Starting, stepping down and stopping medicines: new program from NPS MedicineWise

The latest therapeutic visiting program from NPS MedicineWise illustrates how to start, step down and stop medicines, focusing on proton pump inhibitors (PPIs) to treat patients with gastro-oesophageal reflux disease (GORD) in primary care.

PPIs are among the most commonly prescribed medicines in general practice in Australia. In 2015–16, GORD accounted for 13.2% of all new problems managed in general practice, and heartburn – which can be a symptom of GORD – is experienced by 15% to 20% of adults at least once each week.

NPS MedicineWise reinforces that knowing when a patient can safely and effectively reduce or stop taking PPIs is a key quality use of medicines consideration for GPs. The “Starting, Stepping Down and Stopping Medicines” program is designed to support GPs in this process.

Dr Jill Thistlethwaite, Medical Advisor, NPS MedicineWise, says, “As PPIs are prescribed frequently and are effective at reducing symptoms, some patients may consider them as lifetime medicines. It is therefore important for health professional to discuss appropriate lifestyle changes, such as losing weight, stopping smoking or reducing alcohol consumption, that could reduce or stop the need for future treatment.”

“While serious adverse effects associated with PPI use are rare, the considerable number of people taking PPIs increases the chances that some of them may experience an adverse effect. Long-term regular PPI therapy is generally not necessary nor recommended for most patients with GORD and benefits of ongoing use should be balanced with possible risks. This emphasises the need for GPs to regularly review patients taking PPIs for GORD, with the aim of stepping down to the lowest effective dose, or stopping, when symptoms are well controlled.”

“Discussing and adopting tailored treatment options informed by the patient’s lifestyle and dietary choices that may trigger symptoms could improve their quality of life considerably. Our evidence-based program will further enable GPs to engage with patients in making the best decisions about how GORD should be managed.”

The “Starting, Stepping Down and Stopping Medicines” program offers GPs independent and evidence-based information from an NPS MedicineWise Clinical Services Specialist via an in-practice educational visit. In addition, a Clinical e-Audit (available from September 2018); patient action plan to help facilitate discussions with relevant patients; and the opportunity to participate in an online case study and receive instant feedback can be accessed via www.nps.org.au/ppis

RACGP QI & CPD and ACRRM PD points are available for GPs who participate. To find out more go to www.nps.org.au/ppis

ENDS