Jose Nazareno1, David K Driman, Paul Adams. 1. Department of Medicine (Gastroenterology), The University of Western Ontario, London Health Sciences Centre, London, Canada.
Abstract
BACKGROUND: Helicobacter pylori is causally associated with peptic ulcer disease and gastric cancer. Although effective treatment is available, studies have shown that patients with H pylori are often not well managed. Recently, there has also been increasing awareness of patient safety concerns arising from missed follow-up of abnormal test results. OBJECTIVE: To examine whether inpatients and outpatients diagnosed with H pylori receive appropriate treatment. PATIENTS AND METHODS: All patients who were diagnosed with H pylori by gastric biopsy in London, Ontario between January 1, 2004, and December 31, 2004, were identified. The hospital charts of these patients were reviewed. Outpatient office charts, clinic notes, pathology reports and endoscopy reports were also reviewed. RESULTS: One hundred ninety-three patients were diagnosed with H pylori by gastric biopsy in 2004. Of the 193 patients, 143 (74%) were outpatients and 50 (26%) were inpatients. Overall, 89% of patients received treatment for H pylori. Ninety-two per cent of outpatients were treated, while only 60% of inpatients received treatment (P<0.001). Among the inpatients, the pathology report was available in 40% of the cases before the patient was discharged from the hospital. After discharge from the hospital, 30% of inpatients received appropriate treatment and follow-up. There was no significant difference in treatment whether the patient was admitted to a medical or a nonmedical service. CONCLUSION: H pylori is treated relatively poorly in inpatients compared with outpatients. Results of the present study reveal opportunities to improve delivery of care for inpatients on a number of different levels. More research is needed to ensure safety, effectiveness and timeliness in the test result management process.
BACKGROUND:Helicobacter pylori is causally associated with peptic ulcer disease and gastric cancer. Although effective treatment is available, studies have shown that patients with H pylori are often not well managed. Recently, there has also been increasing awareness of patient safety concerns arising from missed follow-up of abnormal test results. OBJECTIVE: To examine whether inpatients and outpatients diagnosed with H pylori receive appropriate treatment. PATIENTS AND METHODS: All patients who were diagnosed with H pylori by gastric biopsy in London, Ontario between January 1, 2004, and December 31, 2004, were identified. The hospital charts of these patients were reviewed. Outpatient office charts, clinic notes, pathology reports and endoscopy reports were also reviewed. RESULTS: One hundred ninety-three patients were diagnosed with H pylori by gastric biopsy in 2004. Of the 193 patients, 143 (74%) were outpatients and 50 (26%) were inpatients. Overall, 89% of patients received treatment for H pylori. Ninety-two per cent of outpatients were treated, while only 60% of inpatients received treatment (P<0.001). Among the inpatients, the pathology report was available in 40% of the cases before the patient was discharged from the hospital. After discharge from the hospital, 30% of inpatients received appropriate treatment and follow-up. There was no significant difference in treatment whether the patient was admitted to a medical or a nonmedical service. CONCLUSION: H pylori is treated relatively poorly in inpatients compared with outpatients. Results of the present study reveal opportunities to improve delivery of care for inpatients on a number of different levels. More research is needed to ensure safety, effectiveness and timeliness in the test result management process.
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