Abstract
BACKGROUND: Consensus guidelines recommend that in regions with a high rate of clarithromycin resistance, Helicobacter pylori (H. pylori) infection be treated with 4 drugs. Compliance with this recommendation among primary care physicians (PCPs) is low. We aimed to examine whether PCP compliance with H. pylori treatment recommendations increased following a targeted educational intervention. METHODS: A questionnaire assessing H. pylori treatment was sent to >2000 PCPs in June 2015 and June 2018. In the interim, 3 interventions were performed: distribution of printed materials, educational outreach visits, and education over a social media platform. RESULTS: A total of 635 PCPs returned questionnaires, including 314 in 2015 and 321 in 2018 (148 [46.3%] male, age 44.7±10.9 years). The number of PCPs who recommended a 4-drug treatment protocol increased from 12 (3.8%) in 2015 to 119 (37.1%) in 2018 (P<0.001). The number of PCPs who recommended bismuth- or levofloxacin-based therapy for second-line treatment increased from 95 (30.3%) in 2015 to 247 (77.1%) in 2018 (P<0.001). Independent predictors for a 4-drug treatment protocol included central clinic location (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.38-5.60; P<0.003), exposure to printed educational materials (OR 1.64, 95%CI 0.99-2.72; P=0.04) and exposure to the social media platform (OR 6.60, 95%CI 3.08-14.13; P<0.001. There were no independent predictors of compliance with second-line treatment. CONCLUSIONS: PCP compliance with H. pylori guidelines remains suboptimal. Educational initiatives may be effective in increasing PCPs' knowledge and compliance with guidelines. Direct web-based interaction between PCPs and gastroenterologists may be particularly effective.