Effect of implementation of a dyspepsia and Helicobacter pylori eradication guideline in primary care.
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.
Cardin
Fabrizio
F
Gastroenterology Service, Geriatric Department, Azienda Ospedaliera, Via Giustiniani, IT-35100 Padua, Italy. word.online@tin.it
Zorzi
Manuel
M
Bovo
Emanuela
E
Guerra
Cosimo
C
Bandini
Fabio
F
Polito
Daniele
D
Bano
Francesca
F
Grion
Anna Maria
AM
Toffanin
Roberto
R
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