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Controlled trial of interventions to increase testing and treatment for Helicobacter pylori and reduce medication use in patients with chronic acid-related symptoms Majumdar SR; Ross-Degnan D; Farraye FA; Lee M; Kemp JA; Lecates RF; Henning JM; Tunis SR; Schrammel P; Soumerai SBAliment Pharmacol Ther 2005[Apr]; 21 (8): 1029-39BACKGROUND: Many symptomatic patients take proton pump inhibitors or histamine-2 blockers for years and those without gastro-oesophageal reflux disease might benefit from Helicobacter pylori eradication. AIM: To increase testing and treatment of H. pylori and reduce chronic use of proton pump inhibitors and histamine-2 blockers. METHODS: We conducted a three-armed controlled trial in 14 managed care practices. We included adults who used proton pump inhibitors or histamine-2 blockers for >1 year and excluded those with gastro-oesophageal reflux disease or previous endoscopy. We compared usual care (n = 312 patients from 6 practices) to low-intensity (n = 147 from 3 practices) and high-intensity (n = 122 from 5 practices) interventions. Low-intensity intervention consisted of guidelines, patient-lists, and a "toolkit"; high-intensity intervention added academic group detailing by a gastroenterologist with reinforcement by pharmacists. RESULTS: Compared with usual care, the high-intensity intervention increased H. pylori test-ordering (29% versus 9% at 12 months, P = 0.02). About half (23 of 58) of patients tested positive and 22 received eradication treatments. The high-intensity intervention decreased proton pump inhibitor use by 9% per year (P = 0.028), but did not alter histamine-2 blocker use. The low intensity intervention was ineffective. CONCLUSIONS: Providing guidelines, patient-lists, and toolkits was no better than usual care. Adding group detailing and pharmacist reinforcements led to improvements in H. pylori management and decreases in proton pump inhibitor use.|*Helicobacter pylori[MESH]|*Proton Pump Inhibitors[MESH]|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Dyspepsia/*drug therapy[MESH]|Female[MESH]|Helicobacter Infections/diagnosis/*drug therapy[MESH]|Histamine H2 Antagonists/*therapeutic use[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH] |
