Quality standard
Quality statement 1: Advice to support self‑management
Quality statement 1: Advice to support self‑management
Quality statement
Adults with dyspepsia or reflux symptoms who present to community pharmacists are given advice about making lifestyle changes, using over‑the‑counter medicines and when to consult their GP.
Rationale
Adults with dyspepsia or reflux symptoms who present to their community pharmacist may be able to alleviate and manage their symptoms by making changes to their lifestyle (eating healthily, losing weight if they are overweight, not smoking) and using over‑the‑counter medicines. It is also important that adults receive advice about when they should consult their GP to ensure that symptoms are investigated and managed appropriately.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults with dyspepsia or reflux symptoms who present to their community pharmacist are given advice about making lifestyle changes, using over‑the‑counter medicines and when to consult their GP.
Data source: Local data collection.
Process
Proportion of presentations of adults with dyspepsia or reflux symptoms to community pharmacists in which advice is received about making lifestyle changes, using over‑the‑counter medicines and when to consult a GP.
Numerator – the number in the denominator in which advice is received about making lifestyle changes, using over‑the‑counter medicines and when to consult a GP.
Denominator – the number of presentations of adults with dyspepsia or reflux symptoms to community pharmacists.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (community pharmacists) ensure that processes are in place so that adults presenting with dyspepsia or reflux symptoms receive advice about making lifestyle changes, using over‑the‑counter medicines and when to consult their GP. This may include providing information leaflets when over‑the‑counter medicines are purchased.
Community pharmacists advise adults presenting with dyspepsia or reflux symptoms about making lifestyle changes, using over‑the‑counter medicines and when to consult their GP.
Commissioners (NHS England area teams and clinical commissioning groups) commission services that ensure community pharmacists advise people presenting with dyspepsia or reflux symptoms about making lifestyle changes, using over‑the‑counter medicines and when to consult their GP. Commissioners should work collaboratively with available minor ailment schemes to ensure that advice to adults with dyspepsia or reflux symptoms is included in any relevant service specifications.
Adults with indigestion or heartburn receive advice from their pharmacist about what they can do to relieve their symptoms. This should include advice about eating healthily, losing weight if they are overweight and not smoking. They should also receive information about medicines that can be bought 'over‑the‑counter' without a prescription and when people should make an appointment to see their GP. This information will help adults with indigestion or heartburn to manage their condition themselves.
Source guidance
Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE guideline CG184 (2014, updated 2019), recommendations 1.1.1 and 1.2.1 to 1.2.3
Definitions of terms used in this quality statement
Advice about lifestyle changes
Adults presenting with dyspepsia or reflux symptoms should be given simple lifestyle advice including:
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Healthy eating, weight loss for people who are overweight and smoking cessation for people who smoke.
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Avoiding known causes that may be associated with symptoms, including smoking, alcohol, coffee, chocolate, fatty foods and being overweight.
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Other factors that might help, such as raising the head of the bed and having a main meal at least 3 hours before going to bed.
[NICE's guideline on gastro-oesophageal reflux disease and dyspepsia in adults, recommendations 1.2.1, 1.2.2 and information for the public]
Advice about using over‑the‑counter medication
Adults presenting with dyspepsia or reflux symptoms should be advised to avoid long‑term, frequent dose, continuous antacid therapy, because it only relieves symptoms in the short‑term rather than preventing them. Adults with these symptoms should also be advised that non‑steroidal anti‑inflammatory drugs (NSAIDs) can be a potential cause. [Adapted from NICE's guideline on gastro-oesophageal reflux disease and dyspepsia in adults, recommendations 1.3.2 and 1.8.7]
Advice about when to consult their GP
Adults presenting with dyspepsia or reflux symptoms should be advised to see their GP if their symptoms have persisted for several weeks, get worse over time, or do not improve with medication. They should be advised to see their GP urgently if they have dysphagia or if they are aged 55 and over with additional symptoms that may be a cause for concern including weight loss, haematemesis, nausea or vomiting, or upper abdominal pain. [Adapted from NICE's guideline on gastro-oesophageal reflux disease and dyspepsia in adults, section 4.1.2.1, NICE's guideline on suspected cancer, recommendations 1.2.1 to 1.2.3 and 1.2.7 to 1.2.9, and expert opinion]
Equality and diversity considerations
Healthcare professionals should offer prescriptions to socially disadvantaged adults for over‑the‑counter medicines for dyspepsia or reflux symptoms if needed.
Community pharmacists should take into account cultural and communication needs when providing advice and educational materials.
Not all adults will want to self‑manage their dyspepsia or reflux symptoms, or be able to do so, and community pharmacists should identify any vulnerable people who may need additional support.