DIAGNOSIS AND TREATMENT OF HELICOBACTER-PYLORI INFECTION AMONG CALIFORNIA MEDICARE PATIENTS

Background: Antibiotic treatment of Helicobacter pylori infection in a ctive peptic ulcer disease has been demonstrated to speed ulcer healin g, reduce the risk of rebleeding, and prevent long-term recurrence. Th e objective of this study was to determine whether Medicare patients w ith peptic ulcer disease who are admitted to acute care hospitals are being tested or treated for H pylori infection as recommended by a Nat ional Institutes of Health consensus panel. Methods: The study was des igned as a retrospective medical records survey. From the Medicare Nat ional Claims History File, all persons 65 years and older admitted to California fee-for-service hospitals for peptic ulcer disease in 1994 were identified. A random sample of 600 claims was selected for review . After exclusions, 524 patients were eligible for study. The main out come measures were (1) the proportion of patients who were tested for H pylori infection by 1 of the 5 available methods (histopathologic st udy, urease assay, microbiologic culture, serum antibody testing, or u rea breath test) and (2) the proportion who were treated with antibiot ics (amoxicillin, tetracycline, clarithromycin, or metronidazole) for H pylori infection. Results: Thirty-nine percent of patients with pept ic ulcer disease were tested for H pylori infection and 3% were treate d empirically. Only 47% of the patients who had a positive diagnostic test result for H pylori were treated with antibiotics. Conclusion: Be cause diagnosis and treatment of H pylori infection has been demonstra ted to improve outcomes and decrease expenses, the data indicate a sub stantial opportunity to improve the care of elderly Medicare patients with peptic ulcer disease.