title: Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Australian College of Pharmacy, Level 2, 9/65 Tennant St, Fyshwick, ACT, 2609, Australia. brett.macfarlane@acp.edu.au.
authors.forename: Brett
authors.initials: B
authors.lastname: MacFarlane
authors.affiliation: Pharmacy Guild of Australia, Level 2, 'Pharmacy Guild House' 15 National Circuit, Barton, ACT, 2600, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Matthews
authors.affiliation: Australian College of Pharmacy, Level 2, 9/65 Tennant St, Fyshwick, ACT, 2609, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Bergin
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001315:Australia; D003157:Community Pharmacy Services; D005260:Female; D005764:Gastroesophageal Reflux / Q000139:chemically induced* / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use*; D016544:Patient Simulation
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D004366:Nonprescription Drugs
keywords: Australia; GORD; Guidelines; Over the counter; Proton pump inhibitors; Reflux; Simulated patients