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Table 1 Studies included in the Review with specifications of implementation strategies and efficacy of treatment and costs

From: Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review

Authors, year Research design Evidence quality Study characteristics: Population; i+c gr. (A) Participants (B) Stakeholders (C) Method characteristics: Intervention type (A) Content guideline (B) Practical Attributes (C) Implementation strategy Results treatment Results costs
41. Bursey & Crowley 2000 Dynamic population cohort B A: 110.000 residents of NF-land, Canada
B: All GPs
C: Government
A: Authorisation program for reimbursement.
B: Patient selection for PPI use.
C: Algorithm for prescription management.
I. passive > 80% decrease PPI PPI < 82% ($1.3 mil) first year; <62% after 2 years.
ASD <36% ($2.0 mil) first year; <16% after 2 years
42. Ladabaum & Fendrick 2001 Prospective multicentre trial. B A: P. ulcer patients (54+39)
B: PC-centres (3+3), GPs?
C: University Michigan.
A: Interactive sessions by GE.
B: Test & treat strategy
C: H. pylori serological test for PC.
III. multiple 32% more tests; same referrals;
31% less prescriptions (p > .001)
79% in intervention group ($ 122 pp) (p = .17)
43. Chan & Patel 2001 RCT A2 A: All dyspepsia patients
B: GPs (133+146); voluntary Hampshire
C: Health authority
A: Posted guidelines and reinforcement visits by NP
B: Management dyspepsia, H pylori.
C: Wall chart, booklet
III. multiple - 5% decrease in medication
44. Huren-kamp & Grund-meijer 2001 RCT A2 A: H. pylori patients (89/85)
B: 48 GP practices, voluntary
C: University Amsterdam
A: Education of protocol; support by NP.
B: Tapering prescriptions of ASD by doses and on demand treatment.
C: follow up patients by NP.
III. multiple Decrease of 1,5 PDD;
40% stopped ASD (ns);
More HP neg, more H2RA
-
45. Weynen & de Wit 2002 RCT Cluster A2 A: 260 (99/73/88) patients
B: 28 GPs; voluntary
C: University Utrecht
A: Education program, financial incentives and personal feedback.
B: H. Pylori diagnosis and treatment
C: Dyspepsia questionnaire, HP test.
III. multiple 17% better follow-up (ns), in incentive group Less overall costs (€46 pp; ns) in incentive group
46. Banait & Sibbald 2003 RCT cluster, A2 A: Practice population (265.000)
B: GP practices (57+56); voluntary NW England.
C: University, GE, Health authorities.
A: Posted guidelines with education outreach and follow-up visit.
B: Clinical strategies for referral.
C: Open access to endo-scopies and serological tests
III. multiple 14% more referrals, 4 more tests/practice 6% more costs ASD
47. Jones & Lydeard 1993 RCT, A2 A: Practice population (500.000)
B: GPs (78+101); voluntary; Southampton
C: Consensus group GP+GE
A: Consensus meetings GP-SP.
B: Investigation and refer dyspepsia; appropriate use of guidelines.
C: reference cards,
II. single No difference in referrals and endoscopies 22% more prescribing costs
48. Allison & Hurley 2003 RCT A2 A: ASD patients (321+329).
B: Physicians from study
C: HMO California
A: Test & treatment random group.
B: T&T protocol
C: Detailed instructions
II single Less ulcerlike symptoms and abdominal pain;
8% less users' medication
Higher costs because of HP treatment (not hospital)
49. Kearney & Liu 2004 Follow up Cohort B A: ASD patients (432)
B: GE from study
C: MHO Seattle
A: Patient Interview and HP test
B: Hospital stopped ASD medicine
C: Instruction for GPs' review.
I. passive 71% ulcer;
29% dyspepsia; number stopped?
Hospital $34 less pp;
Medication ns;
Only ulcer cases
50. Krol & Wensing 2004 RTC cluster A2 A: ASD patients (63+50)
B: 20 GP practices voluntary
C: University Utrecht
A: Direct mail to patients to reduce ASD.
B: Postal instructions for patients.
C: Instruction and flowchart
II single 17% reduction (10% stopped); no change in symptoms and quality -