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Better quality and lower cost in prescribing for reflux

Why was the initiative launched?
What was done?
Did it work?
Tips for success
To find out more contact
ImpAct bottom line

Better treatment of reflux through partnerships between patients and GPs at Beswick surgery resulted in higher quality at lower cost


ImpAct bottom line



Why was the initiative launched?


Repeat prescriptions account for about 75% of items and 80% of the costs of all prescribing. Within this overall picture reflux is a common relapsing condition and a common cause of consultations in general practice. Although the majority of patients suffering from this condition self-medicate with over the counter preparations, those visiting their GP still represent a significant workload for primary care. Expenditure by practices on H2-antagonists for these patients is likely to be significant. Adequate controls on repeat prescribing are an essential feature of effective primary care. The Beswick surgery in Manchester decided to look for ways to reduce repeat prescribing.

What was done?


The first steps were to collect together information to help the practice understand current knowledge about the condition and treatments. This allowed them to become confident about the effectiveness of alternative treatments. It was clear from their enquiries that omeprazole had been shown to be the most effective maintenance therapy in patients with reflux oesophagitis.

To help them understand the consequence of their initiative the practice identified 32 patients with reflux who were being prescribed H2-antagonists or other treatments (11 different treatments). They developed a protocol for a review of treatment, including the patient's view of their treatment. The protocol guided discussion about the incidence of pain, the use of medicines - what is used and how frequently and related lifestyle issues.

The review was designed to explore current medication and the presence or absence of symptoms and the record of compliance with medication. A key feature of the consultation was the objective of 'negotiating' with the patient a change to a daily dose of omeprazole 20 mg with related emphasis on the need to take the full-prescribed course.

A notional 'agreement' between the GP and the patient was the intended outcome of this review. Patients' progress was reviewed after an eight-week treatment programme.

Did it work?


The eight week review showed that 17 out of the 32 patients required continuing repeat prescriptions. These were changed to omeprazole 20 mg or 10 mg daily because the evidence is that this is better than H2-antagonists for maintenance therapy. The other 15 patients required no repeat prescriptions, were given omeprazole 20 mg as pulsed therapy to tailor their needs, and were invited to attend surgery if the problems returned. Patients welcomed the process of review.

The initiative produced cost savings of £2,900 over six months in the prescribing budget. This saving was identified from data directly related to the project. Subsequently, PACT data confirmed the significant reduction in money spent on acid suppressing medicines (Figure).



The process for managing repeat prescribing for reflux has now been adopted by the practice and is ongoing.

Tips for success



To find out more contact


Dr Vijay Nathoo
The Beswick Surgery
Bradford Day Centre
Raglan Close
Beswick
Manchester M11 3TH

Telephone 0161 223 4293
Fax 0161 230 6728

The following material is available


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