Influence of the NIH Consensus Conference on Helicobacter Pylori on Physician Prescribing among a Medicaid Population

• Published in: Medical care Vol. 36; no. 5; pp. 646 - 660
• Main Authors: Thamer, Mae, Ray, Nancy Fox, Henderson, Scott C., Rinehart, Cheryl S., Sherman, Charles R., Ferguson, John H.
• Format: Journal Article
• Language: English
• Published: United States J. B. Lippincott-Raven Publishers 01-05-1998; Lippincott-Raven Publishers
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anti-Ulcer Agents - therapeutic use; Antimicrobials; Base year; Cohort Studies; Consensus Development Conferences, NIH as Topic; Drug prescriptions; Drug Prescriptions - statistics & numerical data; Duodenal ulcer; Epidemiology; Female; Guideline Adherence - statistics & numerical data; Helicobacter Infections - drug therapy; Helicobacter pylori; Histamine H2 Antagonists - therapeutic use; Humans; Male; Medicaid; Medicaid - statistics & numerical data; Middle Aged; Omeprazole - therapeutic use; Pennsylvania; Peptic ulcer; Peptic Ulcer - drug therapy; Peptic Ulcer - microbiology; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Prescription drugs; Proton Pump Inhibitors; United States; United States; Pennsylvania
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-199805000-00005

Objectives. In February 1994, an National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate Helicobacter pylori in the treatment of peptic ulcer disease. The goal of this study was to determine if these recommendations resulted in a change in physician prescribing among an underserved population. Methods. Computerized Pennsylvania Medicaid data from January 1993 through February 1996 were used to evaluate prescribing patterns in the year before and 2 years after the NIH conference. An interrupted time series model, based on 12,737 outpatient peptic ulcer disease encounters, assessed the impact of the conference in influencing physician prescribing. Results. The prescription of antimicrobial agents for the treatment of peptic ulcer disease significantly increased across the study period, from 6.5% in January 1993 to 10.2% in February 1996. Similarly, the prescription rate for the proton pump inhibitor, omeprazole, significantly increased from 9.4% in January 1993 to 25.6% in February 1996. Neither trend, however, could be attributed to the NIH Consensus Development Conference. Stratification by physician specialty, ulcer type, nonsteroidal anti-inflammatory drug use, and patient demographics did not affect these results. The traditional treatment approach, using H2-receptor antagonists, remained the preferred pharmacotherapy (72% of all prescriptions). Conclusions. Two years after the highly publicized NIH conference on the eradication of Helicobacter pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. In treating this underserved population, physicians do not appear to be using recommendations developed by an NIH expert panel based on recent scientific advances.