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Arno W. Hoes - One of the best experts on this subject based on the ideXlab platform.
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A Health Insurance Company-Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care
2017Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective: To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods: In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescriptionoptimizationprotocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results: At baseline, 2.4% of the patients (n=967 506) of the participating practices used ASDs frequently on a long-term basis (180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (=0.33 for DDD; 95% CI �3.00 to 3.60). Conclusions: A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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A Health Insurance Company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.
European journal of gastroenterology & hepatology, 2011Co-Authors: Hugo M. Smeets, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. Hoes, Niek J. De WitAbstract:Background: A Health Insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs). Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription. Materials and methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis. Results: At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively. Conclusion: This Health Insurance Company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
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A Health Insurance Company–Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care: A Randomized Controlled Trial
Archives of internal medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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a Health Insurance Company initiated multifaceted intervention for optimizing acid suppressing drug prescriptions in primary care a randomized controlled trial
JAMA Internal Medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
Niek J. De Wit - One of the best experts on this subject based on the ideXlab platform.
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A Health Insurance Company-Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care
2017Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective: To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods: In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescriptionoptimizationprotocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results: At baseline, 2.4% of the patients (n=967 506) of the participating practices used ASDs frequently on a long-term basis (180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (=0.33 for DDD; 95% CI �3.00 to 3.60). Conclusions: A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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A Health Insurance Company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.
European journal of gastroenterology & hepatology, 2011Co-Authors: Hugo M. Smeets, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. Hoes, Niek J. De WitAbstract:Background: A Health Insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs). Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription. Materials and methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis. Results: At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively. Conclusion: This Health Insurance Company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
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A Health Insurance Company–Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care: A Randomized Controlled Trial
Archives of internal medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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a Health Insurance Company initiated multifaceted intervention for optimizing acid suppressing drug prescriptions in primary care a randomized controlled trial
JAMA Internal Medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
Hugo M. Smeets - One of the best experts on this subject based on the ideXlab platform.
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A Health Insurance Company-Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care
2017Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective: To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods: In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescriptionoptimizationprotocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results: At baseline, 2.4% of the patients (n=967 506) of the participating practices used ASDs frequently on a long-term basis (180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (=0.33 for DDD; 95% CI �3.00 to 3.60). Conclusions: A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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A Health Insurance Company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.
European journal of gastroenterology & hepatology, 2011Co-Authors: Hugo M. Smeets, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. Hoes, Niek J. De WitAbstract:Background: A Health Insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs). Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription. Materials and methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis. Results: At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively. Conclusion: This Health Insurance Company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
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A Health Insurance Company–Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care: A Randomized Controlled Trial
Archives of internal medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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a Health Insurance Company initiated multifaceted intervention for optimizing acid suppressing drug prescriptions in primary care a randomized controlled trial
JAMA Internal Medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
Siegfried Geyer - One of the best experts on this subject based on the ideXlab platform.
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Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory Health Insurance Company
Journal of epidemiology and community health, 2007Co-Authors: Richard Peter, Holger Gässler, Siegfried GeyerAbstract:Background: Inconsistency in social status and its impact on Health have been a focus of research 30–40 years ago. Yet, there is little recent information on it’s association with ischaemic heart disease (IHD) morbidity and IHD is still defined as one of the major Health problems in socioeconomically developed societies. Methods: A secondary analysis of prospective historical data from 68 805 male and female members of a statutory German Health Insurance Company aged 25–65 years was conducted. Data included information on sociodemographic variables, social status indicators (education, occupational grade and income) and hospital admissions because of IHD. Results: Findings from Cox regression analysis showed an increased risk for IHD in the group with the highest educational level, whereas the lowest occupational and income groups had the highest hazard ratio (HR). Further analysis revealed that after adjustment for income status inconsistency (defined by the combination of higher educational level with lower occupational status) accounts for increased risk of IHD (HR for men, 3.14 and for women, 3.63). An association of similar strength was observed regarding high education/low income in women (HR 3.53). The combination of low education with high income reduced the risk among men (HR 0.29). No respective findings were observed concerning occupational group and income. Conclusions: Status inconsistency is associated with the risk of IHD as well as single traditional indicators of socioeconomic position. Information on status inconsistency should be measured in addition to single indicators of socioeconomic status to achieve a more appropriate estimation of the risk of IHD.
Arnold P. M. Van Der Lee - One of the best experts on this subject based on the ideXlab platform.
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A Health Insurance Company-Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care
2017Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective: To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods: In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescriptionoptimizationprotocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results: At baseline, 2.4% of the patients (n=967 506) of the participating practices used ASDs frequently on a long-term basis (180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (=0.33 for DDD; 95% CI �3.00 to 3.60). Conclusions: A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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A Health Insurance Company-initiated practice support intervention for optimizing acid-suppressing drug prescriptions in primary care.
European journal of gastroenterology & hepatology, 2011Co-Authors: Hugo M. Smeets, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. Hoes, Niek J. De WitAbstract:Background: A Health Insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs). Aim: To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription. Materials and methods: A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis. Results: At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively. Conclusion: This Health Insurance Company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
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A Health Insurance Company–Initiated Multifaceted Intervention for Optimizing Acid-Suppressing Drug Prescriptions in Primary Care: A Randomized Controlled Trial
Archives of internal medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
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a Health Insurance Company initiated multifaceted intervention for optimizing acid suppressing drug prescriptions in primary care a randomized controlled trial
JAMA Internal Medicine, 2010Co-Authors: Hugo M. Smeets, Niek J. De Wit, Nicolaas P. A. Zuithoff, Paul C. M. Van Dijk, Arnold P. M. Van Der Lee, Arno W. HoesAbstract:Objective To evaluate the effectiveness of a Health Insurance Company–initiated intervention strategy aimed at optimizing acid-suppressing drug (ASD) prescriptions in primary care. Methods In a cluster randomized controlled trial design, 112 primary care physician (PCP) peer review groups (993 PCPs) in the central region of the Netherlands were randomized. The PCPs in the intervention group received anASD prescription optimization protocol, a list of their patients taking ASDs frequently on a long-term basis, and financial compensation for additional consultations with these patients. The PCPs in the control group did not receive any of these interventions. Prescription data on 23 433 patients were extracted from the database of the regional Health Insurance Company. The main outcome measures were the proportion of patients who reduced ASD consumption by more than 50% and changes in annual volume and costs of ASD prescriptions. Differences in ASD reduction and in volume were analyzed applying multilevel regression analyses. Results At baseline, 2.4% of the patients (n = 967 506) of the participating practices used ASDs frequently on a long-term basis (>180 daily defined doses [DDDs] annually). During the 6-month intervention, 14.1% of the patients in the intervention group reduced ASD consumption compared with 13.7% in the control group (adjusted relative risk, 1.04; 95% confidence interval [CI], 0.97-1.11). Changes in intervention and control group in mean volume of ASD prescription per patient were similar (β = 0.33 for DDD; 95% CI −3.00 to 3.60). Conclusions A Health Insurance Company–initiated multifaceted intervention, including practical tools and financial incentives, did not alter ASD prescription practice in primary care. More tailored interventions, including patient-targeted initiatives, are required to optimize ASD prescription.
