Effect of Implementation of a Dyspepsia and <i>Helicobacter pylori</i> Eradication Guideline in Primary Care

Abstract

Background: Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management. Aims: To evaluate the impact on general practitioner (GP) practice and healthcare costs of a participatory intervention to modify primary dyspepsia and Helicobacter pylori (Hp) infection management, by standardised implementation of an international guideline in the local setting, through a prospective, controlled before-and-after study. Methods: Primary dyspepsia management was monitored in the Local Health District of Padua; 63 of all 354 local GPs (total patient population: 82,284) took part in a primary-care improvement programme. Measured variables were: mean prescribed gastroscopies/1,000 registered patients, mean expenditure/1,000 registered patients for antisecretories (H₂ blockers) and proton pump inhibitors (PPIs), inter-GP prescribing variability and adherence to guidelines, analysed through prospectively filled-out reports on GP consultations for dyspepsia. A 3-month pre-survey period was compared with a 6-month intervention period following implementation of an agreed guideline. Results: Compared to non-participating GPs, intervention yielded a 30 and 26.4% reduction in H₂-blocker and PPI expenditure, respectively. Application of the guideline led to an upward trend in endoscopy prescriptions, coupled with a 7% increase in appropriate referrals. Intra-group variability marginally decreased; guideline compliance rose slightly. Conclusions: Participatory intervention can reduce prescribing variability among GPs and inappropriate esophagogastroduodenoscopies, lowering related costs. Results may not have been spectacular, but in view of the number of patients involved, they may have an important impact on Local Health District expenditure.

The impact of proton pump inhibitor therapy on patients with liver disease

“…The findings from this study highlight that these guidelines are not being followed. Financial incentives to reward doctors for following dyspepsia guidelines were found to be useful in Italy, France and Sweden . Following evidence‐based prescribing will result in large savings for health budgets, as one Irish study reported costs being reduced by one quarter if all patients were stepped down to maintenance dose after 3 months of maximum dose PPI therapy .…”

“…Financial incentives to reward doctors for following dyspepsia guidelines were found to be useful in Italy, France and Sweden. [35][36][37] Following evidence-based prescribing will result in large savings for health budgets, as one Irish study reported costs being reduced by one quarter if all patients were stepped down to maintenance dose after 3 months of maximum dose PPI therapy. 38 The handover from secondary back to primary care should be closely monitored with regards to PPI prescription to ensure appropriate review of treatment.…”

Proton pump inhibitors: potential cost reductions by applying prescribing guidelines

“…An Italian study which linked implementation of dyspepsia guidelines to a pay deal for general practitioners reported a 26% reduction in PPI expenditure in comparison with non-participating practices [40]. France and Sweden, have introduced prescribing targets such as the percentage of prescriptions for generic PPIs linked with financial incentives [41,42].…”

Elevated Serum Lipase Levels in Patients with Dyspepsia of Unknown Cause in General Practice

“…Eradication of H. pylori infection showed a 14% reduction of functional dyspepsia compared with placebo [26] . However, most of our patients (elder Japanese) were expected to be infected with H. pylori , but routine H. pylori testing is not recommended in older patients with dyspepsia in primary care [27] .…”