title: Effect of implementation of a dyspepsia and Helicobacter pylori eradication guideline in primary care.
abstract: BACKGROUND
  Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management.
  
  
  OBJECTIVE
  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 (H(2) 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 H(2)-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.
authors.affiliation: Gastroenterology Service, Geriatric Department, Azienda Ospedaliera, Via Giustiniani, IT-35100 Padua, Italy. word.online@tin.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cardin
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Bovo
authors.forename: Cosimo
authors.initials: C
authors.lastname: Guerra
authors.forename: Fabio
authors.initials: F
authors.lastname: Bandini
authors.forename: Daniele
authors.initials: D
authors.lastname: Polito
authors.forename: Francesca
authors.initials: F
authors.lastname: Bano
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Grion
authors.forename: Roberto
authors.initials: R
authors.lastname: Toffanin
mesh_terms: D003363:Cost Control; D004415:Dyspepsia / Q000188:drug therapy*; D019983:Guideline Adherence; D017048:Health Care Costs / Q000706:statistics & numerical data; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D007558:Italy; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care