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Lansoprazole overutilization: methods for step-down therapy.

Cynthia J Pohland1, Stephanie A Scavnicky, Steve S Lasky

  • 1Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Penn 15240, USA.

The American Journal of Managed Care
|May 15, 2003
PubMed
Summary
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Many patients on twice-daily lansoprazole did not meet guidelines for use, leading to overprescribing. Interventions successfully reduced costs by encouraging step-down therapy for nearly half of these patients.

Area of Science:

  • Pharmacology
  • Health Services Research
  • Gastroenterology

Background:

  • Long-term use of proton pump inhibitors (PPIs) like lansoprazole requires adherence to established guidelines.
  • Inappropriate prescribing of PPIs can lead to increased healthcare costs and potential adverse effects.
  • Optimizing lansoprazole therapy is crucial for appropriate patient care and resource management.

Purpose of the Study:

  • To determine the adherence to guidelines for long-term lansoprazole 30 mg twice daily therapy.
  • To evaluate the potential for step-down therapy in patients receiving this medication.
  • To reduce overprescribing and medication costs through targeted interventions.

Main Methods:

  • Prospective review of patient records for lansoprazole 30 mg twice daily prescriptions.

Related Experiment Videos

  • Patient interviews to assess compliance, symptom control, and lifestyle factors.
  • Provider interventions to promote step-down therapy for eligible patients.

    • Main Results:

    • 66% of patients reviewed lacked guideline-compliant indications for twice-daily lansoprazole.
    • 88% had no documented attempt at step-down therapy, and 49% lacked documented gastrointestinal workup.
    • Interventions led to step-down therapy in 46% of recommended cases, saving $85,000 annually.

    Conclusions:

    • Significant noncompliance with lansoprazole 30 mg twice daily prescribing guidelines was identified.
    • Interventions effectively facilitated step-down therapy, reducing costs and improving prescribing patterns.
    • This approach highlights the importance of regular medication reviews and provider education.