• M M Mamdani, K Tu, L Jaakkimainen, A Bica, and J Hux.
• Institute for Clinical Evaluative Sciences, Toronto, Ont.
• Can Fam Physician. 2001 Mar 1; 47: 531-5.

ObjectiveTo assess compliance with a step-up approach to proton pump inhibitor (PPI) therapy before implementation of a new provincial policy to promote histamine-type 2 receptor antagonist (H2RA) use before PPI therapy.DesignPopulation-based, retrospective, open cohort study using prescribing and medical procedure data from January 1, 1995, to April 30, 1999.SettingHealth administration databases for the universal health care system in Ontario.ParticipantsApproximately 1.4 million residents of Ontario older than 65 years.Main Outcome MeasuresProportion of patients who received a trial of H2RA therapy or gastrointestinal diagnostic testing 12 months before starting PPI therapy in 1996.ResultsAmong the 25,870 patients who met study criteria in 1996, about 63% had received H2RAs 12 months before starting PPI therapy and 73% had had a trial of H2RAs or gastrointestinal diagnostic testing. Repeat analysis for January through April 1999, following the new policy implementation, showed that about 72% of patients had had a trial of H2RAs within 12 months of starting PPI therapy.ConclusionA modest gain (9%) in compliance with using H2RA therapy within 12 months before starting PPI therapy was seen following introduction of the step-up intervention. In future, costs and benefits of potential interventions should be carefully considered before implementing new policies.

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