Insurance company's anti-antacid project had little effect

An insurance company's effort to encourage physicians to reduce use of acid-suppressive medications did not change prescription rates, a Dutch study found.

The health insurance company initiated a multi-faceted intervention in the central region of the Netherlands. Primary care physicians in the intervention group received a prescription-optimization protocol, a list of their patients who took acid-suppressive drugs (ASDs) on a long-term basis, and financial compensation for additional consultations with these patients. After six months of follow-up, the use of ASDs and the cost and volume of prescriptions were compared between these physicians' patients and the patients of a control group of physicians who did not receive the intervention. The total study included 112 physicians and data on more than 20,000 patients.

At the start of the study, 2.4% of patients in the practices used ASDs frequently (defined as more than 180 daily doses per year). During the six-month intervention, 14.1% of the patients in the intervention group reduced their use of the drugs. However, an almost identical percentage, 13.7%, of control group participants also reduced their consumption. The groups also had similar changes in the number of prescriptions per patient. The results were published in the July 26 Archives of Internal Medicine.

The study authors offered a number of possible explanations for the apparent failure of the intervention. It's possible that six months was too short a time to accomplish major shifts in prescriptions. Physicians may also have assumed that the project was financially motivated and therefore reacted negatively to an insurance company offering advice about prescribing. The project was also conducted during a time when ASD use was being publicly discussed, so more patients and physicians in the control group may have been reducing their use of the drug than would have been expected.

The continued use of ASDs may also have been due to patient preference, the authors suggested, noting that drug dependency may have made it difficult for physicians to convince patients to quit or cut back on the drug. Future interventions may need to be tailored to convincing patients, as well as physicians, of the benefits of reduced antacid use, the authors concluded.