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GPs urged to discuss OTC drugs in every consultation

The Health Protection Agency is urging PCTs to

audit GPs' dyspepsia care after finding 'huge' variation in treatment strategies.

The agency found rates of Helicobacter pylori testing varied 600-fold between practices as a consequence of sharply differing awareness on the benefits of serology.

Low-testing practices were often putting patients at unnecessary risk by overusing endoscopy, often because they had easy access to endoscopy services.

Dr Cliodna McNulty, head of the HPA primary care unit in Gloucester, said PCTs needed to audit current practice in order to target GPs with low testing rates.

She said: 'There was a huge difference in rates of testing. We need proactive implementation of NICE guidance.

'We've found from doing workshops with GPs that if you present their testing rates compared with other practices they're very open to changing their practice.'

The study, in Alimentary Pharmacology and Therapeutics (June), found annual rates of H. pylori testing in 97 practices in Birmingham and Hereford varied from 0.1 to 59 per 1,000, with a mean of seven.

Focus groups of GPs from 15 practices suggested low-testing GPs were less aware of the benefits of serology and had lower endoscopy waiting times than higher testers.

All GPs reported access to breath tests was difficult and there was little knowledge of stool tests.

Dr McNulty said the annual rate of H. pylori testing should be about 10 per 1,000 patients.

'If you're doing 0.1 that's very very little but if you're doing 60 you're probably doing too many. Also if you're doing an awful lot of endoscopy you need to do less.'

Dr Keith MacDermott, a GP in York and member of the NICE dyspepsia guideline development group, said: 'It's the availability of testing that's crucial.'

By Emma Wilkinson

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