Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions

Abstract

Introduction Dyspepsia and Helicobacter pylori are two of the most relevant digestive conditions in primary care. Several consensuses on the subject have been published, but the assimilation/implementation of these guidelines is uncertain. Aims and Methods To evaluate the attitudes, perceptions, limitations, and adherence to recommendations of Spanish primary care physicians using an open online survey. Responses were anonymously codified. Estimated margin of error was 3.4%. Responses were weighted by province, gender, age, and type of practice. Survey was performed using the AEG‐REDCap platform. Results A total of 1445 responses, received between December 2017 and April 2018, were analyzed. Women represented 54%, and the average age was 48 years; 59% were from urban context, 20% from semi‐urban, and 21% from rural; 93% provided public practice. Over 40% had read at least one Maastricht consensus (24% Maastricht V), and 34% had attended a course related to H. pylori. 16% reported no direct access to any validated diagnostic method, only 44% to urea breath test, and 33% did not systematically refer to eradication confirmation test. The first‐line treatment of choice was standard triple therapy in 56%, followed by concomitant therapy (28%). Only 20% of physicians had optimal adherence to recommendations. Conclusion Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed. To provide optimal primary care, the barriers for implementation, access to diagnostic tests and to continuous medical education, should be removed. Rigorous dissemination, implementation, and evaluation programs are desired in future consensuses.

Protocol of the European Registry on the management of Helicobacter pylori infection (Hp‐EuReg)

“…The EHMSG realizes that H pylori infection is a burden of paramount importance for the healthcare systems throughout Europe and the world as it affects over half of the world's population, and it is the leading cause of peptic ulcer and gastric cancer. However, there is an immense variety of strategies regarding the management of this chronic infection, affecting the indication, diagnosis, treatment, and follow‐up . Although the Maastricht IV and V Consensus provide clear recommendations, their implementation is not certain and, therefore, their effect for society is unknown.…”

Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

“…Spanish primary care survey on the management of H pylori infection and dyspepsia concluded that only 20% of physicians had optimal adherence to recommendations. Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed 26 …”

“…Primary care physicians (PCPs) play a very important role in the detection and treatment of H pylori infection. Previous research of the application of guidelines for the detection and treatment of H pylori infection has shown an insufficient level of knowledge and adherence to management of H pylori in PCPs in the world for last two decades 14‐26 …”

Review ‐ Helicobacter pylori and non‐malignant upper gastro‐intestinal diseases

“…Analysing 1445 responses, only 40% of the physicians had read at least one Maastricht consensus report. Sixteen percent reported no access at all to validated H pylori diagnostics and 33% of the responders do not systematically refer to eradication confirmation tests 28 . In conclusion, there is a clear need to improve the perception/availability and adherence to current guidelines.…”