J Clin Outcomes Manage
A population-based intervention to improve management of patients on chronic acid suppression: a group-randomized trial
Ferris TG, Shea T, Jacobson BC, Bainbridge J, Dudley J, Mahlis EM, Kuo B, Wang TC, Lee TH
Abstract Objective: To determine the effectiveness of providing physicians with patient-specific suggestions and pharmacist support for the care of patients on chronic acid suppression medication. Design: Prospective group-randomized trial. Patients and setting: Commercially insured adults on chronic (> 90 days) acid suppression in a Massachusetts physician network. Intervention: Patient-specific management suggestions and pharmacist support. Measures: Medication changes, patient symptoms, gastrointestinal diagnostic testing, specialty visits, and health care charges 9 months after enrollment. Results: 1532 of 175,000 patients (0.88%) had filled more than 90 days of an acid suppression medication within any 6-month period of the previous year. We enrolled 95% of eligible physicians and 45% (385) of eligible patients. Upon completion of the study, intervention patients were more likely to have had medication changes consistent with program suggestions, but the changes were small. Intervention patients for whom diagnostic testing was recommended were more likely to undergo serologic testing for Helicobacter pylori (33% versus 1%; p < 0.001). The intervention did not result in changes in patient symptoms, quality of life, specialty visits, or health care costs. Conclusion: Patient-specific feedback and team-based care changed medication prescribing and diagnostic test use in primary care. Failure of the intervention to change patient outcomes or costs of care suggest that there are limitations to care redesign that relies on administrative data and voluntary patient participation.
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