ప్రాథమిక సంరక్షణలో నాణ్యత అందరికి ప్రవేశం

నైరూప్య

Management of dyspepsia in general practice: an observational study

Nicole Krol

AimTo determine what medical care is provided in general practice to patients with dyspepsia and to investigate associated factors.Method Observational study with 331 patients recruited by 183 general practitioners.Results Re? ux-like symptoms were reported by 142 patients, ulcer-like symptoms by 60 patients and non-speciŽ c symptoms by 129 patients. Endoscopic investigation was performed in 49 patients. There was no association between the type of symptoms and the order of endoscopic investigation. Acid suppressive drugs were prescribed to the majority of patients (n = 199).Respectively 66% and 64% of patients with re? uxlike and ulcer-like symptoms received prescriptions for acid suppressive drugs. Fifty Ž five per cent of patients with non-speciŽ c dyspeptic symptoms received a prescription for acid suppressive drugs. In sum 46% of all patients who received these drugs had neither a relapse nor a history of earlier drug treatment or endoscopic investigation. Of all patients who recently had endoscopic investigation (n = 30), 73% received proton pump inhibitorsregardless of the results. Most predictive for prescription of proton pump inhibitors was the use of these drugs in an earlier episode. Earlier use of proton pump inhibitors showed a negative association with the prescription of H2-receptor antagonists. Ninety-four per cent of all patients received at least one piece of advice on lifestyle, most frequently the advice was to avoid the use of alcohol.Conclusion Many patients with dyspepsia received acid suppressive drugs and the most relevant predictor of prescribing these was earlier use of the same drugs. Daily practice contradicts with guidelines that recommend a step-up approach and regular evaluation of medication use. Improvement may depend on the general practitioner’s attitude as well as appropriate implementation of evidence-based guidelines.