ABSTRACT
BACKGROUND: It is unclear what impact Helicobacter pylori infection has had on the management of dyspepsia in primary care and to what extent published guidelines on H. pylori are implemented in routine clinical practice. AIM: To assess the impact of H. pylori infection on the management of dyspepsia in primary care. METHODS: Patients referred by primary care doctors to an open-access 13-carbon urea breath test service over a 2-year period for their first urea breath test were included in the study. Individual breath results were linked with data on prescribing obtained from the General Medical Services prescription database. RESULTS: Of 805 patients, 374 (47%) had a positive urea breath test and 431 (54%) a negative urea breath test. Of positive urea breath test patients, only 245 (64%) were prescribed eradication therapy in the 3 months after the breath test and only 43% were referred back for re-testing. In the year after the urea breath test, there was a significant fall in prescribing of antisecretory therapy which was greatest in the patients who received H. pylori therapy (P < 0.001). CONCLUSIONS: There appears to be under and inappropriate treatment of H. pylori infection in primary care, and a low rate of re-testing after eradication, indicating that current guidelines are not well implemented in practice.
Subject(s)
Antacids/therapeutic use , Dyspepsia/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori , Adult , Drug Prescriptions/statistics & numerical data , Dyspepsia/microbiology , Female , Guideline Adherence , Humans , Male , Middle Aged , Practice Guidelines as Topic , Primary Health Care/standardsABSTRACT
Keystone 65, the Medicare Program of Keystone Health Plan East, has designed case management programs around the needs of America's seniors. Keystone 65 utilizes a health risk assessment tool to aid in determining a member's health risk profile. This tool, the Health Risk Assessment Form, consists of the Short Form 36, the Nutrition Screening Initiative Nutrition Checklist, self-reported disease questions, and questions related to the health plan. Preliminary analysis has led Keystone to believe that the use of such an assessment tool will aid in identifying those members who need proactive case management and intervention. The increased use of the Checklist may provide the case management department with an important element in the assessment of Keystone 65 members.
