Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study
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.
KeywordsAustralia GORD Guidelines Over the counter Proton pump inhibitors Reflux Simulated patients
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.
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.
- 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
- 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.