MANAGEMENT OF DYSPEPSIA, PEPTIC ULCER DISEASE, AND GERD

消化不良在美国人口中的患病率约为25%，是2 - 4%的初级保健诊所就诊的主要症状。质子泵抑制剂（PPI）占药房支出的比例越来越大，其长期使用对患者结局的影响尚不确定。占PPI支出很大一部分的其他GI疾病是消化性溃疡和胃食管反射疾病。诊断和治疗的直接成本以及工作时间损失的间接成本总计超过40亿美元。对患有特定疾病的人群进行系统的医疗管理，即疾病管理，旨在促进采用和继续使用适当的检测、治疗和患者随访标准。拟议的研究使用分组随机设计来测试一个系统，该系统旨在改善利用抑酸治疗的上消化道症状患者的护理，并评估医生管理上消化道症状的影响。该方案的目的是：增加适当的H。幽门螺杆菌在消化不良或消化性疾病患者中的应用，减少抑酸治疗的不适当的长期使用，并评估该计划对患者功能，满意度和资源使用以及医生满意度的影响。这项研究将评估这样的计划是否可以有效地管理上消化道症状的护理质量和成本。

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.