Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration.
Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration.
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退伍军人健康管理局治疗后幽门螺杆菌感染根除的低复检率。
DOI：
10.1016/j.cgh.2020.03.059
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Goldberg DS
中科院分区：
文献类型：
--
作者：
Kumar S;Metz DC;Kaplan DE;Goldberg DS
专家共识要求在治疗后重新检测幽门螺杆菌感染的根除，但目前尚不清楚有多少患者实际上重新检测。我们在全国范围内的大型队列中评估了与重新检测幽门螺杆菌相关的因素。我们对1994年1月1日至2018年12月31日在退伍军人健康管理局（VHA）接受根除方案的幽门螺杆菌感染（通过尿素呼气试验、粪便抗原或病理学检测）患者进行了一项回顾性队列研究。我们收集了有关人口统计学特征、吸烟史、社会经济状况、设施贫困水平和学术地位以及提供者专业和职业的数据。主要结局是重新检测根除。统计分析包括混合效应logistic回归。在27，185例接受幽门螺杆菌根除治疗的患者中，6486例患者（23.9%）接受了重新检测。在7623例患者中，我们可以确定订购测试的提供者，2663例患者（34.9%）从胃肠病提供者那里收到了订单。女性（比值比，1.22; 95%CI，1.08-1.38; P= 0.002）和吸烟史（比值比，1.24; 95%CI，1.15-1.33; P<0.001）是与复检相关的患者因素。幽门螺杆菌感染的初始诊断方法和提供者之间存在交互作用（P<0.001）。VHA机构之间的复检率存在显著差异（P<0.001）。在对幽门螺杆菌感染患者VHA队列数据的分析中，我们发现根除治疗后的复检率较低。VHA设施之间的复检率存在显著差异。幽门螺杆菌检测是由非胃肠病专家下令三分之二的时间。根除幽门螺杆菌是强制性的，需要广泛的质量保证协议。
Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for H pylori in a large, nationwide cohort. We performed a retrospective cohort study of patients with H pylori infection (detected by urea breath test, stool antigen, or pathology) who were prescribed an eradication regimen from January 1, 1994 through December 31, 2018 within the Veterans Health Administration (VHA). We collected data on demographic features, smoking history, socioeconomic status, facility poverty level and academic status, and provider specialties and professions. The primary outcome was retesting for eradication. Statistical analyses included mixed-effects logistic regression. Of 27,185 patients prescribed an H pylori eradication regimen, 6486 patients (23.9%) were retested. Among 7623 patients for whom we could identify the provider who ordered the test, 2663 patients (34.9%) received the order from a gastroenterological provider. Female sex (odds ratio, 1.22; 95% CI, 1.08–1.38; P=.002) and history of smoking (odds ratio, 1.24; 95% CI, 1.15–1.33; P<.001) were patient factors associated with retesting. There was an interaction between method of initial diagnosis of H pylori infection and provider who ordered the initial test (P<.001). There was significant variation in rates of retesting among VHA facilities (P<.001). In an analysis of data from a VHA cohort of patients with H pylori infection, we found low rates of retesting after eradication treatment. There is significant variation in rates of retesting among VHA facilities. H pylori testing is ordered by non-gastroenterology specialists two-thirds of the time. Confirming eradication of H pylori is mandatory and widespread quality assurance protocols are needed.
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