Adoption of new pharmacotherapeutic regimens: Analysis of physician prescribing for peptic ulcer disease

OBJECTIVES. In February 1994, a National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate H. pylori in the treatment of peptic ulcer disease (PUD). The goal of this study is to determine if these recommendations were followed by physicians treating PUD in an underserved population. METHODS. Computerized Pennsylvania Medicaid data were used to evaluate prescribing patterns among 997 patients newly treated for PUD between March 1, 1994 through March 31, 1995. Prescription of PUD therapy was assessed during the 12-month period following PUD diagnosis. Pharmacotherapy for the initial management of PUD, defined as the one-month period following the initial diagnosis, and for the follow-up period, defined as the II-month period following the incident episode, was determined. The extent to which patients had an H. pylori or PUD invasive or noninvasive diagnostic procedure was examined. Rates of PUD outpatient physician encounters and inpatient hospitalizations were also assessed during the II-month follow-up period. RESULTS. Only 9.9% of the study population received an antimicrobial agent during their initial episode of care, compared to 78.1% of patients prescribed an H-2 receptor antagonist and 19.0% of patients prescribed a proton pump inhibitor. Race, age, and ulcer type were found to be significant in predicting the prescription of an antimicrobial during the initial episode of care. The majority of the study population (71.5%) was prescribed PUD treatment empirically; this did nor vary based on their initial PUD therapeutic regimen. During the 11-month follow-up period, very few patients (2.2%) were prescribed an antimicrobial for treatment of PUD. Finally there was no difference in the frequency of PUD-related outpatient physician or inpatient hospital stays based on a patient's initial PUD pharmacotherapy regimen. CONCLUSIONS. Two years after the highly publicized NIH conference on the eradication of H. pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. An important opportunity to eradicate PUD is being lost, which may lead to avoidable adverse clinical, quality of life, and economic outcomes.