MANAGEMENT OF DYSPEPSIA, PEPTIC ULCER DISEASE, AND GERD

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Dyspepsia has a prevalence of approximately 25% of the US population and is a primary symptom in 2 to 4% of primary care office visits. Proton pump inhibitors (PPIs) account for an increasing percent of pharmacy expenditures and the effects of their long-term use on patient outcomes is uncertain. Additional GI disease which utilize a significant portion of the expenditure of PPIs are peptic ulcer disease and gastroesophageal reflex disease. The direct cost of diagnosis and treatment and the indirect costs of time lost from work total greater than four billion dollars. Systematic medical management of populations with a specific disease, disease management, is intended to facilitate the adoption and continued use of standards for appropriate testing, treating, and follow-up of patients. The proposed study uses a group-randomized design to test a system designed to improve the care of patients with upper GI symptoms utilizing acid suppression therapy and to evaluate the impact of physician management of upper GI symptoms. The program is designed: to increase appropriate testing for H. pylori among patients with dyspepsia or peptic disease, decrease inappropriate chronic use of acid suppression therapy, and assess the effect of the program on patient function, satisfaction, and resource use as well as physician satisfaction. The study will evaluate if such a program can be effective in managing upper GI symptoms in terms of quality of care and cost.