gloucestershire, said he preferred to treat patients with a cheaper, short burst of high-dose PPIs rather than low-dose long-term maintenance therapy.

He added: 'A lot of GPs still use the older drugs that are not as effective, while some doctors will be in the habit of prescribing PPIs to cover a course of NSAIDs, rather than prescribing a more expensive Cox-2 inhibitor.'

New advice on faecal occult blood testing

Patients taking non-essential anticoagulants should stop their medication before colorectal cancer screening, a new study has shown.

An ongoing pilot of screening using faecal occult blood testing has found consistent, significantly high rates of false positive results in people taking anticoagulant medication.

Researchers from the colorectal screening programme at Ninewells Hospital in Dundee found a 'small but significant' increase in the incidence of false positive results.

The Tayside screening programme of patients aged 50 to 69 looked at 846 patients with positive FOB results, of whom more than a third were taking anticoagulants.

When patients underwent endoscopies there were 9 per cent more negative colonoscopies found in patients taking anticoagulants compared with patients not on the drugs.

The researchers advised GPs should consider stopping the drugs before screening.

Gastrointestinal care better with emerging technology

A study of wireless capsule

endoscopy – in which patients swallow a camera less than 3cm long – has found it effective in detecting gastrointestinal haemorrhages where conventional methods have failed.

Researchers from Imperial College London detected

lesions that were the definite or probable cause of bleeding in 52 per cent of cases that

had not previously been detected.

The authors said in future GPs may be able to refer for wireless capsule endoscopy as a non-invasive option.

Endoscopy can change GPs' approach to reflux

Endoscopy can change the management of uncomplicated gastro-oesophageal reflux disease in the majority of cases and could lead to large savings for the NHS, a study suggests.

Researchers in Belfast used endoscopy on 100 patients with simple GORD. The results, presented at the conference, showed a reduction in medication in 41 per cent of patients and a rise in 50 per cent.

The study concluded that for patients under 55, the extra cost of endoscopy would be offset within 3.5 years by more cost-effective treatment.

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