Supporting best practice in PPI use for managing patients with GORD as an example to demonstrate quality use of medicine (QUM) principles. These principles include starting medicines only when necessary, and stepping down or stopping medicines when no longer required.
Relevance to General Practice
Gastro-oesophageal reflux is common, with 15-20% of Australians experiencing heartburn at least once a week. Gastro-oesophageal reflux disease (GORD) occurs when patients experience frequent or severe reflux symptoms, and is managed mainly through a combination of lifestyle changes and medicines.
Current guidelines recommend starting GORD treatment with short-term standard-dose PPI (4-8 weeks), followed by regular review to step-down the dose or stop the medicine. However evidence suggests that in Australia, most PPIs are being used in the long term, with overuse in inpatient and outpatient settings, often without appropriate indication.
While PPIs are generally safe, 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.
- Review patient clinical presentation, medicines and lifestyle to establish a valid indication before prescribing PPIs.
- 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 in GORD patients who have adequately controlled symptoms.
- Explain the benefits and risks of ongoing PPI treatment 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