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Reducing community dyspepsia drug costs: a controlled trial | Gut
<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE html> <html lang="en" dir="ltr" version="HTML+RDFa+MathML 1.1" xmlns:dc="http://purl.org/dc/terms/" xmlns:foaf="http://xmlns.com/foaf/0.1/" xmlns:og="http://ogp.me/ns#" xmlns:rdfs="http://www.w3.org/2000/01/rdf-schema#" xmlns:sioc="http://rdfs.org/sioc/ns#" xmlns:sioct="http://rdfs.org/sioc/types#" xmlns:skos="http://www.w3.org/2004/02/skos/core#" xmlns:xsd="http://www.w3.org/2001/XMLSchema#" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head profile="http://www.w3.org/1999/xhtml/vocab"> <!--[if IE]><![endif]--> <link rel="dns-prefetch" href="//securepubads.g.doubleclick.net" /> <link rel="dns-prefetch" href="//d1bxh8uas1mnw7.cloudfront.net" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://gut.bmj.com/sites/default/themes/bmjj/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Reducing community dyspepsia drug costs: a controlled trial","hwUrl":"https://gut.bmj.com/content/49/4/495","hwPath":"/content/49/4/495","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"no","hwEntitled":"no","mail":"e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855"},"content":{"hwIssueDate":"2001-10-01","hwIssueDateTime":"2001-10-01 00:00:00","hwPublicationDate":"2022-01-10","hwPublicationDateTime":"2022-01-10 09:40:27","hwNlmArticleType":"research-article","hwDOI":"10.1136/gut.49.4.495","hwAuthors":"R M Valori,C M Brown,P Strangeways,M Bradburn","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1468-3288","hwPissn":"0017-5749","hwVolume":"49","hwIssue":"4","hwArticleType":"Gastro-oesphageal reflux and dyspepsia","hwTabView":"main_tab","hwViewType":"","hwAccessType":"Paywall","hwOpenAccess":"no","hwFreeAccess":"no","hwTaxonomy":"Dyspepsia|Pancreatic cancer|Endoscopy","hwCorpusCode":"gutjnl","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"gutjnl;49/4/495","hwFirstPage":"495","hwLastPage":"501","hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"Gut: 49 (4)","hwElectronicPubDate":"2022-01-10","hwElectronicPubDateTime":"2022-01-10 09:40:27"}}); //--><!]]></script> <link rel="canonical" href="https://gut.bmj.com/content/49/4/495" /> <meta name="Generator" content="Drupal 7 (http://drupal.org)" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/49/4/495.full.pdf" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/49/4/495.full.txt" /> <meta name="article_thumbnail" content="https://gut.bmj.com/content/gutjnl/49/4/495/embed/graphic-1.gif" /> <meta name="issue_cover_image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/49/4.cover.gif" /> <meta name="type" content="article" /> <meta name="category" content="research-article" /> <meta name="HW.identifier" content="/gutjnl/49/4/495.atom" /> <meta name="HW.pisa" content="gutjnl;49/4/495" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Reducing community dyspepsia drug costs: a controlled trial" /> <meta name="DC.Identifier" content="10.1136/gut.49.4.495" /> <meta name="DC.Date" content="2001-10-01" /> <meta name="DC.Publisher" content="BMJ Publishing Group" /> <meta name="DC.Rights" content="British Society of Gastroenterology" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/gut.51.4.613" /> <meta name="DC.Description" content="BACKGROUND Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs. AIM To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8–69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of £1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy. * NHS : National Health Service NSAIDs : non-steroidal anti-inflammatory drugs GPs : general practitioners EPOC : Effective Practice and Organisation of Care FHSA : Family Health Services Authority ARIMA : autoregressive integrated moving average" /> <meta name="DC.Contributor" content="R M Valori" /> <meta name="DC.Contributor" content="C M Brown" /> <meta name="DC.Contributor" content="P Strangeways" /> <meta name="DC.Contributor" content="M Bradburn" /> <meta name="article:published_time" content="2001-10-01" /> <meta name="article:section" content="Gastro-oesphageal reflux and dyspepsia" /> <meta name="citation_title" content="Reducing community dyspepsia drug costs: a controlled trial" /> <meta name="citation_abstract" lang="en" content="<h3>BACKGROUND</h3> <p>Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs.</p><h3>AIM</h3> <p>To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy.</p><h3>METHODS</h3> <p>A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only.</p><h3>RESULTS</h3> <p>Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8–69.9 pence/half year; p&lt;0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of £1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period.</p><h3>CONCLUSION</h3> <p>A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy.</p>" /> <meta name="citation_journal_title" content="Gut" /> <meta name="citation_publisher" content="BMJ Publishing Group" /> <meta name="citation_publication_date" content="2001/10/01" /> <meta name="citation_mjid" content="gutjnl;49/4/495" /> <meta name="citation_id" content="49/4/495" /> <meta name="citation_public_url" content="https://gut.bmj.com/content/49/4/495" /> <meta name="citation_abstract_html_url" content="https://gut.bmj.com/content/49/4/495.abstract" /> <meta name="citation_full_html_url" content="https://gut.bmj.com/content/49/4/495.full" /> <meta name="citation_pdf_url" content="https://gut.bmj.com/content/gutjnl/49/4/495.full.pdf" /> <meta name="citation_issn" content="0017-5749" /> <meta name="citation_issn" content="1468-3288" /> <meta name="citation_doi" content="10.1136/gut.49.4.495" /> <meta name="citation_pmid" content="11559645" /> <meta name="citation_volume" content="49" /> <meta name="citation_issue" content="4" /> <meta name="citation_article_type" content="Research Article" /> <meta name="citation_section" content="Gastro-oesphageal reflux and dyspepsia" /> <meta name="citation_firstpage" content="495" /> <meta name="citation_lastpage" content="501" /> <meta name="citation_author" content="R M Valori" /> <meta name="citation_author_institution" content="aGloucestershire Royal Hospital, Gloucestershire, UK, bRoyal Lancaster Infirmary, Ashton Rd, Lancaster LA1 4RP, UK, cGloucestershire Family Health Services Authority, Gloucestershire, UK, dICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Rd, Headington, Oxford OX3 7LF, UK" /> <meta name="citation_author" content="C M Brown" /> <meta name="citation_author_institution" content="aGloucestershire Royal Hospital, Gloucestershire, UK, bRoyal Lancaster Infirmary, Ashton Rd, Lancaster LA1 4RP, UK, cGloucestershire Family Health Services Authority, Gloucestershire, UK, dICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Rd, Headington, Oxford OX3 7LF, UK" /> <meta name="citation_author" content="P Strangeways" /> <meta name="citation_author_institution" content="aGloucestershire Royal Hospital, Gloucestershire, UK, bRoyal Lancaster Infirmary, Ashton Rd, Lancaster LA1 4RP, UK, cGloucestershire Family Health Services Authority, Gloucestershire, UK, dICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Rd, Headington, Oxford OX3 7LF, UK" /> <meta name="citation_author" content="M Bradburn" /> <meta name="citation_author_institution" content="aGloucestershire Royal Hospital, Gloucestershire, UK, bRoyal Lancaster Infirmary, Ashton Rd, Lancaster LA1 4RP, UK, cGloucestershire Family Health Services Authority, Gloucestershire, UK, dICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Rd, Headington, Oxford OX3 7LF, UK" /> <meta name="citation_reference" content="citation_journal_title=Gut;citation_journal_abbrev=Gut;citation_author=B. 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AIM To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8–69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of £1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy. * NHS : National Health Service NSAIDs : non-steroidal anti-inflammatory drugs GPs : general practitioners EPOC : Effective Practice and Organisation of Care FHSA : Family Health Services Authority ARIMA : autoregressive integrated moving average" /> <meta name="og-title" property="og:title" content="Reducing community dyspepsia drug costs: a controlled trial" /> <meta name="og-url" property="og:url" content="https://gut.bmj.com/content/49/4/495" /> <meta name="og-site-name" property="og:site_name" content="Gut" /> <meta name="og-description" property="og:description" content="BACKGROUND Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs. AIM To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8–69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of £1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy. * NHS : National Health Service NSAIDs : non-steroidal anti-inflammatory drugs GPs : general practitioners EPOC : Effective Practice and Organisation of Care FHSA : Family Health Services Authority ARIMA : autoregressive integrated moving average" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/49/4.cover.gif" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/49/4/495.ppt" /> <title>Reducing community dyspepsia drug costs: a controlled trial | Gut</title> <link type="text/css" rel="stylesheet" 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class="field-items"><div class="field-item even">Gastro-oesphageal reflux and dyspepsia</div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation col-mobile-10 col-narrow-10 col-normal-11 article-title" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node146979" data-node-nid="146979" id="node-146979--2215876258" data-pisa="gutjnl;49/4/495" data-pisa-master="gutjnl;49/4/495" data-apath="/gutjnl/49/4/495.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Reducing community dyspepsia drug costs: a controlled trial</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="gutjnl;49/4/495" data-atom-uri="/gutjnl/49/4/495.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://gut.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">R M Valori</span><a id="xref-target-1-1" class="xref-aff" href="#target-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">C M Brown</span><a id="xref-target-2-1" class="xref-aff" href="#target-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">P Strangeways</span><a id="xref-target-3-1" class="xref-aff" href="#target-3">c</a>, </li><li class="last" id="contrib-4"><span class="name">M Bradburn</span><a id="xref-target-4-1" class="xref-aff" href="#target-4">d</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address> <a id="target-1"> <sup>a</sup>Gloucestershire Royal Hospital, Gloucestershire, UK, </a> <a id="target-2"> <sup>b</sup>Royal Lancaster Infirmary, Ashton Rd, Lancaster LA1 4RP, UK, </a> <a id="target-3"> <sup>c</sup>Gloucestershire Family Health Services Authority, Gloucestershire, UK, </a> <a id="target-4"> <sup>d</sup>ICRF Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Old Rd, Headington, Oxford OX3 7LF, UK</a> </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Dr R Valori, Gloucestershire Royal Hospital, Great Western Road, Gloucestershire GLI 3NN, UK</li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND</strong> Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>AIM</strong> To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy.</p></div><div id="sec-3" class="subsection methods"><p id="p-3"><strong>METHODS</strong> A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>RESULTS</strong> Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8–69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of £1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period.</p></div><div id="sec-5" class="subsection"><p id="p-5"><strong>CONCLUSION</strong> A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy.</p></div></div><ul class="kwd-group"><li class="kwd">dyspepsia</li><li class="kwd">drug costs</li><li class="kwd">general practitioners</li></ul><div class="section glossary"><li class="fn" id="glossary-1"><h2 class="">Abbreviations used in this paper</h2><dl id="def-list-1"><dt id="def-item-1">NHS<span class="def-item-dt-sep"></span></dt><dd>National Health Service<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">NSAIDs<span class="def-item-dt-sep"></span></dt><dd>non-steroidal anti-inflammatory drugs<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">GPs<span class="def-item-dt-sep"></span></dt><dd>general practitioners<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">EPOC<span class="def-item-dt-sep"></span></dt><dd>Effective Practice and Organisation of Care<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">FHSA<span class="def-item-dt-sep"></span></dt><dd>Family Health Services Authority<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">ARIMA<span class="def-item-dt-sep"></span></dt><dd>autoregressive integrated moving average</dd></dl></li></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-dfp-pane oas-ads oas-ads-mid pull-right" > <div class="pane-content"> <div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a href="https://doi.org/10.1136/gut.49.4.495" target="_new">https://doi.org/10.1136/gut.49.4.495</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1136/gut.49.4.495" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. 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