Quality of Helicobacter pylori Infection Management Through Telemedicine: A Nationwide Cross-Sectional Study

To evaluate the clinical practice and quality of first-line Helicobacter pylori eradication therapy by gastroenterologists in direct-to-consumer telemedicine (DTCT) settings.

The study was conducted between November 2024 and February 2025 using unannounced standardized patients (USPs). Six trained and validated USPs questioned clinicians using specific H. pylori infection scenarios on hospital- or enterprise-sponsored DTCT platforms. Accessibility and effective consultation rates of the enquiry platforms were evaluated. The consultation process at each visit was also analyzed for guideline adherence and patient-centeredness.

USPs conducted 552 visits on 53 hospital- and 19 enterprise-sponsored accessible platforms, with effective consultation rate of 65.6% (362 of 552). Based on a 10-point quality checklist, the overall guideline adherence score was 5.0, which was significantly higher for the enterprise-sponsored platforms than for hospital platforms (5.4 ± 2.7 vs. 4.8 ± 2.8, p = 0.045). When stratified by professional title of the clinicians involved, clinicians with intermediate title achieved a higher guideline adherence score than those with junior or senior titles (5.5 ± 2.7 vs. 4.3 ± 2.7 vs. 4.8 ± 2.8, p = 0.009). Altogether 72% of clinicians prescribed the correct treatment regimen for H. pylori infection. Furthermore, patient satisfaction during the treatment process was generally acceptable.

We identified gaps in guideline adherence and clinical standardization for telemedicine-based H. pylori eradication in China. Further nationwide standardized training for gastroenterologists should prioritize structured history-taking, appropriate prescribing, resistance-guided antibiotic selection, and patient follow-up management.

ClinicalTrials.gov ID: NCT06749873.