| Sumario: | Objective: To determine whether dissemination of inpatient practice guidelines for Helicobacter pylori management improves the testing and treatment rates of patients admitted with acute upper gastrointestinal (GI) bleeding from gastric or duodenal ulcers. Design: Prospective, non-randomized, interventional study. Setting and patients: 189 patients admitted to a single, urban academic medical center with a primary diagnosis of acute upper GI bleeding from gastric or duodenal ulcers between January 1998 and June 1999. The patients were managed by 18 gastroenterology physicians (12 staff, 6 private practice). Outcome measures: Rate and type of testing used for the diagnosis of H. pylori infection and the rate of initiation of appropriate anti-H. pylori therapy. Interventions: Outcomes were measured during a 6-month baseline period before dissemination of guidelines to gastroenterologists and during a 1-year period after dissemination of guidelines. In the year following dissemination, chart reminders and contacts by a physician opinion leader were used to increase physicians' adherence to the guidelines. Results: Testing for H. pylori increased from 78% in the baseline group (n = 58) to 88% in the postintervention group (n = 131) (P= 0.081). Testing for H. pylori using the rapid urease method increased from 27% in the baseline group to 51% in the postintervention group (P = 0.004). There was a highly significant increase in the rate of initiation of appropriate anti-H. pylori therapy (before hospital discharge) from 45% in the baseline group to 84% in the postintervention group (P < 0.001). Conclusion: H. pylori treatment can be markedly improved in patients admitted with acutely bleeding gastroduodenal ulcers by the active promotion of inpatient care guidelines.
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