| Autor: |
Majumdar, S. R., Ross‐Degnan, D., Farraye, F. A., Lee, M., Kemp, J. A., Lecates, R. F., Henning, J. M., Tunis, S. R., Schrammel, P., Soumerai, S. B. |
| Předmět: |
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| Zdroj: |
Alimentary Pharmacology & Therapeutics; Apr2005, Vol. 21 Issue 8, p1029-1039, 11p |
| Abstrakt: |
: Many symptomatic patients take proton pump inhibitors or histamine-2 blockers for years and those without gastro-oesophageal reflux disease might benefit fromHelicobacter pylorieradication.: To increase testing and treatment ofH. pyloriand reduce chronic use of proton pump inhibitors and histamine-2 blockers.: We conducted a three-armed controlled trial in 14 managed care practices. We included adults who used proton pump inhibitors or histamine-2 blockers for>1 year and excluded those with gastro-oesophageal reflux disease or previous endoscopy. We compared usual care (n = 312 patients from 6 practices) to low-intensity (n = 147 from 3 practices) and high-intensity (n = 122 from 5 practices) interventions. Low-intensity intervention consisted of guidelines, patient-lists, and a‘toolkit’; high-intensity intervention added academic group detailing by a gastroenterologist with reinforcement by pharmacists.: Compared with usual care, the high-intensity intervention increasedH. pyloritest-ordering (29% versus 9% at 12 months,P = 0.02). About half (23 of 58) of patients tested positive and 22 received eradication treatments. The high-intensity intervention decreased proton pump inhibitor use by 9% per year (P = 0.028), but did not alter histamine-2 blocker use. The low intensity intervention was ineffective.: Providing guidelines, patient-lists, and toolkits was no better than usual care. Adding group detailing and pharmacist reinforcements led to improvements inH. pylorimanagement and decreases in proton pump inhibitor use. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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