Outcomes of Helicobacter pylori treatment in community practice and impactof therapeutic effectiveness information on physician behaviour

Background: The effect of knowledge of Helicobacter pylori eradication rate s on physician choice of treatment regimen is unknown. As practice variatio n results in differences in outcome, it is important to determine whether p hysician behaviour can be altered by such knowledge. Aims: (i) To determine whether dissemination of practice variation and effe ctiveness data regarding H. pylori changes subsequent prescribing behaviour and (ii) whether this change results in an improvement in the effectivenes s of therapy. Methods: Community gastroenterologists in the Portland metropolitan area en rolled patients being treated for H. pylori, The regimen used, diagnostic m ethod, indication and success in eradication was measured. Patient-centred factors were also measured, including symptoms, interest in post-treatment diagnostic testing and willingness to pay. Results: Significantly more physicians participating in both studies used p roton pump inhibitor-triple therapy based regimens in this trial (46% vs. 8 5%, P = 0.01), although the overall difference between the two trials was n ot significant (62% vs. 83%, P = 0.11). There was no change in overall erad ication rates by per protocol analysis between trials (84% vs. 85%, P = 0.7 8), but a significant decrease in effectiveness by intention-to-treat analy sis observed in this study (80% vs. 71%, P = 0.03). Significantly more pati ents were treated for reasons other than peptic ulcer disease in this study (P = 0.0003). Conclusions: The overall effectiveness of H. pylori therapy in practice rem ains good. There has been a shift in the choice of treatment regimen and in dication for therapy between the time periods of the two studies. Dissemina tion of treatment data appears to effect prescribing behaviour, but whether it has a beneficial effect on treatment outcome remains unproven.