Variation in the use of H. pylori tests in UK general practice--a qualitative study.
BACKGROUND
Although serology is the main Helicobacter pylori test used by general practitioners in the UK, there is no information available on variation in requesting rates.


OBJECTIVE
To explore the reasons for any variation in H. pylori serology testing by general practices in the UK using qualitative methods.


METHODS
Serology requesting rates were determined using laboratory and population data. Staff from randomly selected practices in the lowest and highest quintiles of testing attended focus groups to discuss the management of H. pylori and dyspepsia. Transcribed data were analysed using an interpretative phenomenological approach.


RESULTS
Serology submission varied 600-fold (0.1-59/1000 population/year) and H. pylori positivity rate 17-100%. Low-testing practices were less aware of the benefits of H. pylori testing and had shorter endoscopy waiting times. They preferred endoscopy diagnosis over serology test. Three high-testing practices had a high non-white population with high H. pylori positivity. Most staff knew little about the predictive value of serology, the availability of urea breath test on prescription or the existence of a stool test.


CONCLUSIONS
Seroprevalence of H. pylori is still high in dyspeptics, especially in non-white populations. Laboratories and primary care trusts should audit H. pylori requests and endoscopy referrals, target education at high endoscopy referrers and low H. pylori testers and inform clinicians of the more accurate H. pylori tests and NICE dyspepsia guidance.
McNulty
C A M
CA
Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK. jill.whiting@hpa.org.uk
Freeman
E
E
Bowen
J
J
Delaney
B C
BC
D002983:Clinical Competence; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012698:Serologic Tests / Q000706:statistics & numerical data*; D006113:United Kingdom