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Israel Journal of Health Policy Research

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01-12-2020 | Helicobacter Pylori | Original research article

Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Authors: Wasef Na’amnih, Amir Ben Tov, Amna Bdair-Amsha, Shlomi Cohen, Judith Tsamir, Gabriel Chodick, Khitam Muhsen

Published in: Israel Journal of Health Policy Research | Issue 1/2020

Abstract

Background

Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract. The study aim was to assess the adherence of PCPs to the guidelines on the management of Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) in adults.

Methods

We conducted a cross-sectional study during March–July 2017 using the survey platform of Maccabi Healthcare Services in Israel. The study questionnaire assessed adherence to the Maastricht/Florence guidelines on H. pylori infection and the American College of Gastroenterology guidelines on the management of GERD. We sent the study questionnaires to a random sample of 610 PCPs via electronic mails. We contacted those who did not respond by telephone; eventually 180 physicians completed the survey.

Results

Ninety (50%) and 60 (36%) of the responders reported using professional guidelines for the diagnosis and management of H. pylori infection and GERD, respectively. Of the 180 participants, 153 (85%) reported referring patients with suspected peptic ulcer disease to H. pylori testing, 109 (61%) reported referring patients with unexplained iron deficiency anemia and 83 (46%) refer relatives of gastric cancer patients. In caring for young patients who have dyspepsia without alarm symptoms, 127 (74%) reported referral to a urea breath test for the diagnosis of H. pylori infection, and 136 (81%) referral to a specialist in gastroenterology if alarm symptoms present. Triple therapy with proton pump inhibitors/clarithromycin/amoxicillin or metronidazole was reported as first-line therapy by 141 (83%) participants. For GERD, 94–98% of the participants followed the appropriate recommendations.

Conclusions

We identified gaps between the practices of PCPs and the guidelines on H. pylori infection management, while guidelines on GERD management are well adopted. Simplification of the guidelines and exploring barriers towards their implementation by PCPs is warranted.

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Avramidou M, Angst F, Angst J, Aeschlimann A, Rossler W, Schnyder U. Epidemiology of gastrointestinal symptoms in young and middle-aged Swiss adults: prevalences and comorbidities in a longitudinal population cohort over 28 years. BMC Gastroenterol. 2018;18:21. https://doi.org/10.1186/s12876-018-0749-3.CrossRefPubMedPubMedCentral

Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018. Gastroenterology. 2019;156:254−+. doi:https://doi.org/10.1053/j.gastro.2018.08.063.

Adar T, Levkovich I, Castel OC, Karkabi K. Patient's utilization of primary care: a profile of clinical and administrative reasons for visits in Israel. J Prim Care Communit. 2017;8:221–7. https://doi.org/10.1177/2150131917734473.CrossRef

Broker LE, Hurenkamp GJB, ter Riet G, Schellevis FG, Grundmeijer HG, van Weert HC. Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study. BMC Fam Pract. 2009;10. doi:Artn 63 https://doi.org/10.1186/1471-2296-10-63.

Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002;347:1175–86. doi:Doi https://doi.org/10.1056/Nejmra020542.

Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence consensus report. Gut. 2017;66:6–30. https://doi.org/10.1136/gutjnl-2016-312288.CrossRefPubMed

Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? J Neurogastroenterol Motil. 2018;24:559–69. https://doi.org/10.5056/jnm18140.CrossRefPubMedPubMedCentral

Petrick JL, Nguyen T, Cook MB. Temporal trends of esophageal disorders by age in the Cerner health facts database. Ann Epidemiol. 2016;26:151–4. https://doi.org/10.1016/j.annepidem.2015.11.004.CrossRefPubMed

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28. https://doi.org/10.1038/ajg.2012.444.CrossRefPubMed

10.

Maconi G, Tosetti C, Miroglio G, Parente F, Colombo E, Sainaghi M, et al. Management of Helicobacter pylori-related gastrointestinal diseases by general practitioners in Italy. Aliment Pharm Therap. 1999;13:1499–504.CrossRef

11.

Sharma VK, Howden CW. A national survey of primary care physicians' perceptions and practices related to Helicobacter pylori infection. J Clin Gastroenterol. 2004;38:326–31. doi:Doi https://doi.org/10.1097/00004836-200404000-00006.

12.

Sharma VK, Vasudeva R, Howden CW. A survey of gastroenterologists' perceptions and practices related to helicobacter pylori infection. Am J Gastroenterol. 1999;94:3170–4.CrossRef

13.

Ahmed S, Salih M, Jafri W, Ali Shah H, Hamid S. Helicobacter pylori infection: approach of primary care physicians in a developing country. BMC Gastroenterol. 2009;9:23. https://doi.org/10.1186/1471-230X-9-23.CrossRefPubMedPubMedCentral

14.

Canbaz S, Sunter AT, Peksen Y, Leblebicioglu H. Survey of general practitioners' knowledge about Helicobacter pylori infection. BMC Gastroenterol. 2005;5. doi:Artn 4https://doi.org/10.1186/1471-230x-5-4.

15.

Cano-Contreras AD, Rascon O, Amieva-Balmori M, Rios-Galvez S, Maza YJ, Meixueiro-Daza A, et al. Approach, attitudes, and knowledge of general practitioners in relation to helicobacter pylori is inadequate. There is much room for improvement! Rev Gastroenterol Mex. 2018;83:16–24. https://doi.org/10.1016/j.rgmx.2017.02.004.CrossRefPubMed

16.

Mansour Ghanaei F, Joukar F, Soati F, Gharib S. Knowledge and practice of general practitioners and internists about helicobacter pylori infection in Guilan. Iran Middle East J Dig Dis. 2011;3:119–25.

17.

Fischbach W, Zerl A, Klassert C. How do primary care physicians manage their patients with helicobacter pylori infection? Results of a survey and their implementation into the German S2k guideline 2016. Z Gastroenterol. 2017;55:136–9. https://doi.org/10.1055/s-0042-119453.CrossRefPubMed

18.

Huang JQ, Lam SK, Malfertheiner P, Hunt RH. Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care physicians. J Gastroenterol Hepatol. 2003;18:512–20. doi:DOI https://doi.org/10.1046/j.1440-1746.2003.03017.x.

19.

Murakami TT, Scranton RA, Brown HE, Harris RB, Chen Z, Musuku S, et al. Management of Helicobacter Pylori in the United States: results from a national survey of gastroenterology physicians. Prev Med. 2017;100:216–22. https://doi.org/10.1016/j.ypmed.2017.04.021.CrossRefPubMed

20.

Chey WD, Inadomi JM, Booher AM, Sharma VK, Fendrick AM, Howden CW. Primary-care physicians' perceptions and practices on the management of GERD: results of a national survey. Am J Gastroenterol. 2005;100:1237–42. https://doi.org/10.1111/j.1572-0241.2005.41364.x.CrossRefPubMed

21.

Vakil N, Malfertheiner P, Salis G, Flook N, Hongo M. An international primary care survey of GERD terminology and guidelines. Dig Dis. 2008;26:231–6. https://doi.org/10.1159/000121352.CrossRefPubMed

22.

Shirin H, Birkenfeld S, Shevah O, Levine A, Epstein J, Boaz M et al. Application of Maastricht 2–2000 guidelines for the management of Helicobacter pylori among specialists and primary care physicians - In Israel are we missing the malignant potential of Helicobacter pylori? J Clin Gastroenterol. 2004;38:322–5. doi:Doi https://doi.org/10.1097/00004836-200404000-00005.

23.

Boltin D, Kimchi N, Dickman R, Gingold-Belfer R, Niv Y, Birkenfeld S. Attitudes and practice related to helicobacter pylori infection among primary care physicians. Eur J Gastroenterol Hepatol. 2016;28:1035–40. https://doi.org/10.1097/Meg.0000000000000659.CrossRefPubMed

24.

Niv Y, Birkenfield S. Gastroesophageal reflux disease: a need for guidelines for the primary care physician. Isr Med Assoc J. 2002;4:684–6.PubMed

25.

Na'amnih W, Katz R, Goren S, Ben-Tov A, Ziv-Baran T, Chodick G et al. Correlates of gastroenterology health-services utilization among patients with gastroesophageal reflux disease: a large database analysis. Isr J Health Policy. 2019;8. doi:ARTN 66 https://doi.org/10.1186/s13584-019-0335-3.

26.

Cassel CK, Guest JA. Choosing wisely helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801–2. https://doi.org/10.1001/jama.2012.476.CrossRefPubMed

27.

Clarfield AM, Manor O, Nun GB, Shvarts S, Azzam ZS, Afek A, et al. Health and health care in Israel: an introduction. Lancet. 2017;389:2503–13. https://doi.org/10.1016/S0140-6736(17)30636-0.CrossRefPubMed

28.

Porath A, Lev B. The new Israeli national health insurance law and quality of care. Int J Qual Health Care. 1995;7:281–4. https://doi.org/10.1093/intqhc/7.3.281.CrossRefPubMed

29.

Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon ATR, Bazzoli F, et al. Management of Helicobacter pylori infection-the Maastricht IV/ Florence consensus report. Gut. 2012;61:646–64. https://doi.org/10.1136/gutjnl-2012-302084.CrossRefPubMed

30.

Harkanen T, Kaikkonen R, Virtala E, Koskinen S. Inverse probability weighting and doubly robust methods in correcting the effects of non-response in the reimbursed medication and self-reported turnout estimates in the ATH survey. BMC Public Health. 2014;14:1150. https://doi.org/10.1186/1471-2458-14-1150.CrossRefPubMedPubMedCentral

31.

Benjamini Y, Hochberg Y. Controlling the false discovery rate - a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289–300.

32.

Muhsen K, Athamna A, Bialik A, Alpert G, Cohen D. Presence of Helicobacter pylori in a sibling is associated with a long-term increased risk of H. pylori infection in Israeli Arab children. Helicobacter. 2010;15:108–13. doi:DOI https://doi.org/10.1111/j.1523-5378.2010.00746.x.

33.

Uptodate. 2017. https://www.uptodate.com/contents/search. Access date March 2019.

34.

Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016;150:1113−+. doi:https://doi.org/10.1053/j.gastro.2016.01.028.

35.

Weyermann M, Rothenbacher D, Brenner H. Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings. Am J Gastroenterol. 2009;104:182–9. https://doi.org/10.1038/ajg.2008.61.CrossRefPubMed

36.

Kim N, Shin CM. Stomach cancer risk in gastric cancer relatives: interaction between Helicobacter pylori infection and family history of gastric cancer for the risk of stomach cancer. Gastroenterology. 2009;136:A462-A.

37.

Peretz A, Paritsky M, Brodsky D, Pastukh N, On A. Resistance of helicobacter pylori to antibiotics in Israel: past vs present. Harefuah. 2017;156:642–4.PubMed

38.

Boltin D, Schmilovitz-Weiss H, Gingold-Belfer R, Leibovitzh H, Snir Y, Perets TT, et al. Temporal trends in helicobacter pylori eradication success in a test-and-treat population. Digestion. 2018;98:169–74. https://doi.org/10.1159/000488448.CrossRefPubMed

39.

Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260–73. https://doi.org/10.7326/0003-4819-142-4-200502150-00008.CrossRefPubMed

40.

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65. https://doi.org/10.1001/jama.282.15.1458.CrossRefPubMed

41.

Fujiwara Y, Takahashi S, Arakawa T, Sollano JD, Zhu Q, Kachintorn U, et al. A 2008 questionnaire-based survey of gastroesophageal reflux disease and related diseases by physicians in east Asian countries. Digestion. 2009;80:119–28. https://doi.org/10.1159/000226088.CrossRefPubMed

42.

Meining A, Driesnack U, Classen M, Rosch T. Management of gastroesophageal reflux disease in primary care: results of a survey in 2 areas in Germany. Zeitschrift fur Gastroenterologie. 2002;40:15–20. https://doi.org/10.1055/s-2002-19638.CrossRefPubMed

Title: Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study
Authors: Wasef Na’amnih
Amir Ben Tov
Amna Bdair-Amsha
Shlomi Cohen
Judith Tsamir
Gabriel Chodick
Khitam Muhsen
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Helicobacter Pylori
Proton Pump Inhibitors
Care
Gastroesophageal Reflux Disease
Gastric Cancer
Gastric Cancer
Iron Deficiency Anemia
Published in: Israel Journal of Health Policy Research / Issue 1/2020
Electronic ISSN: 2045-4015
DOI: https://doi.org/10.1186/s13584-020-00389-y

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Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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