This small group meeting with a trained facilitator provides practices with a clinical update and an opportunity for interactive discussion with peers regarding quality use of medicines in their patients, using the prescribing of proton pump inhibitors (PPIs) in the management of gastro-oesophageal reflux disease (GORD) as an example.
This includes discussion about indications for prescribing PPIs and recommendations on using a plan which includes length of treatment, time of review and when to initiate a withdrawal trial in response to patients’ symptoms and consideration to long-term risks. GPs are encouraged to reinforce the role of non-pharmacological management as an adjunct to PPIs for their patients in the management of GORD. Data from the NPS MedicineInsight program will be provided to help GPs and practice staff draw insights from current practice.
Relevance to General Practice
Gastro-oesophageal reflux is common, with 15-20% of Australians experiencing heartburn at least once a week. GORD occurs when patients experience either frequent or severe reflux symptoms, and is managed primarily through a combination of lifestyle modifications and medicines.
Current guidelines for the management of GORD recommend starting treatment on a short-term standard dose PPI (4-8 weeks), followed by regular review to step-down or stop the medicine. However, evidence in Australia suggests the majority of PPIs are being used in the long term and often without appropriate indication. While PPIs are generally a safe class of medicines, there is some emerging evidence of possible rare but serious adverse events that also need to be considered.
This educational visit will address the holistic management of GORD, specifically addressing the recommended use of PPIs, providing guidance on starting, stepping down and stopping treatment, as well as long-term risks.
- Distinguish between what is GORD or not when patients present with reflux symptoms.
- Develop a plan for patients with GORD starting a PPI that considers lifestyle modifications and stepping down or stopping of PPI at review.
- Discuss stepping down or stopping PPIs with patients with GORD who have adequately controlled symptoms.
- Explain the balance of benefits and risks of ongoing PPI treatment for GORD.
- Discuss systems in your practice and prioritise areas for improvement in the management of patients prescribed PPIs for GORD.
Domains of General Practice
D1. Communication skills and the patient-doctor relationship
D2. Applied professional knowledge and skills
D3. Population health and the context of general practice
D4. Professional and ethical role
D5. Organisational and legal dimensions
Curriculum Contextual Units
- Adult health
- Care of older people