E0689 - Factors Associated With Failure to Complete H. pylori Eradication Testing in an Urban Tertiary Care Center

Brian White, MD¹, Parth Patel, MD², Michael Schwartz, MD³, Krystal Hunter, PhD³, Joshua DeSipio, MD³, Sangita Phadtare, PhD^4
1Hospital of the University of Pennsylvania, Philadelphia, PA; ²Montefiore Medical Center, New York, NY; ³Cooper University Healthcare, Camden, NJ; ⁴Cooper Medical School of Rowan University, Camden, NJ

Introduction: Global trends in antibiotic resistance have limited progress in H. pylori eradication rates. Current data reflecting local antibiotic resistance and cure rates obtained from eradication tests are critical, but these tests may be inconsistently completed. As the first phase of a quality improvement initiative, we studied 481 patients treated for H. pylori at our institution to identify barriers to eradication test completion.

Methods: Patients > 18 years and treated for H. pylori during the 25-month study period were identified via ICD-10 code query. Demographic data were collected along with data pertinent to the H. pylori diagnosis communication, provider characteristics, antibiotic prescription, and eradication test. Chi-squared testing was used to compare eradication test completion and cure rates between different groups. Multivariable logistic regression models were used to identify factors associated with incompletion of eradication tests and eradication failure.

Results: Overall, 301 patients (63%) completed eradication tests (minimum follow-up 8 months since antibiotic prescription). 71% of these patients had confirmed cure. 352 patients reported treatment completion; 83% of these (n= 292) completed eradication testing. Univariate analysis identified multiple factors associated with failure to complete eradication tests, including male sex, African-American race, and letters to communicate the diagnosis. Multivariate analysis showed that communication via letter was associated with lower odds of eradication test completion compared to telephone call (OR = 0.29, CI: 0.10 - 0.84). Scheduled treatment encounters (i.e. in-office or telehealth encounters) for antibiotic prescription were also associated with lower odds of eradication test completion (OR = 0.20, CI: 0.06 - 0.68). Patients who had eradication testing ordered on the same day as antibiotic prescription were not more likely to complete eradication testing overall, but were more likely to complete it early (21.4% vs 9.2%, p = 0.004.

Discussion: Our patients and prescribers may benefit from a standardized protocol to guide diagnosis communication, follow-up, and eradication testing which will be evaluated in the second phase of this quality improvement project. The protocol will include i) two methods of communicating the H. pylori diagnosis to each patient and deferral of ii) follow-up visit and iii) eradication testing order until after antibiotic completion.



Disclosures:


Brian White, MD¹, Parth Patel, MD², Michael Schwartz, MD³, Krystal Hunter, PhD³, Joshua DeSipio, MD³, Sangita Phadtare, PhD⁴. E0689 - Factors Associated With Failure to Complete H. pylori Eradication Testing in an Urban Tertiary Care Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.