title: Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers.
abstract: BACKGROUND
  Although 'best practice' guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines.
  
  
  OBJECTIVE
  To compare adherence to 'best practice' guidelines among dyspepsia experts, community gastroenterologists and primary-care providers (PCPs).
  
  
  METHODS
  We administered a vignette survey to elicit knowledge and beliefs about dyspepsia including a set of 16 best practices, to three groups: (i) dyspepsia experts; (ii) community gastroenterologists and (iii) PCPs.
  
  
  RESULTS
  The expert, community gastroenterologist and PCP groups endorsed 75%, 73% and 57% of best practices respectively. Gastroenterologists were more likely to adhere with guidelines than PCPs (P < 0.0001). PCPs were more likely to define dyspepsia incorrectly, overuse radiographic testing, delay endoscopy, treat empirically for Helciobacter pylori without confirmatory testing and avoid first-line proton pump inhibitors (PPIs). PCPs had more concerns about adverse events with PPIs [e.g. osteoporosis (P = 0.04), community-acquired pneumonia (P = 0.01)] and higher level of concern predicted lower guideline adherence (P = 0.04).
  
  
  CONCLUSIONS
  Gastroenterologists are more likely than PCPs to comply with best practices in dyspepsia, although compliance remains incomplete in both groups. PCPs harbour more concerns regarding long-term PPI use and these concerns may affect therapeutic decision making. This suggests that best practices have not been uniformly adopted and persistent guideline-practice disconnects should be addressed.
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. bspiegel@mednet.ulca.edu
authors.forename: B M R
authors.initials: BM
authors.lastname: Spiegel
authors.forename: M
authors.initials: M
authors.lastname: Farid
authors.forename: M G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: L
authors.initials: L
authors.lastname: Laine
authors.forename: C W
authors.initials: CW
authors.lastname: Howden
authors.forename: E
authors.initials: E
authors.lastname: Esrailian
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000592:standards; D004415:Dyspepsia / Q000628:therapy*; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires