LEONARDO PALOMBI, MD ANTONIO PIETROIUSTI, MD ANTONIO NOCE, MD ALBERTO GALANTE, MD Rome and Velletri, Italy From the Epidemiology Laboratory, Tor Vergata University, Rome (L.P. and A.N.); the Department of Internal Medicine–Medical Semiology and Methodology, Tor Vergata University, Rome (A.P., A.G.); and the Clinica San Raffaele-Tosinvest Sanità, Velletri, Italy (A.G.). Competing interest: Janssen–Cilag Pharmaceuticals–Italy provided financial assistance for software and distribution. All requests for reprints should be addressed to Antonio Pietroiusti, Dipartmento di Medicina Interna, University Tor Vergata, Via di Tor Vergata 135, 00135 Rome, Italy. E-mail: pietroiusti@med.uniroma2.it.
Interestingly, antibiotic therapy was prescribed at a significantly lower rate for NUD patients with a definitive diagnosis. This fact suggests that physicians did not expect important benefits from H pylori eradication in patients who did not have gastroduodenal lesions. Another important finding was that most treated patients received less than optimal treatment. The majority of patients receiving eradication therapy were given a regimen consisting of no more than 2 drugs although this regimen is less effective25 and less convenient from a cost–benefit perspective than is a 3-drug combination.26,27 Our findings are strikingly similar to those of a small study performed in Scotland28 that showed that more than 55% of patients receiving eradication therapy were treated with PPI-based dual therapy. These data suggest that PCPs are choosing their prescribing options in relation to short-term cost minimization rather than long-term cost effectiveness.
Generalizing our data to the entire Italian health care system may not be valid. Although much attention was paid to the reliability of collected data and to creating a wide geographic distribution of physicians involved in the study, stringent criteria were used for inclusion: ownership of a personal computer, capability of using fairly complex software, and willingness to participate. The majority of Italian PCPs do not share these characteristics. This hypothesis is demonstrated by the fact that only 80 physicians were selected from the initial pool of 19,000. There is no reason, however, to suggest that the above-mentioned characteristics interfere with changing clinicians’ practice patterns.
Conclusions
Our study shows that recommendations for eradication therapy for PUD did not translate into clinical practice in Italy until at least 2000. This means that Italian PCPs failed to reap the clinical and financial benefits resulting from this treatment. This finding, in conjunction with the administration of suboptimal eradication therapy to treated patients, indicates the need for both educational efforts and behavior-oriented interventions aimed at causing the prescribing patterns of eradication therapy of Italian PCPs to conform to the standard reported in the literature.
Acknowledgments
The authors are indebted to Paola Piccolo, MD, for her assistance in the preparation of this manuscript and for English language consultation.
