Diagnosis and treatment of Helicobacter pylori infection among California Medicare patients
Diagnosis and treatment of Helicobacter pylori infection among California Medicare patients
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DOI：
10.1001/archinte.157.9.994
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发表时间：
1997-05-12
影响因子：
--
通讯作者：
Newman, J
中科院分区：
文献类型：
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作者：
Roll, J;Weng, A;Newman, J
背景：活动性消化性溃疡病中幽门螺杆菌感染的抗生素治疗已被证明可以加速溃疡愈合、降低再出血风险并防止长期复发。本研究的目的是确定入住急症护理医院的消化性溃疡病医疗保险患者是否按照美国国立卫生研究院共识小组的建议接受幽门螺杆菌感染检测或治疗。 方法：该研究旨在作为一项回顾性病历调查。从医疗保险国家索赔历史档案中，确定了 1994 年因消化性溃疡病入住加州收费服务医院的所有 65 岁及以上人员。我们随机抽取了 600 项索赔样本进行审查。排除后，524 名患者符合研究资格。主要结局指标为（1）通过 5 种可用方法（组织病理学研究、尿素酶测定、微生物培养、血清抗体检测或尿素呼气试验）中的一种检测幽门螺杆菌感染的患者比例，以及（2）接受幽门螺杆菌抗生素（阿莫西林、四环素、克拉霉素或甲硝唑）治疗的患者比例 结果：39% 的消化性溃疡病患者接受了幽门螺杆菌感染检测，3% 的患者接受了经验治疗。只有 47% 的幽门螺杆菌诊断检测结果呈阳性的患者接受了抗生素治疗。结论：由于幽门螺杆菌感染的诊断和治疗已被证明可以改善结果并减少费用，因此数据表明有很大机会改善患有消化性溃疡病的老年医疗保险患者的护理。
Background: Antibiotic treatment of Helicobacter pylori infection in active peptic ulcer disease has been demonstrated to speed ulcer healing, reduce the risk of rebleeding, and prevent long-term recurrence. The objective of this study was to determine whether Medicare patients with peptic ulcer disease who are admitted to acute care hospitals are being tested or treated for H pylori infection as recommended by a National Institutes of Health consensus panel.Methods: The study was designed as a retrospective medical records survey. From the Medicare National Claims History File, all persons 65 years and older admitted to California fee-for-service hospitals for peptic ulcer disease in 1994 were identified. A random sample of 600 claims was selected for review. After exclusions, 524 patients were eligible for study. The main outcome measures were (1) the proportion of patients who were tested for H pylori infection by 1 of the 5 available methods (histopathologic study, urease assay, microbiologic culture, serum antibody testing, or urea breath test) and (2) the proportion who were treated with antibiotics (amoxicillin, tetracycline, clarithromycin, or metronidazole) for H pylori infection.Results: Thirty-nine percent of patients with peptic ulcer disease were tested for H pylori infection and 3% were treated empirically. Only 47% of the patients who had a positive diagnostic test result for H pylori were treated with antibiotics.Conclusion: Because diagnosis and treatment of H pylori infection has been demonstrated to improve outcomes and decrease expenses, the data indicate a substantial opportunity to improve the care of elderly Medicare patients with peptic ulcer disease.