Coordinator research program Learning Health System; endowed professor 'Transparency in healthcare from a patient perspective', Tranzo, Tilburg University, the Netherlands
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On demand vs continuous use of proton pump inhibitors (PPI) on symptom burden and quality of life: results of a real-world RCT in primary care patients with gastroesophageal reflux disease (GORD).
Andreasson, A., Agreus, L., Verheij, R., Wright, E., Curcin, V., Delaney, B.D. On demand vs continuous use of proton pump inhibitors (PPI) on symptom burden and quality of life: results of a real-world RCT in primary care patients with gastroesophageal reflux disease (GORD). Gastroenterology: 2019, 156(supp. 1) Abstract. In: Digestive Disease Week 2019, 2-5 mei 2019, San Diego.
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ABSTRACT:
Aim
The aim was to investigate if prescription of on demand vs continuous use of PPI influenced symptom burden, health related quality of life and selfrated health in primary care. Previous trials in this area have used 'willingness to continue' as a proxy outcome measure.
Method
The use of an innovative trials platform integrating the electronic record and patient outcomes via smartphone enables symptoms and quality of life profile to be captured. 36 primary care centres participated in the study.
Results
A total of 488 patients (median age 51 years, 58% women) completed the first visit and 360 completed the follow-up visit:
- There was no significant difference in baseline PPI use, reflux symptom burden or QoL, or in study completion, between treatment allocation.
- There was no difference between continuous or on-demand advice on PPI use, however, PPI use increased between baseline and follow-up in both groups.
- There was no difference between continuous or on-demand on either of the patient reported outcomes. However, symptom burden and health related quality of life improved significantly between baseline and follow up in both groups. - An increased PPI intake correlated significantly with a reduced reflux symptom score and an improved physical score, while no significant association was found for mental subscale or self-rated health.
Conclusion
Both continuous and on-demand dosing increase PPI consumption in real-world settings. Reaching a sufficient dose of PPI to reduce reflux symptom burden improves quality of life in patients with GORD.
ABSTRACT:
Aim
The aim was to investigate if prescription of on demand vs continuous use of PPI influenced symptom burden, health related quality of life and selfrated health in primary care. Previous trials in this area have used 'willingness to continue' as a proxy outcome measure.
Method
The use of an innovative trials platform integrating the electronic record and patient outcomes via smartphone enables symptoms and quality of life profile to be captured. 36 primary care centres participated in the study.
Results
A total of 488 patients (median age 51 years, 58% women) completed the first visit and 360 completed the follow-up visit:
- There was no significant difference in baseline PPI use, reflux symptom burden or QoL, or in study completion, between treatment allocation.
- There was no difference between continuous or on-demand advice on PPI use, however, PPI use increased between baseline and follow-up in both groups.
- There was no difference between continuous or on-demand on either of the patient reported outcomes. However, symptom burden and health related quality of life improved significantly between baseline and follow up in both groups. - An increased PPI intake correlated significantly with a reduced reflux symptom score and an improved physical score, while no significant association was found for mental subscale or self-rated health.
Conclusion
Both continuous and on-demand dosing increase PPI consumption in real-world settings. Reaching a sufficient dose of PPI to reduce reflux symptom burden improves quality of life in patients with GORD.
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