OPTIMIZING ADHERENCE TO QUADRUPLE THERAPY FOR H PYLORI ERADICATION AMONGST ETHNIC MINORITIES: A QUALITY IMPROVEMENT INITIATIVE AT A SAFETY-NET MEDICAL CENTER

Introduction: H. Pylori is more prevalent in populations with lower socioeconomic status, Hispanic, Black, and Asian race. Despite the recommendations for bismuth-based quadruple therapy in cases of high macrolide resistance, adherence to these recommendations remains suboptimal and many clinicians continue to prescribe clarithromycin-based triple therapy. There is paucity of data on appropriate treatment regimens and eradication rates among patients from ethnic minorities living in the U.S. We aimed to improve adherence to the current recommendations and improve the eradication rates of H. Pylori.
Methods: We designed a quality improvement protocol to improve eradication rates of H. Pylori in a safety-net county teaching medical center, serving primarily ethnic minorities and those of lower socioeconomic status. This pre-post study was conducted from October 2022 to August 2023 at a federally qualified health center in Indianapolis, IN. An order set was introduced in the electronic medical records (EHR) to guide clinicians towards appropriate H. pylori eradication therapy and follow-up testing. Bilingual (Spanish or English) patient-friendly information about H. pylori and eradication testing was mailed to patients. The primary outcomes were H. pylori eradication rates and completion of eradication testing, with secondary outcomes focusing on appropriate quadruple therapy prescription.
Results: The study involved 38 (55.3% female) patients in the pre-intervention phase, 47 (70.2% female) in the pilot, and 66 (60.6% female) in the intervention phase, all testing positive for H. pylori. Spanish-speaking patients ranged from 30.4% to 42.1% (p=0.58) across all phases of this study. There was a significant improvement in H. Pylori eradication rates from pre-intervention (53.5%) compared to pilot and intervention phases (87.5% and 84.6% respectively) (p=0.047)). There was also a significant improvement in the prescription of appropriate quadruple therapy, and a trend toward an increase in eradication testing from the pre-intervention to the pilot and intervention phases. Interestingly, there was an increase in ordered follow up stool Antigen tests, but the main barrier to completion was patient compliance with repeat testing.
Conclusions: Implementing an EHR order set, along with enhanced patient-targeted educational material, significantly improved ordering appropriate H. pylori therapy and eradication rates. Further studies with larger sample sizes are needed to understand the full impact on additional outcome measures amongst patients from ethnic minorities.