Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers
Article first published online: 15 JAN 2009
© 2009 Blackwell Publishing Ltd. No claim to original US government works
Alimentary Pharmacology & Therapeutics
Volume 29, Issue 8, pages 871–881, April 2009
How to Cite
SPIEGEL, B. M. R., FARID, M., VAN OIJEN, M. G. H., LAINE, L., HOWDEN, C. W. and ESRAILIAN, E. (2009), Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers. Alimentary Pharmacology & Therapeutics, 29: 871–881. doi: 10.1111/j.1365-2036.2009.03935.x
- Issue published online: 19 MAR 2009
- Article first published online: 15 JAN 2009
- Publication data Submitted 2 November 2008 First decision 24 November 2008 Resubmitted 28 December 2008 Accepted 5 January 2009 Epub Accepted Article 15 January 2009
Background Although ‘best practice’ guidelines for dyspepsia management have been disseminated, it remains unclear whether providers adhere to these guidelines.
Aim To compare adherence to ‘best practice’ guidelines among dyspepsia experts, community gastroenterologists and primary-care providers (PCPs).
Methods We administered a vignette survey to elicit knowledge and beliefs about dyspepsia including a set of 16 best practices, to three groups: (i) dyspepsia experts; (ii) community gastroenterologists and (iii) PCPs.
Results The expert, community gastroenterologist and PCP groups endorsed 75%, 73% and 57% of best practices respectively. Gastroenterologists were more likely to adhere with guidelines than PCPs (P < 0.0001). PCPs were more likely to define dyspepsia incorrectly, overuse radiographic testing, delay endoscopy, treat empirically for Helciobacter pylori without confirmatory testing and avoid first-line proton pump inhibitors (PPIs). PCPs had more concerns about adverse events with PPIs [e.g. osteoporosis (P = 0.04), community-acquired pneumonia (P = 0.01)] and higher level of concern predicted lower guideline adherence (P = 0.04).
Conclusions Gastroenterologists are more likely than PCPs to comply with best practices in dyspepsia, although compliance remains incomplete in both groups. PCPs harbour more concerns regarding long-term PPI use and these concerns may affect therapeutic decision making. This suggests that best practices have not been uniformly adopted and persistent guideline-practice disconnects should be addressed.