Management of Helicobacter pylori-associated diseases: survey of attitudes changes among general practitioners in Bosnia and Herzegovina.

The aim of the study was to investigate the attitude change of general practitioners (GPs) in Bosnia and Herzegovina considering the key decision points in the management of treatment of Helicobacter pylori (H. pylori)-associated diseases in 2008, after the four-year period. The first survey was done from February to April 2004. Two hundred and sixty four GPs in B&H responded to questionnaire especially designed for the study. In May 2008, four years after the first survey, data were collected again by same questionnaire from 53 GPs. The most important source of information about the management of treatment of H. pylori-associated diseases in both surveys were symposia sponsored by pharmaceutical companies, but the percent decreased from 53% in 2004 to 34% in 2008. The percent of GPs who named the Internet as the major information source increased from 5% in 2004 to 28% in 2008. Medical journals were used as the most important source of information by every fourth GP in 2008 almost in the same percent as in 2004. In 2008 the percent of GPs who considered that the main obstacle to proper management of H. pylori-related diseases was the patient's low income status which was doubled in relation to 2004 (64%; 31% respectively). Almost all GPs (98%) claimed to eradicate H. pylori in 2008--a significant increase compared to 2004 when 71% of GPs reported eradication. Sixty percent of GP in 2008 claimed confirmation of infection prior to prescribing the eradication therapy which was significant increase in comparison to 2004 when only 9% of GPs confirmed presence of the H. pylori infection before starting eradication. All GPs who claimed to eradicate H. pylori infection used a proton pump inhibitor based on triple drug therapy, while in 2004 18% of GPs chose some other inadequate eradication therapy. As a conclusion, better selection of information sources eliminated management options of questionable value, but scarce economic resources in B&H will probably remain the main obstacle to the comprehensive H. pylori treatment.