Variation in the use of H. pylori tests in UK general practice--a qualitative study

Patients' attitudes to Helicobacter pylori breath and stool antigen tests compared to blood serology

BACKGROUND

The National Institute for Health and Clinical Excellence (NICE) recommends that patients with uninvestigated dyspepsia, unresponsive to proton pump inhibitors, should be tested for Helicobacter pylori using a stool antigen or urea breath test rather than blood-based serology.

OBJECTIVE

To determine if a stool antigen or urea breath test is acceptable to patients.

METHOD

Satisfaction questionnaire circulated to all primary care patients who had blood serology for H. pylori between January and July 2004.

RESULTS

Four hundred and sixty-two out of 717 Gloucestershire patients returned the questionnaire. Three-quarters of respondents stated that they would be willing to provide a stool or breath H. pylori test if they were told they were more accurate than the blood test. If the blood test was not available, 58% stated they would prefer the breath test and 34% the stool test. When patients were not given an explanation for the transfer to the new tests, only 11% stated they would prefer to provide a stool and 19% the breath test. 80% required an extra appointment for their blood test.

CONCLUSION

The majority of patients would be happy to provide a stool sample or breath test provided they are made aware that these tests are more accurate than blood serology.

Helicobacter pylori test & treat strategy for dyspepsia: a qualitative study exploring the barriers and how to overcome them

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.