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Different Implementation Methods Change the Impact of Dyspepsia Guidelines on Pharmaceutical Spending

Abstract
It has been demonstrated that different implementation methods are more or less instrumental to the guidelines (GLs)' acceptance in primary care. This study analyzes the effect on drug expenditure of three different methods for implementing the same GLs adopted by three different groups of general practitioners. The investigation was based on: a negotiated, multifaceted implementation method lasting nine months (with financial incentives to complete the program) (Project A); a one-day, peer-led, evidence-based training session in small work groups (Project B); a pre/post-application meeting held by an expert (Project C). For each project, we compared the monthly expenditure on proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs) per 1 000 patients registered by participating vs control general practitioners (GPs), before and after implementing the GLs. The 58 GPs involved in Project A reduced their expenditure on PPIs by 26% (4 564 euros vs. 6 201 euros for 222 controls, p = 0.057) and on H2RAs by 30% (954 vs. 1 365 euros; p = 0.026). The 101 GPs enrolled in Project B spent 5 535 euros on PPIs and 556 euros on H2 blockers, as opposed to the 5 732 and 706 euros spent in the same period by 61 GP controls (meaning a saving of 3% for PPI and 21% for H2RAs; p = ns). The 15 GPs joining Project C spent 2 479 euros on PPIs and 1, 258 euros on H2RAs, compared to the 2 215 euros spent on PPIs and 1 524 euros on H2 blockers by 270 GP controls (i.e. with a 12% increase in expenditure for PPI and a 17% reduction for H2RAs; p = ns). Our study suggests that adopting the same GLs on the management of dyspepsia only reduces pharmaceutical spending on anti-ulcer drugs if a multifaceted, negotiated and formally-accepted implementation method is used.

Key words
dyspepsia guidelines, implementation method, pharmaceutical spending, proton pump inhibitors, histamine-2 receptor antagonists

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