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

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.

Outcome

Adults with dyspepsia or reflux symptoms are satisfied that they are able to self‑manage their condition.

Data source: Local data collection.

Patient‑reported health outcomes for adults with dyspepsia or gastro‑oesophageal reflux disease.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

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.

What the quality statement means for patients, service users and carers

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

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:

  • Healthy eating, weight loss for people who are overweight and smoking cessation for people who smoke.

  • Avoiding known causes that may be associated with symptoms, including smoking, alcohol, coffee, chocolate, fatty foods and being overweight.

  • 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.

[Dyspepsia and gastro-oesophageal reflux disease (NICE guideline CG184) 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 Dyspepsia and gastro-oesophageal reflux disease (NICE guideline CG184) 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 Dyspepsia and gastro-oesophageal reflux disease (NICE full guideline CG184) section 4.1.2.1, Suspected cancer (NICE guideline NG12) recommendations 1.2.1, 1.2.2, 1.2.3, 1.2.7, 1.2.8, 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.