Treatment of Helicobacter pylori infection in the primary health care system: quality improvement project
DOI:
https://doi.org/10.32385/rpmgf.v38i4.13238Keywords:
Helicobacter pylori, Antibiotic, Bismuth, ClarithromycinAbstract
Introduction: Several antibiotic therapy regimens have been proposed for the eradication of Helicobacter pylori (Hp). Local resistances should be considered when choosing quadruple therapy. The purpose of this study is to improve the quality of prescriptions for the treatment of Hp infections which is based on local health regulations, most recent international recommendations, and antibiotic resistance in Portugal.
Materials and Methods: This is a technical and scientific quality improvement study, based on a cycle of assessment and improvement implemented in five primary care units in the central region of Portugal. Included in this study were all patients with a diagnosis of Hp infection in a three-month period before and after the intervention, where the most recent recommendations for treatment of Hp were presented. All data was collected from MIM@UF® and SClínico® databases, registered and analyzed with Microsoft Excel® 2016.
Results: An initial analysis returned a total of 68 patients diagnosed with Hp infection. Sixty-five were treated for a total of 46% (n=30) of adequate treatment. A short intervention was carried out and data was again collected from 65 patients with Hp infection. Sixty-two were treated for a total of 71% (n=44) of adequate treatment.
Discussion: The intervention led to an improvement in first-line therapy choices. There was an evident decrease in prescription error, namely, a reduction of triple therapy choice.
Conclusion: This study shows that an educational intervention designed and offered to clinicians, is fundamental for quality improvement of prescription for Hp infection treatment.
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References
Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-67.
Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection: the Maastricht IV/ Florence consensus report. Gut. 2012;61:646-64.
Sociedade Portuguesa de Gastrenterologia. Helicobacter pylori: norma de orientação clínica GE Port J Gastroenterology. 2008;15:192-4. Available from: https://www.sped.pt/images/sped/GE/GE_2008/5novdez2008/v15n5a01.pdf
De Francesco V, Bellesia A, Ridola L, Manta R, Zullo A. First-line therapies for Helicobacter pylori eradication: a critical reappraisal of updated guidelines. Ann Gastroenterol. 2017;30(4):373-9.
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-39.
Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection: the Maastricht V/Florence consensus report. Gut. 2017;66(1):6-30.
Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology. 2018;155(5):1372-82.e17. doi:10.1053/j.gastro.2018.07.007
Lopo I, Libânio D, Pita I, Dinis-Ribeiro M, Pimentel-Nunes P. Helicobacter pylori antibiotic resistance in Portugal: systematic review and meta-analysis. Helicobacter. 2018;23(4):e12493.
O’Connor HJ. Helicobacter pylori and dyspepsia: physicians’ attitudes, clinical practice, and prescribing habits. Aliment Pharmacol Ther. 2002;16(3):487-96.
Direção-Geral da Saúde. Supressão ácida: utilização dos inibidores da bomba de protões e das suas alternativas terapêuticas: norma nº 036/2011, de 30/09/2011. Lisboa: DGS; 2011.
WONCA. Classificação internacional de cuidados de saúde primários [Internet]. 2ª ed. Lisboa: Administração Central do Sistema de Saúde; 1999 [updated 2011 Jun]. Available from: https://www2.acss.min-saude.pt/Portals/0/apmcg_ICPC_v_1.7.pdf
Majumdar SR, Soumerai SB, Lee M, Ross-Degnan D. Designing an intervention to improve the management of Helicobacter pylori infection. Jt Comm J Qual Improv. 2001;27(8):405-14.
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