A randomized trial of an acid-peptic disease management program in a managed care environment

Abstract

Objective: To study the effectiveness of a disease management program for patients with acid-related disorders.

Study design: A cluster-randomized clinical trial of 406 patients comparing a disease management program with "usual practice."

Patients and methods: Enrolled patients included those presenting with new dyspepsia and chronic users of antisecretory drugs in 8 geographically separate physician offices associated with the Orlando Health Care Group. There were 35 providers in the intervention group and 48 in the control group. The disease management program included evidence-based practice guidelines implemented by using physician champions, academic detailing, and multidisciplinary teams. Processes of care, patient symptoms, quality of life, costs, and work days lost were measured 6 months after patient enrollment.

Results: Compared with usual practice, disease management was associated with improvements in Helicobacter pylori testing (61% vs 9%; P = .001), use of recommended H pylori treatment regimens (96% vs 10%; P = .001), and discontinuation rates of proton pump therapy after treatment (70% vs 36%; P = .04). There were few differences in patient quality of life or symptoms between the 2 study groups. Disease management resulted in fewer days of antisecretory therapy (71.7 vs 88.1 days; P = .02) but no difference in total costs.

Conclusion: This disease management program for patients with acid-related disorders led to improved processes of care. The effectiveness of such a program in other settings requires further study.