Differences between generalist and specialist physicians regarding Helicobacter pylori and peptic ulcer disease

To assess differences between gastroenterologists and primary care physicians in the United States in their attitudes, timing of adoption, and practice patterns concerning the use of Helicobacter pylori eradication therapy in peptic ulcer disease (PUD) patients.

We surveyed a random sample of 4500 gastroenterologists, family practitioners, and general internists shortly after a National Institutes of Health Consensus Conference recommended eradication of H. pylori in PUD patients.

The survey response rate was 30%. Bivariate comparisons revealed significant differences between primary care physicians and gastroenterologists in sources of information about H. pylori, beliefs about the strength of the evidence supporting the relationship between H. pylori and PUD, adoption of H. pylori eradication therapy and timing of first use, and patients likely to receive eradication therapy. Although adoption of H. pylori eradication therapy was nearly universal among gastroenterologists by April 1994 (99%), approximately one-third of primary care providers had never prescribed H. pylori eradication therapy. Practice patterns of physicians using eradication therapy also varied significantly by specialty group.

Gastroenterologists were more aware of the relationship of H. pylori to PUD and adapted their practices more quickly to this emerging information than did primary care providers. Specialty differences in attitudes and adoption patterns of medical innovation existed, even when the new intervention did not require specialized training or equipment. These findings have important clinical implications as the role of primary care physicians expands and managed care delivery systems decrease the use of specialist services.