Most patients were aware that PPIs were expensive drugs but felt that the severity of their
symptoms justified the cost. Patients accepted the need to reduce costs otherwise drugs
might not be available in the future but wanted reassurance that if changes to their
medication proved ineffective they could revert to the more effective and costly regime. GPs
underestimated patients’ willingness to change to minimum treatment with communication
highlighted as an essential component of a favourable response to alterations in medication.
Some practices had implemented a policy of ‘double switching’- changing brand and lowering
dose at the same time, with the dose reduction producing most of the cost saving. When this
happened, patients were often unaware of the dose reduction, only the brand change. If
symptoms returned they believed the brand was ineffective rather than dose. Double
switching often failed, with patients reverting back to the full dose of PPI.