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Pharmacists could have greater input in managing patients with dyspepsia

Pharmacists could become more involved in the management of patients with dyspepsia when new National Institute for Clinical Excellence guidelines are released, according to Dr Richard Stevens, chairman of the Primary Care Society for Gastroenterology. Speaking at a recent King's Fund symposium in London on dyspepsia, Dr Stevens said that draft NICE guidelines on the primary management of dyspepsia, due to be released in May 2004, downgrade the value of endoscopy. The new guidelines are likely to stress that dyspepsia is a benign, chronic, relapsing and remitting disease, and that endoscopy will be reserved for people with specific alarm symptoms.

If the guidance recommends that the primary investigation should be the urea breath test, then pharmacists and nurses can perform it and become more involved in the patients’ management. Dr Stevens said: “Under the new pharmacy contract there is talk of pharmacists working to a clinical management plan, offering patients a urea breath test and prescribing eradication therapy if it is positive.” It was not clear whether the guidelines were going to advocate a “test and treat” or “symptom and treat” strategy.

Dr Paul Pickering, prescribing lead from Yorkshire Wolds and Coast Primary Care Trust, explained how practice-based dyspepsia clinics led by pharmacists and nurses have proved to be effective in improving patient management. Breaking the cycle of long-term use of proton pump inhibitors by helping patients “step down” (from treatment dose to maintenance dose) or “step off” (from a PPI to an alginate) can lead to considerable savings in prescribing costs.

Reviews and self-management plans, recommended in the draft guidelines, could be conducted by prescribing nurses and pharmacists, Dr Stevens added.

Previous NICE guidance on dyspepsia and the use of proton pump inhibitors is available.

Source: Pharmaceutical Journal, December 13, 2003.

Read the full report and view all the presentation slides from the King’s Fund Primary Care Management of Dyspepsia Symposium

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