McNulty Cliodna, Freeman Elaine, Delaney Brendan
Health Pretection Agency Primary Care Unit, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, and University of Birmingham, Department of Primary Care and General Practice, Birmingham, UK.
Fam Pract. 2006 Apr;23(2):203-9. doi: 10.1093/fampra/cmi107. Epub 2006 Jan 20.
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.
To explore the views of primary care about introducing the helicobacter test and treat NICE dyspepsia guidance.
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.
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.
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.
英国国家临床优化研究所（NICE）发布了相关指南，建议所有无警示症状的消化不良患者，无论年龄大小，在使用质子泵抑制剂一个月后复发的，都应接受幽门螺杆菌检测和治疗。
探讨基层医疗对引入幽门螺杆菌检测和治疗NICE消化不良指南的看法。
在英格兰中部的15家城乡全科诊所中，参与消化不良管理的基层医疗保健人员参加了定性焦点小组讨论，以探讨NICE指南草案及其可能的实施方式。
各诊所担心，对于年轻患者，检测和治疗可能不具有成本效益，而对于老年患者以及三联治疗后复发但未进一步进行幽门螺杆菌检测或内镜检查的患者，可能会漏诊恶性肿瘤。检测和治疗最大的实际障碍是，向患者解释、进行检测并报告结果会对护士和医生的时间产生相当大的影响，以及尿素呼气试验和三联治疗费用对诊所预算的影响。工作人员更喜欢粪便检测而非呼气试验，因为粪便检测对诊所预算和时间的影响较小。全科医生不赞成分别开具三联治疗的三种成分。
全科医生需要得到保证，检测和治疗不会导致漏诊恶性肿瘤。NICE消化不良指南的财务成本和人员配备问题需要由初级保健信托基金、微生物实验室、胃肠病学家和药房顾问在当地进行讨论，并在当地指导、加强沟通和教育的情况下实施。
