基于初级保健的“检测与治疗”消化不良管理策略对内镜检查需求的影响有限：一项随机对照试验的结果
Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial.
作者信息
Shaw Ian S, Valori Roland M, Charlett André, McNulty Cliodna A M
机构信息
Health Protection Agency Primary Care Unit, London.
出版信息
Br J Gen Pract. 2006 May;56(526):369-74.
BACKGROUND
Helicobacter pylori testing has been suggested as an alternative to endoscopy for young patients with dyspepsia. Secondary care studies have suggested that demand for endoscopy among this group could be reduced by up to 74%. However, the effect of H. pylori testing in the primary care setting, where the majority of dyspepsia is managed, is unclear.
AIM
To determine the effects of providing a H. pylori serology service for GPs upon demand for open access endoscopy.
DESIGN OF STUDY
A prospective randomised controlled trial.
SETTING
Forty-seven general practices in Gloucestershire.
METHOD
General practices were stratified by endoscopy referral rate and randomised into two groups. The intervention group was provided with access to H. pylori serology testing and encouraged to use it in place of endoscopy for patients aged under 55 years with dyspepsia. Endpoints were referral for endoscopy and serology use.
RESULTS
There was a significant reduction in referrals for endoscopy in the intervention group compared to the control group: 18.8% (95% confidence interval = 5.0 to 30.6%; P = 0.009).
CONCLUSIONS
Providing GPs with H. pylori serology testing reduced demand for open access endoscopy, but by less than previous studies had predicted.
背景
对于患有消化不良的年轻患者，有人建议将幽门螺杆菌检测作为内镜检查的替代方法。二级医疗保健研究表明，该组患者对内镜检查的需求可降低多达74%。然而，在处理大多数消化不良病例的初级医疗保健环境中，幽门螺杆菌检测的效果尚不清楚。
目的
确定为全科医生提供幽门螺杆菌血清学检测服务对开放式内镜检查需求的影响。
研究设计
一项前瞻性随机对照试验。
研究地点
格洛斯特郡的47家普通诊所。
方法
根据内镜检查转诊率对普通诊所进行分层，并随机分为两组。干预组可进行幽门螺杆菌血清学检测，并鼓励其将该检测用于55岁以下消化不良患者以替代内镜检查。观察终点为内镜检查转诊情况和血清学检测的使用情况。
结果
与对照组相比，干预组的内镜检查转诊率显著降低：18.8%（95%置信区间=5.0%至30.6%；P=0.009）。
结论
为全科医生提供幽门螺杆菌血清学检测可降低开放式内镜检查的需求，但降幅小于先前研究的预测。
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