Long-term prescribing of proton pump inhibitors in general practice

Background. Proton pump inhibitors (PPIs) constitute the largest sector of the National Health Service (NHS) community drugs bill (pound 238m; 5.6%). Little is known of the longterm prescribing component of this. Aim. To study the extent, the reasons for, and the cost implications of the long-term prescription of PPIs in general practice. Method. Subjects on long-term therapy were identified by searches of comput erized and paper records from three practices, comprising 21 GPs with 46 65 0 patients, representing a population cross section in north-east England. Results. Two hundred and nine (0.45%) patients were on long-term PPIs (rang e between practices = 0.3% to 0.55%): 87% were on omeprazole, 13% lansopraz ole; average age = 60 years (male = 56 years, female = 64 years; range = 14 to 91 years); male to female ratio = 47:53. The main indications were 'ref lux' (39%), 'oesophagitis' (17%), non-specified 'dyspepsia' (24%), 'peptic ulcer' (8%). During the study year, 1952 prescriptions (28-day courses) wer e issued: a mean of nine per patient (range = 1 to 8). Sixteen per cent of patients requested fewer than six prescriptions, 27% requested between six and nine prescriptions, and only 21% requested sufficient prescriptions for the entire year. The average cost was pound 3707 per general practitioner per annum, or pound 320 000 for the district, representing 40% of the total PPI bill. Conclusion. Of the total population, 0.45% were prescribed long-term PPIs; most for symptom relief. The long-term component comprised 40% of all PPI c osts estimated at pound 100 million per annum for the United Kingdom. Most patients took their treatment only intermittently. More research is needed into strategies for rationalization of long-term PPI therapy. For most pati ents, doctors can advise on-demand rather than regular once-daily therapy.