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International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 851–856 | Cite as

Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study

  • Brett MacFarlaneEmail author
  • Andrew Matthews
  • Jenny Bergin
Research Article

Abstract

Background Patients regularly present to community pharmacies for advice about and treatment for reflux symptoms and NSAIDs are a common cause of these symptoms. There is no published literature detailing the approach that pharmacies take to these enquiries, the pharmacotherapy they recommend or whether they contribute to the safe and effective use of reflux medicines. Objectives To assess in an observational study design the clinical history gathering, recommendations for GORD management and counselling provided by community pharmacies in a simulated patient scenario involving suspected NSAID induced reflux symptoms. Setting Australian community pharmacies. Method Simulated patients visited 223 community pharmacies to request treatment for reflux symptoms. The interaction was audiotaped and assessed against guidelines for the treatment of reflux symptoms. Main outcome measures Alignment of community pharmacies with international expert gastroenterologist guidance and national professional practice guidelines for the treatment of reflux symptoms by pharmacists including: consultation with a pharmacist; confirmation of reflux diagnosis based on symptoms; recommendation of short courses proton pump inhibitor (PPI) therapy; advice on the safe and effective use of reflux medicines and referral to a doctor for further assessment. Results Pharmacists consulted with the simulated patient in 77 % of cases. Symptoms were enquired about in 95 % of cases and a medicines history taken in 69 % of cases. Recommendations for treatment included: PPIs (18 %), histamine H2 antagonists (57 %) and antacids (19 %). Advice on product use was given in 83 % of cases. Referral to a doctor to discuss reflux symptoms was made in 63 % of cases. Conclusion When assessing patients for the symptoms of GORD, Australian pharmacists and non-pharmacist support staff take a comprehensive history including symptomatology, duration of symptoms, concomitant medicines and medical conditions and any GORD treatments previously trialled. They provide comprehensive counselling on the use of antisecretory and antacid medicines. Counselling could involve more comprehensive information on lifestyle approaches for GORD management and side effects of antisecretory and antacid medicines. Further alignment with guidelines for the management of GORD would result in greater referral to a doctor for assessment of recurrent GORD and greater recommendation of PPIs for symptoms. However alignment with guidelines by all pharmacists is unrealistic if the guidelines are not universally available to them.

Keywords

Australia GORD Guidelines Over the counter Proton pump inhibitors Reflux Simulated patients 

Notes

Acknowledgments

The authors would like to acknowledge work of the Pharmacy Guild of Australia Quality Care Pharmacy Program staff that performed the SP visits to community pharmacies and collected the audio files used for analysis.

Funding

The SMA program that this study was investigated under is funded by the Pharmacy Guild of Australia.

Conflicts of interest

Pharmacists employed by the PGoA were involved in development of the SP scenario however were not involved in analysis of the data. Ms Jenny Bergin and Mr Andrew Matthews were involved in development of the research methodology and reviewed the final manuscript.

References

  1. 1.
    Loffeld RJ. Gastro-oesophageal reflux disease-experience in daily practice: symptoms and symptom assessment. Scand J Gastroenterol Suppl. 2006;243:3–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Ronkainen J, Aro P, Storskrubb T, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scand J Gastroenterol. 2005;40(3):275–85.CrossRefPubMedGoogle Scholar
  3. 3.
    Zagari RM, Fuccio L, Wallander MA, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: the Loiano–Monghidoro study. Gut. 2008;57(10):1354–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Liker HR, Ducrotté P, Malfertheiner P. Unmet medical needs among patients with gastroesophageal reflux disease: a foundation for improving management in primary care. Dig Dis. 2009;27(1):62–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Ruszniewski P, Soufflet C, Barthélémy P. Nonsteroidal anti-inflammatory drug use as a risk factor for gastro-oesophageal reflux disease: an observational study. Aliment Pharmacol Ther. 2008;28(9):1134–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Martín-De-Argila C, Martínez-Jiménez P. Epidemiological study on the incidence of gastroesophageal reflux disease symptoms in patients in acute treatment with NSAIDs. Expert Rev Gastroenterol Hepatol. 2013;7(1):27–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013;5:CD002095. doi: 10.1002/14651858.CD002095.pub5.PubMedGoogle Scholar
  8. 8.
    Zhang JX, Ji MY, Song J, Lei HB, Qiu S, Wang J, et al. Proton pump inhibitor for non-erosive reflux disease: a meta-analysis. World J Gastroenterol. 2013;19(45):8408–19.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Holtmann G, Bigard MA, Malfertheiner P, Pounder R. Guidance of the use of over the counter proton pump inhibitors for the treatment of GORD. Int J Clin Pharm. 2011;33(3):493–500.CrossRefPubMedGoogle Scholar
  10. 10.
    Bundeff AW, Zaiken K. Impact of clinical pharmacists’ recommendations on a proton pump inhibitor taper protocol in an ambulatory care practice. J Manag Care Pharm. 2013;19(4):325–33.PubMedGoogle Scholar
  11. 11.
    Atkins R, Smith L. Impact of pharmacy intervention on the use of proton pump inhibitors in the hospital setting. Consult Pharm. 2013;28(12):786–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Branham AR, Katz AJ, Moose JL, et al. Retrospective analysis of estimated cost avoidance following pharmacist provided medication therapy management services. J Pharm Pract. 2013;26(4):420–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Benrimoj SI, Werner JB, Raffaele C, Roberts AS. A system for monitoring quality standards in the provision of non-prescription medicines from Australian community pharmacies. Pharm World Sci. 2008;30:147–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Pharmaceutical Society of Australia. Standards for the provision of pharmacy medicines and pharmacist only medicines in community pharmacy. PSA Professional practice standards page [internet]; Version 3 2005 [Revised 2005 Nov; cited 2015 March 22]. http://www.psa.org.au/supporting-practice/professional-practice-standards.
  15. 15.
    Kashyap KC, Nissen LM, Smith SS, Kyle G. Management of over the counter insomnia complaints in Australian community pharmacies: a standardised patient study. Int J Pharm Pract. 2014;22:125–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Queddeng K, Chaar B, Williams K. Emergency contraception in Australian community pharmacies: a simulated patient study. Contraception. 2011;83(2):176–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Schneider CR, Emery L, Brostek R, Clifford RM. Evaluation of the supply of antifungal medication for the treatment of vaginal thrush in the community pharmacy setting: a randomized controlled trial. Pharm Pract (Granada). 2013;11(3):132–7.CrossRefGoogle Scholar
  18. 18.
    Schneider CR, Gudka S, Fleischer L, Clifford RM. The use of a written assessment checklist for the provision of emergency contraception via community pharmacies: a simulated patient study. Pharm Pract (Granada). 2013;11(3):127–31.CrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Brett MacFarlane
    • 1
    Email author
  • Andrew Matthews
    • 2
  • Jenny Bergin
    • 1
  1. 1.Australian College of PharmacyFyshwickAustralia
  2. 2.Pharmacy Guild of AustraliaBartonAustralia

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