Table 1 Studies included in the Review with specifications of implementation strategies and efficacy of treatment and costs
Authors, year | Research design | Evidence quality | Study characteristics: Population; i+c gr. (A) Participants (B) Stakeholders (C) | Method characteristics: Intervention type (A) Content guideline (B) Practical Attributes (C) | Implementation strategy | Results treatment | Results costs |
|---|---|---|---|---|---|---|---|
41. Bursey & Crowley 2000 | Dynamic population cohort | B | A: 110.000 residents of NF-land, Canada B: All GPs C: Government | A: Authorisation program for reimbursement. B: Patient selection for PPI use. C: Algorithm for prescription management. | I. passive | > 80% decrease PPI | PPI < 82% ($1.3 mil) first year; <62% after 2 years. ASD <36% ($2.0 mil) first year; <16% after 2 years |
42. Ladabaum & Fendrick 2001 | Prospective multicentre trial. | B | A: P. ulcer patients (54+39) B: PC-centres (3+3), GPs? C: University Michigan. | A: Interactive sessions by GE. B: Test & treat strategy C: H. pylori serological test for PC. | III. multiple | 32% more tests; same referrals; 31% less prescriptions (p > .001) | 79% in intervention group ($ 122 pp) (p = .17) |
43. Chan & Patel 2001 | RCT | A2 | A: All dyspepsia patients B: GPs (133+146); voluntary Hampshire C: Health authority | A: Posted guidelines and reinforcement visits by NP B: Management dyspepsia, H pylori. C: Wall chart, booklet | III. multiple | - | 5% decrease in medication |
44. Huren-kamp & Grund-meijer 2001 | RCT | A2 | A: H. pylori patients (89/85) B: 48 GP practices, voluntary C: University Amsterdam | A: Education of protocol; support by NP. B: Tapering prescriptions of ASD by doses and on demand treatment. C: follow up patients by NP. | III. multiple | Decrease of 1,5 PDD; 40% stopped ASD (ns); More HP neg, more H2RA | - |
45. Weynen & de Wit 2002 | RCT Cluster | A2 | A: 260 (99/73/88) patients B: 28 GPs; voluntary C: University Utrecht | A: Education program, financial incentives and personal feedback. B: H. Pylori diagnosis and treatment C: Dyspepsia questionnaire, HP test. | III. multiple | 17% better follow-up (ns), in incentive group | Less overall costs (€46 pp; ns) in incentive group |
46. Banait & Sibbald 2003 | RCT cluster, | A2 | A: Practice population (265.000) B: GP practices (57+56); voluntary NW England. C: University, GE, Health authorities. | A: Posted guidelines with education outreach and follow-up visit. B: Clinical strategies for referral. C: Open access to endo-scopies and serological tests | III. multiple | 14% more referrals, 4 more tests/practice | 6% more costs ASD |
47. Jones & Lydeard 1993 | RCT, | A2 | A: Practice population (500.000) B: GPs (78+101); voluntary; Southampton C: Consensus group GP+GE | A: Consensus meetings GP-SP. B: Investigation and refer dyspepsia; appropriate use of guidelines. C: reference cards, | II. single | No difference in referrals and endoscopies | 22% more prescribing costs |
48. Allison & Hurley 2003 | RCT | A2 | A: ASD patients (321+329). B: Physicians from study C: HMO California | A: Test & treatment random group. B: T&T protocol C: Detailed instructions | II single | Less ulcerlike symptoms and abdominal pain; 8% less users' medication | Higher costs because of HP treatment (not hospital) |
49. Kearney & Liu 2004 | Follow up Cohort | B | A: ASD patients (432) B: GE from study C: MHO Seattle | A: Patient Interview and HP test B: Hospital stopped ASD medicine C: Instruction for GPs' review. | I. passive | 71% ulcer; 29% dyspepsia; number stopped? | Hospital $34 less pp; Medication ns; Only ulcer cases |
50. Krol & Wensing 2004 | RTC cluster | A2 | A: ASD patients (63+50) B: 20 GP practices voluntary C: University Utrecht | A: Direct mail to patients to reduce ASD. B: Postal instructions for patients. C: Instruction and flowchart | II single | 17% reduction (10% stopped); no change in symptoms and quality | - |