Dr. Sandor Demeter
Failed Execution - What part of this is patients first? Part 5
Shared Health has failed to implement a “patients first” approach to testing patients who have chronic stomach aches.
People with chronic stomach aches (i.e. gastritis) may be suffering from a treatable infection from Helicobacter pylori, or H. pylori. Left untreated H. pylori gastritis can cause stomach ulcers and is also linked to an increased risk of stomach cancer. H. pylori infections are treated with common antibiotics.
Diagnosing H. pylori gastritis has traditionally been done by patients taking a urea breath test (UBT) which involves providing a breath sample (i.e. breathing into a plastic bag). Blood tests looking for specific H. pylori antibodies can also be done but these tests cannot tell the difference between new or past H. pylori infections.
I previously published a survey (June 11, 2019) where the wait times for UBTs in MB ranged from two weeks (Dynacare -where patients have to pay for the test) to one year (HSC). Imagine living with chronic stomach pain for up to a year waiting for a test that may indicate that simple antibiotic therapy may cure you.
Historically Nuclear Medicine has provided UBTs because a trace amount of radioactive material was used. This is no longer the case and the traditional “Nuclear Medicine” UBT approach is no longer the standard of care. A non-radioactive UBT, or alternatively stool antigen tests, have replaced the standard radioactive UBT. It is ironic that, in MB, Nuclear Medicine clinics provide the non-radioactive UBTs even though no radioactive materials are used.
Shared Health reviewed testing strategies for H. pylori and produced a report in November 2019 (i.e. Provincial Coordinated Helicobacter pylori Testing Strategy).
The report’s executive summary:
About one year ago, a Choosing Wisely Working Group was formed to review the various testing types and landscape of H. pylori testing in Manitoba to develop a recommendation that meets the current standard of care for laboratory diagnosis of this infection.
The committee’s conclusions were:
Manitoba should have a coordinated H. pylorus testing algorithm that is clear to ordering clinicians and available to patients close to their communities. The tests used should be as minimally invasive as possible, should diagnose active infection and assist care providers to follow a defined treatment plan. In addition, the testing should be delivered by health care professionals whose skills and services are best matched to the service to be provided and spend healthcare funding wisely.
Based on analysis, we propose the following testing algorithm: Serology should be used as the screening test for patients with suspected and previously undiagnosed H. pylori infection.If positive, follow up stool antigen testing (SAT) would be provided to patients, regardless of age. Blood for serology can be drawn at any laboratory location in Manitoba and shipped to CPL. A sample for SAT can be collected by the patient and provided to any laboratory location in Manitoba with the test being performed on site. Patients with a previous diagnosis of H. pylori may access SAT directly without a new or repeat positive serology test.
If these recommendations were implemented patients would no longer have to travel, some flying in from the North, to Winnipeg for a simple outpatient test. Testing could be done in local clinics, or nursing stations, across the province rather than having to go to a hospital or paying out of pocket at a private lab. Adopting the recommendations would also free up slots in Nuclear Medicine clinics to do other studies for which there are growing wait lists, especially for cancer and cardiac patients.
I understand that COVID-19 had impacted adopting innovated health care solutions, but this issue has been grumbling along for at least three years and it is time to act.
Easier access to a cheaper and accurate H. pylori diagnosis should make implantation of the current recommendations a “no brainer”.
For transparency, I have brought this issue to the attention of WRHA/Shared Health leaders multiple times over the last ~ three years with hopes of finding an internal solution which, obviously, has not come to light.
A good review article on this topic can be found at Hospital News (Canada) .
Image source credit: National Science Foundation