Specialist and Generalist Physicians' Adoption of Antibiotic Therapy to Eradicate Helicobacter pylori Infection


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Abstract

OBJECTIVESThe authors examine how specialist and generalist physicians adapted their practice patterns to emerging information on the role of Helicobacter pylori in peptic ulcer disease (PUD).METHODSData were collected via a mail survey sent to national random samples of gastroenterologists, family practitioners, and general internists in April 1994. A Cox proportional hazards regression was used to evaluate the determinants of the timing of adoption of antibiotic therapy for suspected or confirmed PUD.RESULTSMost respondents (99.1% of specialists and 64.6% of generalists) had prescribed antibiotic therapy to eradicate Helicobacter pylori at least once. The median specialist adopted 21 months before the medical generalist. Timing of adoption also was related to gender, board certification, PUD case load, and practice setting.CONCLUSIONSGastroenterologists were more likely than primary care physicians to adopt antibiotic therapy for PUD, even before the evidence of this therapy's effectiveness was conclusive. Primary care physicians remained less likely to adopt after efficacy was established. The slower adoption by primary care physicians appeared to be related both to having less information than specialists about the new therapy and to more conservative practice styles. Measures to facilitate the flow of information about new technologies to primary care physicians may be warranted. Research on interspecialty differences in adoption of new therapies can contribute to understanding the consequences of the current shift from specialist- to generalist-driven care.

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