A Program to Improve the Management of Patients on Long-Term Acid Suppression Medication

Disease management programs typically focus on a few common chronic conditions for which it is possible to simultaneously improve care and reduce costs, such as asthma and diabetes. Insufficient attention has been paid to the management of upper gastrointestinal (UGI) disorders, including peptic ulcer disease, gastritis, dyspepsia, and gastroesophageal reflux disease (GERD), although there are some notable exceptions [1–3]. UGI conditions are both common and costly, particularly with respect to the increasing use of acid suppression medications [2,4,5]. In addition, recently published guidelines and studies have provided some standards necessary for the development of decision rules, which are used to disseminate population-based management strategies [6–12]. Therefore, UGI disorders may be an appropriate target for improving care through disease management. The need for improved management of UGI disorders is especially clear among chronic users of acid suppression therapy. These patients may be symptomatic despite therapy or asymptomatic, and a large proportion may continue acid suppression therapy indefinitely without having received an adequate investigation of their symptoms [2,13]. Patients on longterm acid suppression medications can be easily identified from pharmacy billing data. Despite these potential opportunities, there are numerous obstacles to a systematic population-based approach to improving the management of UGI disorders. For example, physicians frequently treat UGI symptoms empirically, and the resulting diagnostic uncertainty makes the development of management recommendations challenging. In this paper, we describe a program designed to improve the management of UGI conditions in a large provider organization.