Fendrick A M, Hirth R A, Chernew M E
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, USA.
Am J Gastroenterol. 1996 Aug;91(8):1544-8.
To assess differences between gastroenterologists and primary care physicians in the United States in their attitudes, timing of adoption, and practice patterns concerning the use of Helicobacter pylori eradication therapy in peptic ulcer disease (PUD) patients.
We surveyed a random sample of 4500 gastroenterologists, family practitioners, and general internists shortly after a National Institutes of Health Consensus Conference recommended eradication of H. pylori in PUD patients.
The survey response rate was 30%. Bivariate comparisons revealed significant differences between primary care physicians and gastroenterologists in sources of information about H. pylori, beliefs about the strength of the evidence supporting the relationship between H. pylori and PUD, adoption of H. pylori eradication therapy and timing of first use, and patients likely to receive eradication therapy. Although adoption of H. pylori eradication therapy was nearly universal among gastroenterologists by April 1994 (99%), approximately one-third of primary care providers had never prescribed H. pylori eradication therapy. Practice patterns of physicians using eradication therapy also varied significantly by specialty group.
Gastroenterologists were more aware of the relationship of H. pylori to PUD and adapted their practices more quickly to this emerging information than did primary care providers. Specialty differences in attitudes and adoption patterns of medical innovation existed, even when the new intervention did not require specialized training or equipment. These findings have important clinical implications as the role of primary care physicians expands and managed care delivery systems decrease the use of specialist services.
评估美国胃肠病学家和初级保健医生在消化性溃疡病（PUD）患者中使用幽门螺杆菌根除疗法的态度、采用时间及实践模式上的差异。
在美国国立卫生研究院共识会议建议对PUD患者根除幽门螺杆菌后不久，我们对4500名胃肠病学家、家庭医生和普通内科医生进行了随机抽样调查。
调查回复率为30%。双变量比较显示，初级保健医生和胃肠病学家在幽门螺杆菌信息来源、对支持幽门螺杆菌与PUD关系证据强度的看法、采用幽门螺杆菌根除疗法及首次使用时间，以及可能接受根除疗法的患者等方面存在显著差异。尽管到1994年4月，胃肠病学家中几乎普遍采用幽门螺杆菌根除疗法（99%），但约三分之一的初级保健提供者从未开过幽门螺杆菌根除疗法的处方。采用根除疗法的医生的实践模式也因专业组不同而有显著差异。
与初级保健提供者相比，胃肠病学家更了解幽门螺杆菌与PUD的关系，并更快地根据这一新兴信息调整其诊疗实践。即使新干预措施不需要专门培训或设备，医学创新在态度和采用模式上仍存在专业差异。随着初级保健医生的作用扩大以及管理式医疗服务体系减少专科服务的使用，这些发现具有重要的临床意义。
