Background. The National Institute of Clinical Excellence (NICE) has issued guidance that recommends that all dyspeptic patients without alarm symptoms, irrespective of age, that relapse after one month's proton pump inhibitor, should be offered test and treat for Helicobacter pylori. Objective. To explore the views of primary care about introducing the helicobacter test and treat NICE dyspepsia guidance. Methods. In 15 urban and rural general practices in Central England, primary health care staff involved in the management of dyspepsia took part in qualitative focus groups to discuss the draft NICE guidance and how it might be implemented. Results. Practices expressed concern that test and treat may not be cost-effective in younger patients and that they may miss malignancy, in older patients and in patients who relapse after triple treatment, without a further helicobacter test or endoscopy. The greatest practical barriers to test and treat were the considerable impact on nurses' and doctors' time to explain, undertake tests and report results to patients, and practice budgets from urea breath test and triple treatment costs. Staff preferred stool tests to breath tests, as they impacted less on practice budget and time. GPs did not favour prescribing the three components of the triple treatment separately. Conclusions. GPs will need reassurance that test and treat will not lead to missed malignancies. The financial costs and staffing implications of NICE dyspepsia guidance will need to be discussed locally by Primary Care Trusts, microbiology laboratories, gastroenterologists and pharmacy advisors and implemented with local guidance, increased communication and education.
Bibliographical noteFunding Information:
Funding: This study was funded by Public Health Laboratory Service South West. Ethical approval: Granted by the local research ethics committees for Hereford & Worcester (03/51) and Birmingham (2004/149). Conflicts of interests: Cliodna McNulty is responsible for the Health Protection Agency GP Microbiology Laboratory Use Group guidance and reviewed the NICE guidance. Elaine Freeman, on behalf of the Gloucestershire Research and Development Support Unit, has received sponsorship from AstraZeneca UK and Wyeth Laboratories to support RDSU local conferences. Brendan Delaney was technical lead for the NICE dyspepsia guidelines 2004. He has received speaking honoraria from AstraZeneca UK, AstraZeneca Canada, AstraZeneca Sweden, AxCan-Pharma Canada, Eisai, but has never held a consultancy role; he has also received research grants in dyspepsia from the Medical Research Council and is supported by an NHS R&D Primary Care Career Scientist Award. In line with journal policy this paper was managed by an associate editor double blind to the Editor’s presence as an author.
- Diagnostic tests
- Helicobacter pylori
- NICE guidance