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Helicobacter pylori test & treat strategy for dyspepsia: a qualitative study exploring the barriers and how to
Cliodna McNulty1, Elaine Freeman, Brendan Delaney
1Health Pretection Agency Primary Care Unit, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, and University of Birmingham, Department of Primary Care and General Practice, Birmingham, UK. jill.whiting@hpa.org.uk
Background:
The National Institute of Clinical Excellence (NICE) has issued guidance that recommends that all dyspeptic patients without alarm symptoms, irrespective of age, that relapse after one month's proton pump inhibitor, should be offered test and treat for Helicobacter pylori.
Objective:
To explore the views of primary care about introducing the helicobacter test and treat NICE dyspepsia guidance.
Methods:
In 15 urban and rural general practices in Central England, primary health care staff involved in the management of dyspepsia took part in qualitative focus groups to discuss the draft NICE guidance and how it might be implemented.
Results:
Practices expressed concern that test and treat may not be cost-effective in younger patients and that they may miss malignancy, in older patients and in patients who relapse after triple treatment, without a further helicobacter test or endoscopy. The greatest practical barriers to test and treat were the considerable impact on nurses' and doctors' time to explain, undertake tests and report results to patients, and practice budgets from urea breath test and triple treatment costs. Staff preferred stool tests to breath tests, as they impacted less on practice budget and time. GPs did not favour prescribing the three components of the triple treatment separately.
Conclusions:
GPs will need reassurance that test and treat will not lead to missed malignancies. The financial costs and staffing implications of NICE dyspepsia guidance will need to be discussed locally by Primary Care Trusts, microbiology laboratories, gastroenterologists and pharmacy advisors and implemented with local guidance, increased communication and education.
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