This project reviewed Kansas City VA Medical Center patients identified as part of an MUE. In order to obtain an adequate group, all patients receiving a one-month supply of the formulary PPI, lansoprazole canadian, and with a quantity of 60 doses or greater from January 1 to December 31, 1999, were evaluated. Criteria for step-down therapy included an active prescription or a refill within six months of lansoprazole administered twice daily and a diagnosis of uncomplicated GERD based on EGD results and/or primary care provider notes.
Excluded from the study were patients with evidence of strictures, varices, Barrett’s esophagus, or esophagitis on EGD examination. Patients were also excluded if the VA Medical Center was not their primary health care institution. The P&T committee at the VA Medical Center approved the protocol. canadian antibiotics
Patients were identified and then contacted. During the initial assessment, the pharmacist explained step-down therapy and the follow-up telephone schedule. After the initial contact, letters were mailed to patients to provide written instructions regarding the step-down therapy, the follow-up schedule, some general information about GERD, nonpharmacological ways to reduce symptoms, and the pharmacist’s phone number should any problems arise. Patients’ prescriptions were edited in the computer system to reflect the new dosing schedule for future refills. The pharmacist completed follow-up phone calls at two and four weeks after the initial conversation or bimonthly until symptoms were controlled.
Patients were asked questions that were derived from the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) Scale to assess severity, frequency, and time of day at which the symptoms occurred, if present, following dose reduction. According to the protocol, if patients’ symptoms worsened, 150 mg of medication ranitidine (Zantac canadian, GlaxoSmithKline) was added at bedtime to their regimens and titrated to a maximum dose of 300 mg twice daily. If no reliefwas achieved at the maximum dose, patients were referred to the gastroenterology service and scheduled for EGD before reinitiation of lansoprazole drug therapy twice daily. Medication profiles were also reviewed for age, weight, height, length of treatment with a PPI, and concomitant medications that might have exacerbated symptoms of GERD.
A Student’s Mtest was used to calculate mean and standard deviation (SD) for interval data.