A randomized trial of an acid-peptic disease management program in a managed care environment.
OBJECTIVE
To study the effectiveness of a disease management program for patients with acid-related disorders.


METHODS
A cluster-randomized clinical trial of 406 patients comparing a disease management program with "usual practice."


METHODS
Enrolled patients included those presenting with new dyspepsia and chronic users of antisecretory drugs in 8 geographically separate physician offices associated with the Orlando Health Care Group. There were 35 providers in the intervention group and 48 in the control group. The disease management program included evidence-based practice guidelines implemented by using physician champions, academic detailing, and multidisciplinary teams. Processes of care, patient symptoms, quality of life, costs, and work days lost were measured 6 months after patient enrollment.


RESULTS
Compared with usual practice, disease management was associated with improvements in Helicobacter pylori testing (61% vs 9%; P = .001), use of recommended H pylori treatment regimens (96% vs 10%; P = .001), and discontinuation rates of proton pump therapy after treatment (70% vs 36%; P = .04). There were few differences in patient quality of life or symptoms between the 2 study groups. Disease management resulted in fewer days of antisecretory therapy (71.7 vs 88.1 days; P = .02) but no difference in total costs.


CONCLUSIONS
This disease management program for patients with acid-related disorders led to improved processes of care. The effectiveness of such a program in other settings requires further study.
Ofman
Joshua J
JJ
Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, Calif, USA. jofman@cerner.com
Segal
Richard
R
Russell
Wayne L
WL
Cook
Deborah J
DJ
Sandhu
Meenu
M
Maue
Susan K
SK
Lowenstein
Edward H
EH
Pourfarzib
Ray
R
Blanchette
Erv
E
Ellrodt
Gray
G
Weingarten
Scott R
SR
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005744:Gastric Acid; D019983:Guideline Adherence; D005102:Health Expenditures; D006302:Health Services Research; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010437:Peptic Ulcer / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D017494:Proton Pumps / Q000819:agonists; D011788:Quality of Life; D014481:United States
D000897:Anti-Ulcer Agents; D017494:Proton Pumps