H. pylori Counseling Provides Improvement of Disease Management at Primary Care Level

Implementation of educational counseling helped improve the treatment of Helicobacter pylori (H pylori) infection among primary care physicians (PCPs), but did not improve the appropriateness of indications for eradication of the infection as established by national and international guidelines, according to a recent study.

H pylori in the PCP Setting

The management of H pylori has expanded from gastroenterology specialists to PCPs in recent decades. However, available research on PCP management suggests a low adherence to guideline recommendations at the patient care level.

“Outcomes based on this change in the management of H pylori infections needs to be monitored, since the implications for our health systems are important,” wrote Viviana Laredo, of Hospital Clinico Universitario Lozano Blesa, Spain, and colleagues. “The appropriateness of H pylori diagnosis and treatment is mandatory and should be based on either international or national guidelines.”

In this two-phase study, the researchers first included 650 consecutive urea breath tests (UBTs) requested by PCPs (n = 400) and gastroenterologists (n = 250). The indications and treatments were classified as appropriate or inappropriate based on guidelines. In phase II, 399 UBTs and patients’ treatment outcomes were analyzed after individually counseling PCPs on both aspects.

Of the 1,049 UBTs requested, about one-third (35.9%) requested by PCPs were for inappropriate indications during phase I compared with only 7.2% requested by specialists (P < .001). Additionally, inappropriate treatment regimens were more than double among PCPs compared with gastroenterologists (65.8% vs. 26.4%, P < .001). Specifically, PCPs mainly prescribed standard triple therapy (63.1%) whereas specialists mainly prescribed quadruple concomitant therapy (62.6%, P < .001).

“In Spain, like in most countries now, eradication rates based on standard triple therapy are suboptimal (<75%), and triple therapy is not an appropriate first‐line therapy for H pylori eradication,” the researchers wrote. “The result obtained at the primary care level indicates that most spontaneous treatment regimens (63.1%) issued by PCPs were based on triple therapy, which is inappropriate.”

As a result of these inappropriate regimens, rates of eradication were significantly lower in patients treated in primary care than among those treated by a specialist (63.7% vs. 81.4%, P = .004).

After PCPs underwent counseling, there was significant improvement in rates of adherence to appropriate treatment regimens (75.8% vs. 34.2%; P < .001) and eradication rates (79.2% vs. 63.7%; P = .002), but no improvement in appropriateness of indications was observed.