Soons K R, Lynch T, Seagrave M, Rolley L
University of Vermont College of Medicine, Burlington, USA.
Clin Perform Qual Health Care. 1997 Apr-Jun;5(2):94-8.
Peptic ulcer disease (PUD) affects 10% to 15% of the US population. The causes of PUD are many, including high acid production, low bicarbonate secretion, and infection due to Helicobacter pylori. In 1992, the Vermont Medicaid Program noted a significant increase in prescription drug expenditures, particularly in the area of treatment of PUD. The purpose of this study was to review Medicaid prescription data and to use focus group methodology to gain an understanding of rural nonacademic and semiurban academic physicians' prescribing decisions regarding the treatment of PUD.
Pharmaceutical data from 1991 and 1992, provided by the Department of Social Welfare, Medicaid Division, was reviewed. Focus group discussions were held with primary-care providers from rural and semiurban regions with Vermont.
Pharmaceutical review revealed that expenditures increased 21% for gastrointestinal drugs from 1991 to 1992. Drug utilization review of pharmaceutical prescriptions revealed that H2 antagonists were being prescribed for greater than the recommended 6 to 8 weeks in 60% of the cases. Focus group discussions showed that rural nonacademic and urban academic physicians had similar concerns and management plans in regard to their patients with peptic ulcer disease. However, differences existed in physician perceptions regarding pharmaceutical effectiveness of various agents for the treatment of PUD.
Physician education outreach programs should be designed to standardize treatment methodology for PUD throughout the state. This standardization of treatment could have a significant impact on healthcare costs and the ease with which patients can eradicate this disease.
消化性溃疡病（PUD）影响着10%至15%的美国人口。PUD的病因众多，包括胃酸分泌过多、碳酸氢盐分泌不足以及幽门螺杆菌感染。1992年，佛蒙特州医疗补助计划注意到处方药支出显著增加，尤其是在PUD治疗领域。本研究的目的是回顾医疗补助处方数据，并采用焦点小组方法，以了解农村非学术型和半城市学术型医生在PUD治疗方面的处方决策。
回顾了社会福利部医疗补助司提供的1991年和1992年的药品数据。与来自佛蒙特州农村和半城市地区的初级保健提供者进行了焦点小组讨论。
药品审查显示，1991年至1992年期间，胃肠道药物支出增加了21%。对药品处方的药物利用审查显示，60%的病例中H2拮抗剂的处方时间超过了推荐的6至8周。焦点小组讨论表明，农村非学术型医生和城市学术型医生在消化性溃疡病患者的治疗方面有相似的关注点和管理计划。然而，医生对各种治疗PUD药物的疗效认知存在差异。
应设计医生教育推广项目，以规范全州范围内PUD的治疗方法。这种治疗的标准化可能会对医疗成本以及患者根除该疾病的难易程度产生重大影响。
