title: Attitudes and practice related to Helicobacter pylori infection among primary care physicians.
abstract: OBJECTIVE
  Helicobacter pylori infection is a major public health concern and primary care physicians (PCPs) are at the forefront of H. pylori management. We aimed to assess PCP attitudes related to H. pylori and identify areas where PCP practice deviates from the accepted guidelines.
  
  
  METHODS
  A 13-item multiple-choice internet-based questionnaire was distributed to PCPs on a national level. Five questions were related to H. pylori detection, two were related to treatment, three were related to gastric cancer, and three were related to screening. The Maastricht IV/Florence Consensus Report was used as the benchmark for correct responses.
  
  
  RESULTS
  A total of 314 PCP responses were included [140 (52%) men, age 48.2±12.9 years]. Of the total, 292 (93.0%) prescribed clarithromycin-based triple therapy for first-line treatment, 95 (30.3%) prescribed levofloxacin or bismuth-based protocols for second-line treatment, and 137 (43.6%) routinely confirmed eradication. Screening relatives of gastric cancer patients and screening before NSAID treatment was reported by 87 (30.9%) and 39 (14.1%) PCPs, respectively. Of all, 130 (45.0%) believed that the organism is definitely carcinogenic and only 188 (65.0%) agreed that H. pylori eradication reduces the risk of developing gastric cancer. Adherence with guidelines was associated with younger age, central urban clinic location, and a high volume of H. pylori patients.
  
  
  CONCLUSIONS
  Overall PCP adherence to H. pylori management guidelines is low. Public health agencies should advance educational initiatives aimed at closing these gaps.
authors.affiliation: aDepartment of Gastroenterology, Rabin Medical Center, Petah Tikva bSackler Faculty of Medicine, Tel Aviv University cTel Aviv and Central Administration, Clalit Health Services, Tel Aviv dBat Yamon Medical Center, Clalit Health Services, Bat Yam, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Boltin
authors.forename: Nimrod
authors.initials: N
authors.lastname: Kimchi
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
authors.forename: Rachel
authors.initials: R
authors.lastname: Gingold-Belfer
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Shlomo
authors.initials: S
authors.lastname: Birkenfeld
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D019985:Benchmarking; D032921:Consensus; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011320:Primary Health Care; D000071836:Professional Practice Gaps; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors