Thamer M, Ray N F, Henderson S C, Rinehart C S, Sherman C R, Ferguson J H
Medical Technology and Practice Patterns Institute, Washington, DC 20007, USA.
Med Care. 1998 May;36(5):646-60. doi: 10.1097/00005650-199805000-00005.
In February 1994, an National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate Helicobacter pylori in the treatment of peptic ulcer disease. The goal of this study was to determine if these recommendations resulted in a change in physician prescribing among an underserved population.
Computerized Pennsylvania Medicaid data from January 1993 through February 1996 were used to evaluate prescribing patterns in the year before and 2 years after the NIH conference. An interrupted time series model, based on 12,737 outpatient peptic ulcer disease encounters, assessed the impact of the conference in influencing physician prescribing.
The prescription of antimicrobial agents for the treatment of peptic ulcer disease significantly increased across the study period, from 6.5% in January 1993 to 10.2% in February 1996. Similarly, the prescription rate for the proton pump inhibitor, omeprazole, significantly increased from 9.4% in January 1993 to 25.6% in February 1996. Neither trend, however, could be attributed to the NIH Consensus Development Conference. Stratification by physician specialty, ulcer type, nonsteroidal anti-inflammatory drug use, and patient demographics did not affect these results. The traditional treatment approach, using H2-receptor antagonists, remained the preferred pharmacotherapy (72% of all prescriptions).
Two years after the highly publicized NIH conference on the eradication of Helicobacter pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. In treating this underserved population, physicians do not appear to be using recommendations developed by an NIH expert panel based on recent scientific advances.
1994年2月，美国国立卫生研究院（NIH）共识发展会议小组明确建议采用抗菌疗法根除幽门螺杆菌以治疗消化性溃疡疾病。本研究的目的是确定这些建议是否导致了在服务不足人群中医生处方的改变。
使用1993年1月至1996年2月宾夕法尼亚州医疗补助计划的计算机化数据来评估NIH会议前一年和后两年的处方模式。基于12737例门诊消化性溃疡疾病病例的中断时间序列模型，评估了该会议对影响医生处方的作用。
在整个研究期间，用于治疗消化性溃疡疾病的抗菌药物处方显著增加，从1993年1月的6.5%增至1996年2月的10.2%。同样，质子泵抑制剂奥美拉唑的处方率也从1993年1月的9.4%显著增至1996年2月的25.6%。然而，这两种趋势均不能归因于NIH共识发展会议。按医生专业、溃疡类型、非甾体抗炎药使用情况和患者人口统计学特征进行分层并不影响这些结果。使用H2受体拮抗剂的传统治疗方法仍然是首选的药物疗法（占所有处方的72%）。
在备受关注的NIH根除幽门螺杆菌会议召开两年后，宾夕法尼亚州医疗补助计划人群中抗菌药物的处方并不广泛。在治疗这个服务不足的人群时，医生似乎并未采用NIH专家小组基于近期科学进展制定的建议。
