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PATIENT CARE PROCESS

Patient Care Process for the Management of Gastroesophageal Reflux Disease

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Collect

  • Patient characteristics (e.g., age, race, sex, weight, body mass index, pregnancy status)

  • Patient history (past medical, family, social, dietary habits, tobacco use)

  • Health literacy and barriers to medication access

  • History of prescription, nonprescription, and natural medication use

  • Medication allergies and intolerances (include actual reactions to medication)

  • Laboratory results for major organ function (e.g., SCr, liver enzymes)

  • The type, frequency, and duration of GERD symptoms, and identify exacerbating factors (see Clinical Presentation)

Assess

  • Assess major organ function (e.g., creatinine clearance, hepatic impairment)

  • Determine if alarm symptoms or extraesophageal symptoms are present that require further diagnostic evaluation. (see Clinical Presentation)

  • Identify lifestyle factors, foods, and medications that may be contributing to symptoms. (see Table 32-1)

  • Assess the effectiveness of previous and current treatments for GERD (including medications and lifestyle modifications).

  • Assess the appropriateness and effectiveness of current GERD regimen.

  • Determine if goals of therapy are currently being met. (see Desired Outcomes)

Plan*

  • Identify individualized lifestyle modifications that can be made to improve symptoms. (see Table 32-4)

  • Determine appropriate therapy (may include both nonpharmacologic and pharmacologic) based on patient's presentation. (see Table 32-2)

  • For pharmacologic therapy, include medication name, dose, route, frequency, and duration of therapy recommendation. (see Table 32-3)

  • Establish monitoring parameters for safety (e.g., drug-drug, drug-food, drug-disease, and drug-lab interaction checking; short- and long-term adverse effects, and prevention of complications).

  • Establish monitoring parameters for efficacy (e.g., resolution of symptoms, improvement of symptoms, and healing of injured mucosa). (see Table 32-5)

  • Identify patient education that may be needed (e.g., purpose of medication, individualized lifestyle modifications, adverse effects, administration clinical pearls, adherence, potential need for long-term maintenance therapy, etc.)

Implement*

  • Provide patient education with regard to disease state, lifestyle modifications, and treatment plan. (see Table 32-4)

  • Initiate appropriate nonpharmacologic and pharmacologic therapy based on patient presentation. (see Table 32-2, Table 32-3)

  • Recommend additions, modifications, or discontinuations to therapy based on patient response.

  • Provide patient education with regard to disease state, lifestyle modifications, and treatment plan (see Table 32-4). Explain a) what causes GERD and things to avoid; b) when to take medication (e.g., 30 minutes before meal); c) what potential adverse effects or drug interactions may occur.

  • Use motivational interviewing techniques to maximize medication adherence.

  • Schedule follow-up as appropriate.

Follow-up: Monitor and Evaluate

  • Follow up after 8-16 weeks to assess effectiveness of acid-suppression therapy. Recommend alternative therapy when necessary.

  • For refractory symptoms, seek potential causes such as medication adherence, timing of medication, drug interactions, etc.

  • Evaluate the need for maintenance therapy based on patient presentation and response to therapy.

  • Assess improvement in quality-of-life measures such as physical, psychological, and social functioning and well-being.

  • Evaluate patient for the presence of adverse drug reactions, complications or new drug-drug interactions.

  • Stress the importance of medication adherence to treatment plan

*Collaborate with patient, caregivers, and other health professionals

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