S3174 Improving Helicobacter pylori Eradication Testing Rates Through a Dedicated Pharmacy Clinic: A Quality Improvement Initiative

Introduction: Helicobacter pylori (HP) infects a third of the United States population and is a major cause of peptic ulcers, malabsorption, and malignancy. After diagnosis and treatment, eradication testing is crucial due to high treatment failure rates, yet studies suggest only about 24% of patients undergo eradication testing. Barriers to testing include fragmented care between gastroenterology (GI) and primary care providers (PCPs), lack of standardized protocols, and adherence challenges. Methods: This quality improvement study aimed to compare rates of eradication testing and treatment success for HP diagnosed by esophagogastroduodenoscopy (EGD) before and after implementing a dedicated Clinical Pharmacist Practitioner (CPP) at a Veterans Affairs Medical Center. The study compared veterans diagnosed with HP via gastric biopsy between May and October 2023 to those diagnosed during the same period in 2024. A 6-month observation period was used to allow for appropriate follow-up. In the pre-intervention period, a mandatory EGD patient results letter was modified to provide “clinical decision support” for HP treatment. In the post-intervention period, the letter was modified to trigger a “clinical referral” to the dedicated CPP clinic for HP management. Chi-square tests were used to compare categorical outcome variables. This study was deemed exempt by the Institutional Review Board. Results: There were 601 EGDs in the pre-CPP period (48 HP-positive) and 658 EGDs in the post-CPP period (41 HP-positive). The rate of eradication testing completion increased from 37.5% pre-CPP to 61% post-CPP (P = 0.03). The use of tetracycline-based quadruple therapy increased from 29.2% to 78% (P < 0.001), reflecting concordance with updated guidelines. Indeed, the overall rate of successful eradication improved from 31.3% to 56.1% (P = 0.02). Orders for testing shifted from GI/PCP to CPP-led (76% post-intervention; P < 0.001). Among patients who completed testing, the rate of refractory HP decreased from 16.7% to 8.0%. Conclusion: A dedicated CPP clinic significantly improved HP eradication testing rates and streamlined care, with most post-intervention veterans managed by a pharmacist. Centralized follow-up with standardized, guideline-concordant treatment regimens improved adherence and outcomes, demonstrating a scalable model for HP management. We anticipate continued improvement in outcomes after the “wash-in” period with this new model, given rising utilization and satisfaction with the CPP clinic.