MacFarlane Brett, Matthews Andrew, Bergin Jenny
Australian College of Pharmacy, Level 2, 9/65 Tennant St, Fyshwick, ACT, 2609, Australia.
Pharmacy Guild of Australia, Level 2, 'Pharmacy Guild House' 15 National Circuit, Barton, ACT, 2600, Australia.
Int J Clin Pharm. 2015 Oct;37(5):851-6. doi: 10.1007/s11096-015-0129-9. Epub 2015 May 14.
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.
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.
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.
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.
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.
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.
患者经常前往社区药房咨询反流症状的相关建议及治疗方法，非甾体抗炎药（NSAIDs）是这些症状的常见诱因。目前尚无公开文献详细描述药房针对此类咨询所采取的方法、推荐的药物治疗方案，以及它们是否有助于反流药物的安全有效使用。
在一项观察性研究设计中，评估澳大利亚社区药房在涉及疑似NSAID引起的反流症状的模拟患者场景中收集的临床病史、对胃食管反流病（GORD）管理的建议及提供的咨询服务。
模拟患者走访了223家社区药房，要求治疗反流症状。互动过程进行了录音，并根据反流症状治疗指南进行评估。
社区药房与国际专家胃肠病学家指南以及药剂师治疗反流症状的国家专业实践指南的一致性，包括：与药剂师咨询；根据症状确认反流诊断；推荐短期质子泵抑制剂（PPI）治疗；提供反流药物安全有效使用的建议；转诊至医生处进行进一步评估。
77%的病例中，药剂师与模拟患者进行了咨询。95%的病例询问了症状，69%的病例记录了用药史。治疗建议包括：PPI（18%）、组胺H2拮抗剂（57%）和抗酸剂（19%）。83%的病例提供了产品使用建议。63%的病例转诊至医生处讨论反流症状。
在评估GORD症状的患者时，澳大利亚药剂师和非药剂师支持人员会全面了解病史，包括症状学、症状持续时间、伴随用药和医疗状况以及之前尝试过的任何GORD治疗方法。他们提供关于使用抗分泌和抗酸药物的全面咨询。咨询可能包括关于GORD管理的生活方式方法以及抗分泌和抗酸药物副作用的更全面信息。进一步与GORD管理指南保持一致将导致更多地转诊至医生处评估复发性GORD，并更多地推荐使用PPI治疗症状。然而，如果指南并非所有药剂师都能普遍获取，要求所有药剂师与指南保持一致是不现实的。
