Pharmacy World & Science

, Volume 30, Issue 5, pp 515–525 | Cite as

Design of an algorithm to support community pharmacy dyspepsia management

  • Halldora A. E. AradottirEmail author
  • Moira KinnearEmail author
Research Article


Objectives To design a care pathway and referral documentation system to support dyspepsia management in the community pharmacy according to national guidelines. To explore attitudes of community pharmacists and general practitioners (GPs) towards the proposed model of care. Setting Focus group of four community pharmacists from one locality and one-to-one interviews with five GPs in each of their surgeries in different city localities. Method Literature review; design of a care pathway and referral system; qualitative analysis of focus group discussion and one-to-one interviews. Main outcome measure Modified design of documentation system; attitudes and barriers towards an extended role for pharmacists in a community pharmacy based model of individual care of patients with dyspepsia. Results The care pathway and documentation system was modified to make it simple to use and to assure appropriate referral and reporting to GPs. All participants agreed that the SIGN guideline for Dyspepsia and local dyspepsia guidelines provide an opportunity to extend the role of pharmacists to prescribe therapeutic doses of H2 receptor antagonists, test for Helicobacter pylori in the pharmacy and prescribe eradication therapy. Perceived advantages to patients included better convenience and reduced waiting times for H. pylori testing. Current barriers to this model identified were: medico-legal issues, budgetary issues, limited access to patient data, lack of privacy to talk to patients, inadequate time and remuneration, no patient registration, patients describing vague symptoms and patient confidence in pharmacists. Conclusion The proposed model of care and documentation system for community pharmacy based dyspepsia management generated a favourable response and design contributions from community pharmacists and GPs. Barriers were identified which have to be overcome prior to implementation and evaluation of the model.


Care pathway Community pharmacy Dyspepsia Extended role Guidelines Partnership working Pharmacists Scotland 



The authors would like to thank the community pharmacists and GPs for their participation in the study and Susan McKellar from the University of Strathclyde for help with the focus group and data analysis.

Financial support of the study

No external funding support was associated with this study.

Conflicts of interest



  1. 1.
    Scottish Intercollegiate Guidelines Network. Dyspepsia. Guideline number 68. SIGN, Edinburgh. 2003. Available from:
  2. 2.
    Talley NJ, Stanghellini V, Heading RC, Koch KL, Malagelada JR, Tytgat GN. Functional gastroduodenal disorders. Gut 1999;45:II37–42.PubMedGoogle Scholar
  3. 3.
    National Institute for Clinical Excellence. Clinical Guideline 17, Dyspepsia: managing adults in primary care. National Institute for Clinical Excellence (NICE); 2004.Google Scholar
  4. 4.
    Scottish Executive. The right medicine: a strategy for pharmaceutical care in Scotland. Edinburgh: Scottish Executive; 2002.Google Scholar
  5. 5.
    Hassell K, Whittington Z, Cantrill J, Bates F, Rogers A, Noyce P. Managing demand: transfer of management of self-limiting conditions from general practice to community pharmacies. BMJ 2001;323:146–7.PubMedCrossRefGoogle Scholar
  6. 6.
    News feature. How the minor ailments service works. Pharm J 2004;272:115–6.Google Scholar
  7. 7.
    Vohra S. A community pharmacy minor ailment scheme- effective, rapid and convenient. Pharm J 2006;276:754–6.Google Scholar
  8. 8.
    New Community Pharmacy Contract – Minor Ailments Service – Implementation. NHS circular: PCP(P)(2006)9. Scottish Executive; May 2006.Google Scholar
  9. 9.
    Lothian Minor Ailments Formulary. Available:
  10. 10.
    NHS Education Scotland (NES) Pharmacy. The Minor Ailment Service (MAS) implementation pack. Available:
  11. 11.
    Penston JG, Pounder RE. A survey of dyspepsia in Great Britain. Aliment Pharmacol Ther 1996;10:83–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Jones RH, Lydeard SE, Hobbs FD, Kenkre JE, Williams EI, Jones SJ, Repper JA, Caldow JL, Dunwoodie WM, Bottomley JM. Dyspepsia in England and Scotland. Gut 1990;31:401–5.PubMedCrossRefGoogle Scholar
  13. 13.
    The National Health Service (Charges for drugs and compliances) (Scotland) (No.2) Regulations 2007. NHS circular: CEL (2007) 9. Scottish Government; 2007.Google Scholar
  14. 14.
    Supplementary prescribing: pharmacists practitioners. A guide for implementation within NHS Scotland. Scottish Executive; 2004.Google Scholar
  15. 15.
    Bellingham C. How supplementary prescribing is working for pharmacists in practice? Pharm J 2004;273:2–3.Google Scholar
  16. 16.
    Hobson RJ, Sewell GJ. Supplementary prescribing by pharmacists in England. Am J Health Syst Pharm 2006;63:244–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson G, McCaig D, Bond C, Cunningham S, Diack H, Watson A, Stewart D. Supplementary prescribing: early experiences of pharmacists in Great Britain. Ann Pharmacother 2006;40:843–50.Google Scholar
  18. 18.
    Smalley L. Patients’ experience of pharmacist-led supplementary prescribing in primary care. Pharm J 2006;276:567–9.Google Scholar
  19. 19.
    Pearson K. Non-medical prescribing: managing patients with respiratory disease. Prescriber 2007;18(13):16–8.CrossRefGoogle Scholar
  20. 20.
    Lavender G. Nonmedical prescribing: clinics for long-term conditions. Prescriber 2007;18(17):56–9.CrossRefGoogle Scholar
  21. 21.
    Smalley L. Non-medical prescribing: managing a hypertension clinic. Prescriber 2007;18(18):17–21.CrossRefGoogle Scholar
  22. 22.
    Buckley P, Grime J, Blenkinsopp A. Inter- and intra- professional perspectives on non-medical prescribing in an NHS Trust. Pharm J 2006;277:394–8.Google Scholar
  23. 23.
    Avery A. Pringle M. Extended prescribing by UK nurses and pharmacists. BMJ 2005;331:1154–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson G, Pfleger D, McCaig D, Bond C, Stewart S. Independent prescribing by pharmacists: a study of the awareness, views and attitudes of Scottish community pharmacists. Pharm World Sci 2006;28:45–53.CrossRefGoogle Scholar
  25. 25.
    Bond CM. Guidelines for dyspepsia treatment. Pharm J 1994;252:228–9.Google Scholar
  26. 26.
    Johnsson F, Roth Y, Damgaard Pederson NE, Joelsson B. Cimetidine improves GERD symptoms in patients selected by a validated GERD questionnaire. Aliment Pharmacol Ther 1993;7:81–6.PubMedCrossRefGoogle Scholar
  27. 27.
    El-Omar EM, Banerjee S, Wirz A, McColl KEL. The Glasgow Dyspepsia Severity Score - a tool for the global measurement of dyspepsia. Eur J Gastroenterol Hepatol 1996;8:967–71.PubMedCrossRefGoogle Scholar
  28. 28.
    McColl KEL, El-Nujumi A, Murray LS, El-Omar EM, Dickson A, Kelman AW, Hilditch TE. Assessment of symptomatic response as predictor of Helicobacter pylori therapy in patients with ulcer. Gut 1998;42:618–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analysing qualitative data. London: Routledge; 1993. p. 173–194.Google Scholar
  30. 30.
    Smith F. Referral of clients by community pharmacists: views of general medical practitioners. Int J Pharm Pract 1996;4:30–5.Google Scholar
  31. 31.
    Noyce P. Providing patient care through community pharmacies in the UK: policy, practice and research. Ann Pharmacother 2007;41:861–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.NHS Lothian Pharmacy Practice Unit, Department of PharmacyWestern General HospitalEdinburghScotland
  2. 2.Strathclyde Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowScotland
  3. 3.Islenskar lyfjarannsoknir ehf – EncodeReykjavikIceland

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