Quality of Helicobacter pylori Infection Management Through Telemedicine: A Nationwide Cross‐Sectional Study

OBJECTIVE: To evaluate the clinical practice and quality of first-line Helicobacter pylori eradication therapy by gastroenterologists in direct-to-consumer telemedicine (DTCT) settings. METHODS: The study was conducted between November 2024 and February 2025 using unannounced standardized patients (USPs). Six trained and validated USPs questioned clinicians using specific H. pylori infection scenarios on hospital- or enterprise-sponsored DTCT platforms. Accessibility and effective consultation rates of the enquiry platforms were evaluated. The consultation process at each visit was also analyzed for guideline adherence and patient-centeredness. RESULTS: USPs conducted 552 visits on 53 hospital- and 19 enterprise-sponsored accessible platforms, with effective consultation rate of 65.6% (362 of 552). Based on a 10-point quality checklist, the overall guideline adherence score was 5.0, which was significantly higher for the enterprise-sponsored platforms than for hospital platforms (5.4 ± 2.7 vs. 4.8 ± 2.8, p = 0.045). When stratified by professional title of the clinicians involved, clinicians with intermediate title achieved a higher guideline adherence score than those with junior or senior titles (5.5 ± 2.7 vs. 4.3 ± 2.7 vs. 4.8 ± 2.8, p = 0.009). Altogether 72% of clinicians prescribed the correct treatment regimen for H. pylori infection. Furthermore, patient satisfaction during the treatment process was generally acceptable. CONCLUSIONS: We identified gaps in guideline adherence and clinical standardization for telemedicine-based H. pylori eradication in China. Further nationwide standardized training for gastroenterologists should prioritize structured history-taking, appropriate prescribing, resistance-guided antibiotic selection, and patient follow-up management. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06749873.