Scaling cardiac care
Natalie Raffoul leverages her pharmacy skills in public health, leading national initiatives that improve cardiovascular care.
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[post_content] => The autistic community accesses pharmacy services frequently. Yet pharmacists often report uncertainty about how best to communicate, counsel and build rapport in ways that are respectful, effective and person-centred.
Autism spectrum disorder is heterogeneous, points out disability specialist pharmacist and 2021 Consultant Pharmacist of the Year, Dr Manya Angley FPS.
Communication needs can vary, not only between individuals, but also for the same person from day to day – influenced by anxiety, illness, sensory processing, circadian rhythms or environmental factors, Dr Angley says.
Ideally, pharmacists should use validating, trauma-informed language that fosters safety, trust and empowerment, reducing the risk of re-traumatising individuals, says credentialed pharmacist and casual NSW academic Penny Beirne MPS – who has performed many Home Medicines Reviews (HMRs) for autistic people.
She says such patients have often had their concerns dismissed or minimised due to implicit bias and communication differences.
Best practice principles of communication – including using clear language, confirming understanding and avoiding overload – apply to all patients, Ms Beirne explains. But they are particularly pertinent when it comes to autistic patients and anyone who might need additional accommodations, such as individuals with cognitive impairment, people who have had a stroke or who have dementia.
Pharmacists in community and consultant settings can improve medicine safety and patient experience by adopting flexible strategies that respect each individual’s preferred mode of communication. Disability pharmacists such as Dr Angley emphasise that supporting autonomy and ensuring direct engagement are central to effective, inclusive care.
Ms Beirne also stresses that prioritising structure, predictability and transparency in interactions with autistic patients can be helpful in reducing anxiety, improving comfort and facilitating better access to healthcare.
Practical guidance
A simple Pharmacist Visit Communication Aid (see Case Study 1, page 61) or handover card can communicate a patient’s needs directly to the pharmacist/pharmacy staff without requiring patients to verbalise them repeatedly.
Further professional guidance will be available from the PSA Spectrum Foundation Program when it is launched later this year, and autism-specific organisations (e.g. Aspect at www.aspect.org.au/about-aspect). Referral to a GP, specialist, speech pathologist, behaviour support practitioner or allied health professional may be needed if medicine management is complex or if additional support is required for safe administration (see boxes, pages 59, 61, 62).
Box 1: Practical advice for communicating with autistic patients
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Box 2: Using AAC to support communication
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Patient BG, aged 25, is non-speaking, autistic, lives with epilepsy (tonic-clonic seizures) and communicates using a Pragmatic Organisation Dynamic Display (PODD) Augmentative and Alternative Communication (AAC) system on their iPad.
Medicines include:
[caption id="attachment_31860" align="alignright" width="300"]
Adjunct Professor Manya Angley FPS (CredPharm MMR) Credentialed and Disability PharmacistBG occasionally chooses not to take antiseizure medicines, reporting fatigue, headaches and dizziness related to dosing via their AAC.
To support BG, consultations were conducted in a quiet room using a Pharmacist Visit Communication Aid. The pharmacist collaborated with BG’s disability support worker to use the PODD AAC to:
2. Explain that missing a dose can increase the risk of seizures, which can also result in the same types of symptoms that are often worse, can limit participation in enjoyable activities, and can be associated with risks like falls and injury.
3. Explore an adjusted routine: trying to take antiseizure medicines at the earliest opportunity in the morning to reduce daytime fatigue.
Visual and literal explanations, combined with carer support for medicine administration, allowed BG to engage in decision-making. Liaison with the GP confirmed safety and appropriateness of the adapted schedule.
BG tolerated pharmacy visits with reduced anxiety and adherence improved. The care team reported increased confidence in managing medicines. Using the PODD AAC enabled BG to actively participate in their medication plan, demonstrating the value of flexible, personalised communication strategies.
Pharmacists can enhance safety, trust and autonomy by adopting flexible, person-centred communication strategies. Direct engagement, active listening, environmental adjustments, and collaboration with carers and communication aids like PODD AAC are key.
Tailoring communication to the individual and their specific support needs ensures inclusive, effective and empowering pharmacy care.
Penny Beirne MPSMx Kai (they/them), aged 38, is an autistic person with a new diagnosis of laryngopharyngeal reflux (LPR). Kai’s GP requested an HMR after Kai experienced challenges engaging with the recommended treatment regimen for LPR.
Kai also has a history of chronic migraine, insomnia, avoidant/restrictive food intake disorder (ARFID) and constipation. Kai’s STOP-BANG score, a 0–8 point screening tool for assessing a person’s risk of obstructive sleep apnoea (OSA) also indicated a high risk of OSA (for more on STOP-BANG, visit www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea).
The recommended regimen initially included:
All interventions except the amitriptyline were ceased because of sensory-related challenges.
Kai’s longstanding medicines comprised:
To better manage Kai’s LPR while accommodating sensory preferences, I recommended they trial alternative alginate agents such as the flavourless Gaviscon Infant sachets – two sachets dissolved in 250 mL water after meals and 0.5 hours before bed. Another alternative suggested was Larri oral spray, two sprays to the back of the throat three or four times daily.
For constipation, wheat dextrin (Benefiber) 2 tsp in >1/2 cup water twice daily was suggested as a psyllium alternative, which is flavourless and textureless when dissolved in water. I corrected Kai’s nasal spray technique in the hope that correct use may reduce the unpleasant taste; I recommended the GP change the nasal spray to one with less of a bitter taste if improved technique does not help. I also recommended referral to a neuroaffirming speech pathologist and dietitian. I suggested a sleep study to rule out OSA, and for Kai to consider medicines overuse headache contributing to the chronic migraine, with a 12-week trial of two doses (maximum) of analgesics weekly, with progress recorded in a headache diary.
Box 3: Tips for conducting HMRs with autistic patientsBefore your visit:
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[post_content] => Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
‘I encourage eligible Australians to protect themselves and their community this winter by getting vaccinated against RSV,’ said Mark Butler, Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme.
PSA National President, Professor Mark Naunton MPS, said the federal government's decision will safeguard the health of many Australians who, without this vaccine, could face severe illness, hospitalisation or death.
‘Older Australians who receive their RSV vaccine will be protected not just this winter, but for many winters, as this vaccine provides protection against this potentially debilitating illness for a number of years,’ he said.
‘Until being added to the NIP, the vaccine was costing older patients around $300. Removing this cost will go a long way toward protecting the respiratory health of those most at-risk of severe RSV and its complications.’
Here are the 6 things pharmacists need to know ahead of the May 2026 rollout.
1. Who is now funded under the NIP?
The NIP has added older Australians, who are significantly at risk of severe complications from RSV infection.
This includes:
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[post_content] => New strains, updated recommendations and funding changes require pharmacists to stay vigilant this season.
Flu season is underway and it’s already taking a toll, with 112 influenza-related deaths recorded this year.
There were 25,430 recorded cases of influenza in the first quarter of 2026 – following a whopping 48,641 cases in Q1 2025, and 1738 deaths caused by influenza
After the ‘worst flu year on record’, patients have been urged to prioritise receiving their flu shot in 2026.
Vaccination urgency is particularly pertinent this season due to new circulating strains, including Subclade K, a branch of the H3N2 influenza family, which is spreading much earlier – and faster – in the flu season.
Here’s what pharmacists need to know about the 2026 influenza season.
There’s been a slow start to flu vaccine uptake
While it’s early in the 2026 flu vaccine rollout, coverage is concerningly low in certain priority groups – with some jurisdictions faring worse than others.
Vaccination rates are highest in older Australians aged 75 years and over, with national coverage sitting at 11.7%. But young children aged 2–4 years, who are at risk of severe complications, hospitalisation and death from influenza, have some of the lowest vaccination rates in the country (1.4%). And in South Australia, Western Australia and Tasmania, vaccine coverage in this age cohort is less than 1%.
Among Aboriginal and Torres Strait Islander children aged 2–4, the national vaccine average sits below 1%.
Not just to protect grandkids: ATAGI warns of pertussis in older adults
Recent guidance from the Australian Technical Advisory Group on Immunisation (ATAGI) reminds health professionals that pertussis is not confined to childhood, with cases increasing among adults in recent years.
Older adults and individuals with chronic illnesses have higher pertussis morbidity and mortality rates in comparison to healthy adults.
While not NIP-funded, ATAGI and the Australian Immunisation Handbook recommends adults >65 receive a dose of dTpa every 10 years.
When administering other vaccines such as influenza COVID-19 to patients in the age cohort, pharmacists should either inquire when they had their last dTpa vaccine or check the Australian Immunisation Register.
Pertussis-containing vaccines can be safely co-administered with the influenza or COVID-19 vaccine.
Remember to accurately record funding source
Along with funded flu vaccines under the National Immunisation Program, various state-based programs funded vaccines have also been announced – so pharmacists must ensure they are using the correct stock and claiming process via the Pharmacy Programs Administrator (PPA).
Various funded state and territory flu vaccination programs include:
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[post_content] => The TGA is reviewing andrographis after hundreds of serious adverse events raise safety concerns.
It’s mid April and flu season is kicking into gear. According to Roy Morgan, almost half (44.5%) of Australians over 14 years of age rely on cold and flu medicines to help manage their symptoms.
While orally ingested phenylephrine products have come under scrutiny in recent years due to efficacy concerns, an ingredient in another cold and flu product has risen to the fore – andrographis paniculata.
The herbal ingredient, found in over 100 locally available products, is unscheduled, and is widely available in pharmacies, supermarkets and health food stores.
But this could potentially change, with the Therapeutic Goods Administration (TGA) proposing swift action following a safety review linking the herb to rare but potentially fatal anaphylaxis.
What did the TGA find?
A consistent pattern of serious allergic reactions over time, including:
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[post_content] => Case scenario
Kurt, a 52-year-old slightly overweight electrician, comes into your pharmacy complaining of a burning feeling in his chest after meals, which has persisted for a few weeks.
[caption id="attachment_28205" align="alignright" width="250"]
This CPD activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the speakers and the views expressed are entirely their own.[/caption]
You ask about other symptoms and he describes a burning sensation behind his sternum, generally mild but worse when he lies down after dinner, and the occasional sour taste in the back of the throat 1–2 times a week. He shares that he eats irregularly, is a heavy coffee drinker due to shift work and often has large late-evening meals. He finds late-night snacking, alcohol and spicy takeaways aggravate his symptoms. Kurt takes no other medicines, has no allergies and is a non-smoker.
Learning objectivesAfter reading this article, pharmacists should be able to:
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As accessible primary healthcare providers, community pharmacists are often the first healthcare provider consulted when a patient presents with symptoms of heartburn, regurgitation or reflux.
Globally, the prevalence of heartburn (retrosternal burning or pain), dyspepsia (indigestion, upper abdomen discomfort) and regurgitation (perception of flow of refluxed stomach content into the mouth or hypopharynx) in adults varies widely. Depending on the definition used and geographical location, prevalence ranges from 2.5% to 52.1%.1
While often asymptomatic, it may result in symptoms caused by refluxate flowing backwards into the oesophagus. This condition, termed gastro-oesophageal reflux (GOR, or simply reflux), is a common physiological event that can occur at any age and is generally considered non-erosive.2
Reflux aetiology involves dysfunction of the lower oesophageal sphincter (LOS) and, in some patients, distal oesophageal motility issues.2,3 A pronounced gastric acid pocket – a highly acidic, unbuffered layer of stomach acid forming on top of food in the upper stomach after a meal, acting as a reservoir that can easily backflow into the oesophagus – significantly contributes to reflux symptoms.4
Other components of gastric juice, such as bile, digestive enzymes and microbial pathogens, can also cause oesophageal symptoms.5-7 Pepsin is an endopeptidase activated at low pH to break down proteins, and can play a pivotal role in damaging the oesophageal surface.5-7 Bile is a digestive fluid designed to break down fats. When bile contacts sensitive mucosa, it can cause painful inflammation and the burning sensation associated with heartburn.5-7 The combination of acid, pepsin and bile can collectively act to assault the oesophageal mucosa.5-7
Gastro-oesophageal reflux disease (GORD) is usually associated with defective LOS function.3 It can cause reflux sufficiently severe to damage mucosa and result in oesophagitis or stricture. A meta-analysis of GORD epidemiology suggested global pooled prevalence of 13.9%.8
Laryngopharyngeal reflux (LPR) occurs when refluxate travels to the throat or higher, and may be the underlying cause of atypical reflux symptoms such as hoarse throat, changes in voice quality, excessive throat clearing and coughing.9 Suspicion of atypical reflux or ‘alarm’ symptoms requires medical referral e.g. cardiac-like chest pain, difficulty swallowing, unintended weight loss, severe abdominal pain, sudden onset reflux symptoms in a person ≥65 years, haematemesis or melaena.3
Symptoms across these conditions overlap and do not distinguish non-erosive from erosive pathology, making it difficult to assign a diagnosis without medical investigation such as endoscopy.
As there is no simple, widely accepted screening tool to differentiate between reflux and GORD, and no correlation between the symptom severity and visible changes in the oesophageal mucosa,10 pharmacists must rely on structured history-taking to identify the most appropriate management.
The use of a mnemonic e.g. Chief Complaint History Taking (LOQQSAM),11 together with targeted age or life-event-related questions, are useful to guide symptom description and triage:
The aim of empiric reflux therapy is to control symptoms and improve quality of life. This review focuses on non-pregnant adults and young people, with the management approach dependent on symptom frequency and severity. Options include risk reduction and prevention through lifestyle modification and/or pharmacological treatment.
Lifestyle modifications
The pharmacist’s role includes assessing for reflux risk factors, particularly those that are modifiable, and advising on strategies to prevent or reduce risk. Non-pharmacological strategies to reduce reflux symptom frequency or severity in this cohort include12,13:
A systematic literature review of clinical trial evidence and clinical practice guidelines14 identified that the strongest levels of evidence for non-pharmacological strategies to improve reflux symptoms were for:
Evidence was categorised with a Grade, based on the National Health and Medical Research Council Levels of Evidence for each study type.15,16
Pharmacological treatment
Most national and international guidelines recommend that a formal diagnostic workup beyond patient history is not required to diagnose the majority of patients who present with upper gastrointestinal symptoms.12,14,17-22
Patient safety is not compromised by typical symptoms of acute reflux (or GORD) being initially managed by pharmacists empirically with a short over-the-counter (OTC) trial of acid suppressant and/or alginate medicines. In Australia, the four OTC therapeutic class options available are: antacids, alginates, histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).
Antacids
Antacid formulations contain salts of magnesium, aluminium, calcium or sodium. Antacids neutralise hydrochloric acid secreted by gastric parietal cells, leading to increased pH of gastric contents – with potency generally expressed in terms of acid neutralising capacity (ANC).23
However, onset and duration of action depend on the dose forms (powder and liquid have a higher ANC than tablets) and extent of chewing (for tablets). Onset of action is rapid, often less than a minute, with duration of action ranging from 20–60 minutes to up to 2–3 hours, based on whether taken fasting or 1 hour after a meal, respectively.18 So, antacids need to be taken frequently during the day to provide efficient relief of persistent symptoms.
Antacids provide rapid but temporary symptom relief. In 2013, the World Gastroenterology Organisation developed guidelines for the community-based management of common gastrointestinal symptoms – recommending antacids as an appropriate OTC option for infrequent, mild or moderate symptoms of heartburn.12
While updated with a global focus in 2017, antacid +/- alginate therapy remained an empirical recommendation for self-care in ‘countries with limited resources and low Helicobacter pylori prevalence’.13 They generally have a good safety profile when used below the maximum daily dose.19
Most impact on bowel function is dose-related, with calcium and magnesium salts causing diarrhoea and aluminium salts causing constipation.18 However, due to the potential for systemic adverse effects with sodium bicarbonate, regular use should be avoided in older people, those with renal or liver impairment, or those on a sodium-restricted diet.24,25
Alginates/antacid-alginate combinations
Alginates are seaweed-derived, natural polysaccharides.26 Most formulations consist of three chemical components: sodium alginate, sodium bicarbonate and calcium carbonate. The latter two constituents react with stomach acid to yield carbon dioxide and free calcium ions, respectively.27
The combination produces a low-density viscous gel (‘raft’) that floats on top of the stomach contents, forming a physical barrier to reduce or prevent the postprandial acid pocket from inducing reflux symptoms.27 Alginates can bind bile salts in refluxate, which contributes to their mucoprotective effect.28
Onset of action, symptom relief and duration of action are brand or formulation specific; alginates typically act quickly after administration, and may provide symptom relief for several hours.27–29 Onset of action has been demonstrated to be slower than antacids but faster than either a PPI or H2RA.29 This attribute is particularly useful for nocturnal symptoms and post-meal reflux.
Antacid-alginate combinations have shown to provide rapid and effective relief of mild to moderate reflux symptoms.24 In 2017, Leiman and colleagues30 published a meta-analysis of randomised-controlled trials (RCTs) for treatment of symptomatic GORD (2,095 adult patients – nine studies [N=900] comparing alginate-based products to placebo or antacid, and five studies [N=1195] to PPIs or H2RAs).
Alginate-based products increased the odds of GORD symptom resolution when compared to placebo or antacids (OR:4.42; 95% CI 2.45–7.97), with a moderate degree of heterogeneity between studies (I2=71%, P=0.001). Alginates appeared less effective than PPIs or H2RAs, but the pooled estimate was not statistically significant (OR:0.58; 95% CI 0.27–1.22).30 While, in clinical trials, alginate caused adverse effects with a comparable rate to placebo,30 they are often combined with antacids or contain excipients that may cause adverse effects.
Histamine-2 receptor antagonists (H2RAs)
By blocking the histamine receptor and histamine stimulation of parietal cell acid secretion, H2RAs competitively suppress both stimulated and basal gastric acid secretion induced by histamine.32 H2RAs have good bioavailability.33
Onset of gastric relief is about 60 minutes (decreasing stomach acid production within 1 to 3 hours), with a dose-dependent duration of action of 4 to 12 hours.34 Although less effective than PPIs, H2RAs are useful for mild and/or intermittent symptoms or when PPIs are unsuitable.17,19 Ranitidine is the only H2RA available in short-course Schedule 2 packs, while others are Schedule 4, restricting OTC H2RA options.
Proton pump inhibitors (PPIs)
PPIs are the most potent OTC acid suppression therapy available.21 They are acid-labile pro-drugs. As food can decrease bioavailability, PPIs are best taken on an empty stomach, once daily 30–60 minutes before breakfast.19 Proton pumps become activated during meals, and administration prior to food intake will enhance efficacy.18,19
PPIs are selectively taken up by gastric parietal cells and concentrated within the acidic canalicular space where they become protonated and convert to an active sulfenamide form. The activated compound then covalently binds to cysteine residues on the luminal surface of the hydrogen/potassium ATPase.
By irreversibly inactivating this proton pump, PPIs suppress both basal and stimulated gastric acid secretion. Acid production remains reduced until new pumps are synthesised, a process that may take up to 36 hours.35
Once absorbed, onset of action is about 90 minutes.36 While PPIs have a short elimination half-life (1–2 hours), their pharmacodynamic effect to reliably maintain intragastric pH >4 can last 15 to 21 hours, due to their irreversible covalent bonding to the proton pump. This provides symptom relief for 24 hours or longer, after 1 to 3 days of treatment.37,38
The delay between PPI initiation and inhibition of acid secretion reaching steady state means that patients with frequent reflux symptoms may benefit from concomitant therapy with an agent that provides short-term relief, such as an antacid-alginate, while waiting for the PPI to take effect. Additionally, by co-localising to the postprandial acid pocket to create a mechanical barrier that suppresses gastric reflux at the LOS, and binding bile salts to contribute to the mucoprotective effect, antacid-alginates may be considered as adjunctive therapy in some patients with breakthrough symptoms, and in PPI deprescribing to help manage symptom rebound.39,40
OTC PPIs are indicated for the initial relief of reflux and GORD as:
In contrast, aligned with the Therapeutic Guidelines (TG), pharmacists approved for expanded scope can prescribe 4 weeks of ‘standard dose’ PPI (esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg or rabeprazole 20 mg), 0.5–1 hour before a meal.17
In RCTs, 2–4-weeks of PPIs at doses approved for OTC use are usually effective in the management of those with frequent reflux symptoms.37,42,43 A non-response to a short course of acid-suppressive therapy warrants prompt medical consultation, as it can suggest other diagnoses.
Globally, guideline differences in pharmacist empirical adult management of reflux or GORD largely stem from regulatory limitations, differences in definition of symptom severity and frequency, and whether used for initial or maintenance therapy.
TG recommendations include OTC and prescription options from all four reflux medicines classes. For mild, intermittent symptoms (specified as 1–2 episodes weekly), options are an antacid-alginate, combined magnesium-aluminium antacid or H2RA (all when necessary), or standard dose PPI once daily.17
For frequent or severe typical GORD symptoms, TG recommend a 4–8 week initial course of standard dose PPI; then when symptom control is adequate, step down to maintenance therapy (second daily or half the daily dose to therapy only on days when symptoms arise).17
Unfortunately, TG does not provide guidance when reflux (not GORD) symptoms are more frequent or severe. The Australasian College of Pharmacy guidelines attempt a more nuanced, pharmacist-focused approach to initial management (Figure 1).14
[caption id="attachment_31817" align="alignnone" width="2453"]
Sources: Australasian College of Pharmacy. Management of reflux: a guideline for pharmacists. Queensland Health. Queensland Community Pharmacy Gastro-oesophageal Reflux and Gastro-oesophageal Reflux Disease – Clinical Practice Guideline. NSW Health. NSW Pharmacist Practice Standards for gastro-oesophageal reflux and gastro-oesophageal reflux disease.[/caption]
Irrespective of approach, there is general consensus that13,14,17-19:
Australian pharmacists are expanding their scope of practice, with full scope of practice gaining momentum. In 3 years, the vision has evolved from a 2022 Queensland Government election commitment to work with pharmacy stakeholders to design and implement a pilot of pharmacists practicing to their full scope (the Queensland Community Pharmacy Scope of Practice Pilot) to business-as-usual community pharmacy prescribing services.
Since 1 July 2025, pharmacists completing additional training and meeting the requirements of the Extended Practice Authority have been able to provide clinical advice and treatment, which may include prescribing medicines to adults (18–55 years) for a range of specified acute common conditions, in accordance with a tailored clinical practice guideline.44
NSW Health has also introduced Practice Standards (adults ≥18 to ≤50 years) for expanded pharmacist scope, informed by the Queensland Health clinical practice guidelines and NSW Health emergency care assessment and treatment protocols. It is hoped that a national approach will follow, as other states roll out extended scope services.45 Both jurisdictions list gastro-oesophageal reflux and GORD as an included condition and service, with a companion clinical practice guideline and Practice Standard, respectively.46,47
All pharmacists should take advantage of these reflux resources as they provide an evidence-informed framework for patient assessment and management, primarily aligned to the TG.16 Additional expanded scope training is beneficial to improve pharmacists’ clinical skills and confidence. However, a quality and consistent approach to clinical assessment, triage, and referral is embedded in the competency standards for all pharmacists.48
While extended scope imposes formal responsibilities for patient consultation, documentation and follow-up – pharmacists should undertake these quality care strategies. The main prescribing advantages of expanded scope is extending the initial standard dose PPI treatment period from 2–4 weeks, and, in Queensland, access to Schedule 4 H2RAs. Importantly, the Clinical Practice Guideline and Practice Standard both focus heavily on the use of non-pharmacological management options in reflux symptom management.
Pharmacists play a key role in assessing reflux symptoms through structured history-taking, identifying red flags, and selecting appropriate non-pharmacological and pharmacological options based on symptom frequency and severity. Judicious use of antacid–alginate therapy for rapid relief and adjunctive support during PPI initiation or step-down can optimise symptom control while promoting safe, evidence-based self-management.
Effective management of reflux and GORD in pharmacy practice requires a patient-centred approach that integrates lifestyle modification with tailored use of OTC and, where appropriate, expanded-scope prescribing options. By applying current guidelines and supporting timely review and referral, pharmacists can improve symptom outcomes and quality of life.
Case scenario continuedYou explain to Kurt that his lifestyle is likely contributing to his symptoms and offer targeted counselling to reduce modifiable risks. You provide an OTC PPI once daily, taken 30–60 minutes before his first daily meal for 14 days, and an antacid-alginate, to use for 1–3 days before the PPI starts to work and for breakthrough symptoms, especially at night, when needed. You make an appointment with him to return in 2 weeks to check his progress, or earlier to you or his GP if symptoms worsen. At review, Kurt says he is much improved by his medicines and is avoiding his reflux triggers, especially raising the bedhead. He is happy to step-down to use of antacid-alginate when needed, and return if his symptoms worsen in the future. |
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[post_content] => The autistic community accesses pharmacy services frequently. Yet pharmacists often report uncertainty about how best to communicate, counsel and build rapport in ways that are respectful, effective and person-centred.
Autism spectrum disorder is heterogeneous, points out disability specialist pharmacist and 2021 Consultant Pharmacist of the Year, Dr Manya Angley FPS.
Communication needs can vary, not only between individuals, but also for the same person from day to day – influenced by anxiety, illness, sensory processing, circadian rhythms or environmental factors, Dr Angley says.
Ideally, pharmacists should use validating, trauma-informed language that fosters safety, trust and empowerment, reducing the risk of re-traumatising individuals, says credentialed pharmacist and casual NSW academic Penny Beirne MPS – who has performed many Home Medicines Reviews (HMRs) for autistic people.
She says such patients have often had their concerns dismissed or minimised due to implicit bias and communication differences.
Best practice principles of communication – including using clear language, confirming understanding and avoiding overload – apply to all patients, Ms Beirne explains. But they are particularly pertinent when it comes to autistic patients and anyone who might need additional accommodations, such as individuals with cognitive impairment, people who have had a stroke or who have dementia.
Pharmacists in community and consultant settings can improve medicine safety and patient experience by adopting flexible strategies that respect each individual’s preferred mode of communication. Disability pharmacists such as Dr Angley emphasise that supporting autonomy and ensuring direct engagement are central to effective, inclusive care.
Ms Beirne also stresses that prioritising structure, predictability and transparency in interactions with autistic patients can be helpful in reducing anxiety, improving comfort and facilitating better access to healthcare.
Practical guidance
A simple Pharmacist Visit Communication Aid (see Case Study 1, page 61) or handover card can communicate a patient’s needs directly to the pharmacist/pharmacy staff without requiring patients to verbalise them repeatedly.
Further professional guidance will be available from the PSA Spectrum Foundation Program when it is launched later this year, and autism-specific organisations (e.g. Aspect at www.aspect.org.au/about-aspect). Referral to a GP, specialist, speech pathologist, behaviour support practitioner or allied health professional may be needed if medicine management is complex or if additional support is required for safe administration (see boxes, pages 59, 61, 62).
Box 1: Practical advice for communicating with autistic patients
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Box 2: Using AAC to support communication
|
Patient BG, aged 25, is non-speaking, autistic, lives with epilepsy (tonic-clonic seizures) and communicates using a Pragmatic Organisation Dynamic Display (PODD) Augmentative and Alternative Communication (AAC) system on their iPad.
Medicines include:
[caption id="attachment_31860" align="alignright" width="300"] Adjunct Professor Manya Angley FPS (CredPharm MMR) Credentialed and Disability PharmacistBG occasionally chooses not to take antiseizure medicines, reporting fatigue, headaches and dizziness related to dosing via their AAC.
To support BG, consultations were conducted in a quiet room using a Pharmacist Visit Communication Aid. The pharmacist collaborated with BG’s disability support worker to use the PODD AAC to:
2. Explain that missing a dose can increase the risk of seizures, which can also result in the same types of symptoms that are often worse, can limit participation in enjoyable activities, and can be associated with risks like falls and injury.
3. Explore an adjusted routine: trying to take antiseizure medicines at the earliest opportunity in the morning to reduce daytime fatigue.
Visual and literal explanations, combined with carer support for medicine administration, allowed BG to engage in decision-making. Liaison with the GP confirmed safety and appropriateness of the adapted schedule.
BG tolerated pharmacy visits with reduced anxiety and adherence improved. The care team reported increased confidence in managing medicines. Using the PODD AAC enabled BG to actively participate in their medication plan, demonstrating the value of flexible, personalised communication strategies.
Pharmacists can enhance safety, trust and autonomy by adopting flexible, person-centred communication strategies. Direct engagement, active listening, environmental adjustments, and collaboration with carers and communication aids like PODD AAC are key.
Tailoring communication to the individual and their specific support needs ensures inclusive, effective and empowering pharmacy care.
Penny Beirne MPSMx Kai (they/them), aged 38, is an autistic person with a new diagnosis of laryngopharyngeal reflux (LPR). Kai’s GP requested an HMR after Kai experienced challenges engaging with the recommended treatment regimen for LPR.
Kai also has a history of chronic migraine, insomnia, avoidant/restrictive food intake disorder (ARFID) and constipation. Kai’s STOP-BANG score, a 0–8 point screening tool for assessing a person’s risk of obstructive sleep apnoea (OSA) also indicated a high risk of OSA (for more on STOP-BANG, visit www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea).
The recommended regimen initially included:
All interventions except the amitriptyline were ceased because of sensory-related challenges.
Kai’s longstanding medicines comprised:
To better manage Kai’s LPR while accommodating sensory preferences, I recommended they trial alternative alginate agents such as the flavourless Gaviscon Infant sachets – two sachets dissolved in 250 mL water after meals and 0.5 hours before bed. Another alternative suggested was Larri oral spray, two sprays to the back of the throat three or four times daily.
For constipation, wheat dextrin (Benefiber) 2 tsp in >1/2 cup water twice daily was suggested as a psyllium alternative, which is flavourless and textureless when dissolved in water. I corrected Kai’s nasal spray technique in the hope that correct use may reduce the unpleasant taste; I recommended the GP change the nasal spray to one with less of a bitter taste if improved technique does not help. I also recommended referral to a neuroaffirming speech pathologist and dietitian. I suggested a sleep study to rule out OSA, and for Kai to consider medicines overuse headache contributing to the chronic migraine, with a 12-week trial of two doses (maximum) of analgesics weekly, with progress recorded in a headache diary.
Box 3: Tips for conducting HMRs with autistic patientsBefore your visit:
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[post_content] => Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
‘I encourage eligible Australians to protect themselves and their community this winter by getting vaccinated against RSV,’ said Mark Butler, Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme.
PSA National President, Professor Mark Naunton MPS, said the federal government's decision will safeguard the health of many Australians who, without this vaccine, could face severe illness, hospitalisation or death.
‘Older Australians who receive their RSV vaccine will be protected not just this winter, but for many winters, as this vaccine provides protection against this potentially debilitating illness for a number of years,’ he said.
‘Until being added to the NIP, the vaccine was costing older patients around $300. Removing this cost will go a long way toward protecting the respiratory health of those most at-risk of severe RSV and its complications.’
Here are the 6 things pharmacists need to know ahead of the May 2026 rollout.
1. Who is now funded under the NIP?
The NIP has added older Australians, who are significantly at risk of severe complications from RSV infection.
This includes:
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[post_content] => New strains, updated recommendations and funding changes require pharmacists to stay vigilant this season.
Flu season is underway and it’s already taking a toll, with 112 influenza-related deaths recorded this year.
There were 25,430 recorded cases of influenza in the first quarter of 2026 – following a whopping 48,641 cases in Q1 2025, and 1738 deaths caused by influenza
After the ‘worst flu year on record’, patients have been urged to prioritise receiving their flu shot in 2026.
Vaccination urgency is particularly pertinent this season due to new circulating strains, including Subclade K, a branch of the H3N2 influenza family, which is spreading much earlier – and faster – in the flu season.
Here’s what pharmacists need to know about the 2026 influenza season.
There’s been a slow start to flu vaccine uptake
While it’s early in the 2026 flu vaccine rollout, coverage is concerningly low in certain priority groups – with some jurisdictions faring worse than others.
Vaccination rates are highest in older Australians aged 75 years and over, with national coverage sitting at 11.7%. But young children aged 2–4 years, who are at risk of severe complications, hospitalisation and death from influenza, have some of the lowest vaccination rates in the country (1.4%). And in South Australia, Western Australia and Tasmania, vaccine coverage in this age cohort is less than 1%.
Among Aboriginal and Torres Strait Islander children aged 2–4, the national vaccine average sits below 1%.
Not just to protect grandkids: ATAGI warns of pertussis in older adults
Recent guidance from the Australian Technical Advisory Group on Immunisation (ATAGI) reminds health professionals that pertussis is not confined to childhood, with cases increasing among adults in recent years.
Older adults and individuals with chronic illnesses have higher pertussis morbidity and mortality rates in comparison to healthy adults.
While not NIP-funded, ATAGI and the Australian Immunisation Handbook recommends adults >65 receive a dose of dTpa every 10 years.
When administering other vaccines such as influenza COVID-19 to patients in the age cohort, pharmacists should either inquire when they had their last dTpa vaccine or check the Australian Immunisation Register.
Pertussis-containing vaccines can be safely co-administered with the influenza or COVID-19 vaccine.
Remember to accurately record funding source
Along with funded flu vaccines under the National Immunisation Program, various state-based programs funded vaccines have also been announced – so pharmacists must ensure they are using the correct stock and claiming process via the Pharmacy Programs Administrator (PPA).
Various funded state and territory flu vaccination programs include:
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[post_content] => The TGA is reviewing andrographis after hundreds of serious adverse events raise safety concerns.
It’s mid April and flu season is kicking into gear. According to Roy Morgan, almost half (44.5%) of Australians over 14 years of age rely on cold and flu medicines to help manage their symptoms.
While orally ingested phenylephrine products have come under scrutiny in recent years due to efficacy concerns, an ingredient in another cold and flu product has risen to the fore – andrographis paniculata.
The herbal ingredient, found in over 100 locally available products, is unscheduled, and is widely available in pharmacies, supermarkets and health food stores.
But this could potentially change, with the Therapeutic Goods Administration (TGA) proposing swift action following a safety review linking the herb to rare but potentially fatal anaphylaxis.
What did the TGA find?
A consistent pattern of serious allergic reactions over time, including:
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[post_content] => Case scenario
Kurt, a 52-year-old slightly overweight electrician, comes into your pharmacy complaining of a burning feeling in his chest after meals, which has persisted for a few weeks.
[caption id="attachment_28205" align="alignright" width="250"] This CPD activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the speakers and the views expressed are entirely their own.[/caption]
You ask about other symptoms and he describes a burning sensation behind his sternum, generally mild but worse when he lies down after dinner, and the occasional sour taste in the back of the throat 1–2 times a week. He shares that he eats irregularly, is a heavy coffee drinker due to shift work and often has large late-evening meals. He finds late-night snacking, alcohol and spicy takeaways aggravate his symptoms. Kurt takes no other medicines, has no allergies and is a non-smoker.
Learning objectivesAfter reading this article, pharmacists should be able to:
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As accessible primary healthcare providers, community pharmacists are often the first healthcare provider consulted when a patient presents with symptoms of heartburn, regurgitation or reflux.
Globally, the prevalence of heartburn (retrosternal burning or pain), dyspepsia (indigestion, upper abdomen discomfort) and regurgitation (perception of flow of refluxed stomach content into the mouth or hypopharynx) in adults varies widely. Depending on the definition used and geographical location, prevalence ranges from 2.5% to 52.1%.1
While often asymptomatic, it may result in symptoms caused by refluxate flowing backwards into the oesophagus. This condition, termed gastro-oesophageal reflux (GOR, or simply reflux), is a common physiological event that can occur at any age and is generally considered non-erosive.2
Reflux aetiology involves dysfunction of the lower oesophageal sphincter (LOS) and, in some patients, distal oesophageal motility issues.2,3 A pronounced gastric acid pocket – a highly acidic, unbuffered layer of stomach acid forming on top of food in the upper stomach after a meal, acting as a reservoir that can easily backflow into the oesophagus – significantly contributes to reflux symptoms.4
Other components of gastric juice, such as bile, digestive enzymes and microbial pathogens, can also cause oesophageal symptoms.5-7 Pepsin is an endopeptidase activated at low pH to break down proteins, and can play a pivotal role in damaging the oesophageal surface.5-7 Bile is a digestive fluid designed to break down fats. When bile contacts sensitive mucosa, it can cause painful inflammation and the burning sensation associated with heartburn.5-7 The combination of acid, pepsin and bile can collectively act to assault the oesophageal mucosa.5-7
Gastro-oesophageal reflux disease (GORD) is usually associated with defective LOS function.3 It can cause reflux sufficiently severe to damage mucosa and result in oesophagitis or stricture. A meta-analysis of GORD epidemiology suggested global pooled prevalence of 13.9%.8
Laryngopharyngeal reflux (LPR) occurs when refluxate travels to the throat or higher, and may be the underlying cause of atypical reflux symptoms such as hoarse throat, changes in voice quality, excessive throat clearing and coughing.9 Suspicion of atypical reflux or ‘alarm’ symptoms requires medical referral e.g. cardiac-like chest pain, difficulty swallowing, unintended weight loss, severe abdominal pain, sudden onset reflux symptoms in a person ≥65 years, haematemesis or melaena.3
Symptoms across these conditions overlap and do not distinguish non-erosive from erosive pathology, making it difficult to assign a diagnosis without medical investigation such as endoscopy.
As there is no simple, widely accepted screening tool to differentiate between reflux and GORD, and no correlation between the symptom severity and visible changes in the oesophageal mucosa,10 pharmacists must rely on structured history-taking to identify the most appropriate management.
The use of a mnemonic e.g. Chief Complaint History Taking (LOQQSAM),11 together with targeted age or life-event-related questions, are useful to guide symptom description and triage:
The aim of empiric reflux therapy is to control symptoms and improve quality of life. This review focuses on non-pregnant adults and young people, with the management approach dependent on symptom frequency and severity. Options include risk reduction and prevention through lifestyle modification and/or pharmacological treatment.
Lifestyle modifications
The pharmacist’s role includes assessing for reflux risk factors, particularly those that are modifiable, and advising on strategies to prevent or reduce risk. Non-pharmacological strategies to reduce reflux symptom frequency or severity in this cohort include12,13:
A systematic literature review of clinical trial evidence and clinical practice guidelines14 identified that the strongest levels of evidence for non-pharmacological strategies to improve reflux symptoms were for:
Evidence was categorised with a Grade, based on the National Health and Medical Research Council Levels of Evidence for each study type.15,16
Pharmacological treatment
Most national and international guidelines recommend that a formal diagnostic workup beyond patient history is not required to diagnose the majority of patients who present with upper gastrointestinal symptoms.12,14,17-22
Patient safety is not compromised by typical symptoms of acute reflux (or GORD) being initially managed by pharmacists empirically with a short over-the-counter (OTC) trial of acid suppressant and/or alginate medicines. In Australia, the four OTC therapeutic class options available are: antacids, alginates, histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).
Antacids
Antacid formulations contain salts of magnesium, aluminium, calcium or sodium. Antacids neutralise hydrochloric acid secreted by gastric parietal cells, leading to increased pH of gastric contents – with potency generally expressed in terms of acid neutralising capacity (ANC).23
However, onset and duration of action depend on the dose forms (powder and liquid have a higher ANC than tablets) and extent of chewing (for tablets). Onset of action is rapid, often less than a minute, with duration of action ranging from 20–60 minutes to up to 2–3 hours, based on whether taken fasting or 1 hour after a meal, respectively.18 So, antacids need to be taken frequently during the day to provide efficient relief of persistent symptoms.
Antacids provide rapid but temporary symptom relief. In 2013, the World Gastroenterology Organisation developed guidelines for the community-based management of common gastrointestinal symptoms – recommending antacids as an appropriate OTC option for infrequent, mild or moderate symptoms of heartburn.12
While updated with a global focus in 2017, antacid +/- alginate therapy remained an empirical recommendation for self-care in ‘countries with limited resources and low Helicobacter pylori prevalence’.13 They generally have a good safety profile when used below the maximum daily dose.19
Most impact on bowel function is dose-related, with calcium and magnesium salts causing diarrhoea and aluminium salts causing constipation.18 However, due to the potential for systemic adverse effects with sodium bicarbonate, regular use should be avoided in older people, those with renal or liver impairment, or those on a sodium-restricted diet.24,25
Alginates/antacid-alginate combinations
Alginates are seaweed-derived, natural polysaccharides.26 Most formulations consist of three chemical components: sodium alginate, sodium bicarbonate and calcium carbonate. The latter two constituents react with stomach acid to yield carbon dioxide and free calcium ions, respectively.27
The combination produces a low-density viscous gel (‘raft’) that floats on top of the stomach contents, forming a physical barrier to reduce or prevent the postprandial acid pocket from inducing reflux symptoms.27 Alginates can bind bile salts in refluxate, which contributes to their mucoprotective effect.28
Onset of action, symptom relief and duration of action are brand or formulation specific; alginates typically act quickly after administration, and may provide symptom relief for several hours.27–29 Onset of action has been demonstrated to be slower than antacids but faster than either a PPI or H2RA.29 This attribute is particularly useful for nocturnal symptoms and post-meal reflux.
Antacid-alginate combinations have shown to provide rapid and effective relief of mild to moderate reflux symptoms.24 In 2017, Leiman and colleagues30 published a meta-analysis of randomised-controlled trials (RCTs) for treatment of symptomatic GORD (2,095 adult patients – nine studies [N=900] comparing alginate-based products to placebo or antacid, and five studies [N=1195] to PPIs or H2RAs).
Alginate-based products increased the odds of GORD symptom resolution when compared to placebo or antacids (OR:4.42; 95% CI 2.45–7.97), with a moderate degree of heterogeneity between studies (I2=71%, P=0.001). Alginates appeared less effective than PPIs or H2RAs, but the pooled estimate was not statistically significant (OR:0.58; 95% CI 0.27–1.22).30 While, in clinical trials, alginate caused adverse effects with a comparable rate to placebo,30 they are often combined with antacids or contain excipients that may cause adverse effects.
Histamine-2 receptor antagonists (H2RAs)
By blocking the histamine receptor and histamine stimulation of parietal cell acid secretion, H2RAs competitively suppress both stimulated and basal gastric acid secretion induced by histamine.32 H2RAs have good bioavailability.33
Onset of gastric relief is about 60 minutes (decreasing stomach acid production within 1 to 3 hours), with a dose-dependent duration of action of 4 to 12 hours.34 Although less effective than PPIs, H2RAs are useful for mild and/or intermittent symptoms or when PPIs are unsuitable.17,19 Ranitidine is the only H2RA available in short-course Schedule 2 packs, while others are Schedule 4, restricting OTC H2RA options.
Proton pump inhibitors (PPIs)
PPIs are the most potent OTC acid suppression therapy available.21 They are acid-labile pro-drugs. As food can decrease bioavailability, PPIs are best taken on an empty stomach, once daily 30–60 minutes before breakfast.19 Proton pumps become activated during meals, and administration prior to food intake will enhance efficacy.18,19
PPIs are selectively taken up by gastric parietal cells and concentrated within the acidic canalicular space where they become protonated and convert to an active sulfenamide form. The activated compound then covalently binds to cysteine residues on the luminal surface of the hydrogen/potassium ATPase.
By irreversibly inactivating this proton pump, PPIs suppress both basal and stimulated gastric acid secretion. Acid production remains reduced until new pumps are synthesised, a process that may take up to 36 hours.35
Once absorbed, onset of action is about 90 minutes.36 While PPIs have a short elimination half-life (1–2 hours), their pharmacodynamic effect to reliably maintain intragastric pH >4 can last 15 to 21 hours, due to their irreversible covalent bonding to the proton pump. This provides symptom relief for 24 hours or longer, after 1 to 3 days of treatment.37,38
The delay between PPI initiation and inhibition of acid secretion reaching steady state means that patients with frequent reflux symptoms may benefit from concomitant therapy with an agent that provides short-term relief, such as an antacid-alginate, while waiting for the PPI to take effect. Additionally, by co-localising to the postprandial acid pocket to create a mechanical barrier that suppresses gastric reflux at the LOS, and binding bile salts to contribute to the mucoprotective effect, antacid-alginates may be considered as adjunctive therapy in some patients with breakthrough symptoms, and in PPI deprescribing to help manage symptom rebound.39,40
OTC PPIs are indicated for the initial relief of reflux and GORD as:
In contrast, aligned with the Therapeutic Guidelines (TG), pharmacists approved for expanded scope can prescribe 4 weeks of ‘standard dose’ PPI (esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg or rabeprazole 20 mg), 0.5–1 hour before a meal.17
In RCTs, 2–4-weeks of PPIs at doses approved for OTC use are usually effective in the management of those with frequent reflux symptoms.37,42,43 A non-response to a short course of acid-suppressive therapy warrants prompt medical consultation, as it can suggest other diagnoses.
Globally, guideline differences in pharmacist empirical adult management of reflux or GORD largely stem from regulatory limitations, differences in definition of symptom severity and frequency, and whether used for initial or maintenance therapy.
TG recommendations include OTC and prescription options from all four reflux medicines classes. For mild, intermittent symptoms (specified as 1–2 episodes weekly), options are an antacid-alginate, combined magnesium-aluminium antacid or H2RA (all when necessary), or standard dose PPI once daily.17
For frequent or severe typical GORD symptoms, TG recommend a 4–8 week initial course of standard dose PPI; then when symptom control is adequate, step down to maintenance therapy (second daily or half the daily dose to therapy only on days when symptoms arise).17
Unfortunately, TG does not provide guidance when reflux (not GORD) symptoms are more frequent or severe. The Australasian College of Pharmacy guidelines attempt a more nuanced, pharmacist-focused approach to initial management (Figure 1).14
[caption id="attachment_31817" align="alignnone" width="2453"] Sources: Australasian College of Pharmacy. Management of reflux: a guideline for pharmacists. Queensland Health. Queensland Community Pharmacy Gastro-oesophageal Reflux and Gastro-oesophageal Reflux Disease – Clinical Practice Guideline. NSW Health. NSW Pharmacist Practice Standards for gastro-oesophageal reflux and gastro-oesophageal reflux disease.[/caption]
Irrespective of approach, there is general consensus that13,14,17-19:
Australian pharmacists are expanding their scope of practice, with full scope of practice gaining momentum. In 3 years, the vision has evolved from a 2022 Queensland Government election commitment to work with pharmacy stakeholders to design and implement a pilot of pharmacists practicing to their full scope (the Queensland Community Pharmacy Scope of Practice Pilot) to business-as-usual community pharmacy prescribing services.
Since 1 July 2025, pharmacists completing additional training and meeting the requirements of the Extended Practice Authority have been able to provide clinical advice and treatment, which may include prescribing medicines to adults (18–55 years) for a range of specified acute common conditions, in accordance with a tailored clinical practice guideline.44
NSW Health has also introduced Practice Standards (adults ≥18 to ≤50 years) for expanded pharmacist scope, informed by the Queensland Health clinical practice guidelines and NSW Health emergency care assessment and treatment protocols. It is hoped that a national approach will follow, as other states roll out extended scope services.45 Both jurisdictions list gastro-oesophageal reflux and GORD as an included condition and service, with a companion clinical practice guideline and Practice Standard, respectively.46,47
All pharmacists should take advantage of these reflux resources as they provide an evidence-informed framework for patient assessment and management, primarily aligned to the TG.16 Additional expanded scope training is beneficial to improve pharmacists’ clinical skills and confidence. However, a quality and consistent approach to clinical assessment, triage, and referral is embedded in the competency standards for all pharmacists.48
While extended scope imposes formal responsibilities for patient consultation, documentation and follow-up – pharmacists should undertake these quality care strategies. The main prescribing advantages of expanded scope is extending the initial standard dose PPI treatment period from 2–4 weeks, and, in Queensland, access to Schedule 4 H2RAs. Importantly, the Clinical Practice Guideline and Practice Standard both focus heavily on the use of non-pharmacological management options in reflux symptom management.
Pharmacists play a key role in assessing reflux symptoms through structured history-taking, identifying red flags, and selecting appropriate non-pharmacological and pharmacological options based on symptom frequency and severity. Judicious use of antacid–alginate therapy for rapid relief and adjunctive support during PPI initiation or step-down can optimise symptom control while promoting safe, evidence-based self-management.
Effective management of reflux and GORD in pharmacy practice requires a patient-centred approach that integrates lifestyle modification with tailored use of OTC and, where appropriate, expanded-scope prescribing options. By applying current guidelines and supporting timely review and referral, pharmacists can improve symptom outcomes and quality of life.
Case scenario continuedYou explain to Kurt that his lifestyle is likely contributing to his symptoms and offer targeted counselling to reduce modifiable risks. You provide an OTC PPI once daily, taken 30–60 minutes before his first daily meal for 14 days, and an antacid-alginate, to use for 1–3 days before the PPI starts to work and for breakthrough symptoms, especially at night, when needed. You make an appointment with him to return in 2 weeks to check his progress, or earlier to you or his GP if symptoms worsen. At review, Kurt says he is much improved by his medicines and is avoiding his reflux triggers, especially raising the bedhead. He is happy to step-down to use of antacid-alginate when needed, and return if his symptoms worsen in the future. |
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[post_content] => The autistic community accesses pharmacy services frequently. Yet pharmacists often report uncertainty about how best to communicate, counsel and build rapport in ways that are respectful, effective and person-centred.
Autism spectrum disorder is heterogeneous, points out disability specialist pharmacist and 2021 Consultant Pharmacist of the Year, Dr Manya Angley FPS.
Communication needs can vary, not only between individuals, but also for the same person from day to day – influenced by anxiety, illness, sensory processing, circadian rhythms or environmental factors, Dr Angley says.
Ideally, pharmacists should use validating, trauma-informed language that fosters safety, trust and empowerment, reducing the risk of re-traumatising individuals, says credentialed pharmacist and casual NSW academic Penny Beirne MPS – who has performed many Home Medicines Reviews (HMRs) for autistic people.
She says such patients have often had their concerns dismissed or minimised due to implicit bias and communication differences.
Best practice principles of communication – including using clear language, confirming understanding and avoiding overload – apply to all patients, Ms Beirne explains. But they are particularly pertinent when it comes to autistic patients and anyone who might need additional accommodations, such as individuals with cognitive impairment, people who have had a stroke or who have dementia.
Pharmacists in community and consultant settings can improve medicine safety and patient experience by adopting flexible strategies that respect each individual’s preferred mode of communication. Disability pharmacists such as Dr Angley emphasise that supporting autonomy and ensuring direct engagement are central to effective, inclusive care.
Ms Beirne also stresses that prioritising structure, predictability and transparency in interactions with autistic patients can be helpful in reducing anxiety, improving comfort and facilitating better access to healthcare.
Practical guidance
A simple Pharmacist Visit Communication Aid (see Case Study 1, page 61) or handover card can communicate a patient’s needs directly to the pharmacist/pharmacy staff without requiring patients to verbalise them repeatedly.
Further professional guidance will be available from the PSA Spectrum Foundation Program when it is launched later this year, and autism-specific organisations (e.g. Aspect at www.aspect.org.au/about-aspect). Referral to a GP, specialist, speech pathologist, behaviour support practitioner or allied health professional may be needed if medicine management is complex or if additional support is required for safe administration (see boxes, pages 59, 61, 62).
Box 1: Practical advice for communicating with autistic patients
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Box 2: Using AAC to support communication
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Patient BG, aged 25, is non-speaking, autistic, lives with epilepsy (tonic-clonic seizures) and communicates using a Pragmatic Organisation Dynamic Display (PODD) Augmentative and Alternative Communication (AAC) system on their iPad.
Medicines include:
[caption id="attachment_31860" align="alignright" width="300"] Adjunct Professor Manya Angley FPS (CredPharm MMR) Credentialed and Disability PharmacistBG occasionally chooses not to take antiseizure medicines, reporting fatigue, headaches and dizziness related to dosing via their AAC.
To support BG, consultations were conducted in a quiet room using a Pharmacist Visit Communication Aid. The pharmacist collaborated with BG’s disability support worker to use the PODD AAC to:
2. Explain that missing a dose can increase the risk of seizures, which can also result in the same types of symptoms that are often worse, can limit participation in enjoyable activities, and can be associated with risks like falls and injury.
3. Explore an adjusted routine: trying to take antiseizure medicines at the earliest opportunity in the morning to reduce daytime fatigue.
Visual and literal explanations, combined with carer support for medicine administration, allowed BG to engage in decision-making. Liaison with the GP confirmed safety and appropriateness of the adapted schedule.
BG tolerated pharmacy visits with reduced anxiety and adherence improved. The care team reported increased confidence in managing medicines. Using the PODD AAC enabled BG to actively participate in their medication plan, demonstrating the value of flexible, personalised communication strategies.
Pharmacists can enhance safety, trust and autonomy by adopting flexible, person-centred communication strategies. Direct engagement, active listening, environmental adjustments, and collaboration with carers and communication aids like PODD AAC are key.
Tailoring communication to the individual and their specific support needs ensures inclusive, effective and empowering pharmacy care.
Penny Beirne MPSMx Kai (they/them), aged 38, is an autistic person with a new diagnosis of laryngopharyngeal reflux (LPR). Kai’s GP requested an HMR after Kai experienced challenges engaging with the recommended treatment regimen for LPR.
Kai also has a history of chronic migraine, insomnia, avoidant/restrictive food intake disorder (ARFID) and constipation. Kai’s STOP-BANG score, a 0–8 point screening tool for assessing a person’s risk of obstructive sleep apnoea (OSA) also indicated a high risk of OSA (for more on STOP-BANG, visit www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea).
The recommended regimen initially included:
All interventions except the amitriptyline were ceased because of sensory-related challenges.
Kai’s longstanding medicines comprised:
To better manage Kai’s LPR while accommodating sensory preferences, I recommended they trial alternative alginate agents such as the flavourless Gaviscon Infant sachets – two sachets dissolved in 250 mL water after meals and 0.5 hours before bed. Another alternative suggested was Larri oral spray, two sprays to the back of the throat three or four times daily.
For constipation, wheat dextrin (Benefiber) 2 tsp in >1/2 cup water twice daily was suggested as a psyllium alternative, which is flavourless and textureless when dissolved in water. I corrected Kai’s nasal spray technique in the hope that correct use may reduce the unpleasant taste; I recommended the GP change the nasal spray to one with less of a bitter taste if improved technique does not help. I also recommended referral to a neuroaffirming speech pathologist and dietitian. I suggested a sleep study to rule out OSA, and for Kai to consider medicines overuse headache contributing to the chronic migraine, with a 12-week trial of two doses (maximum) of analgesics weekly, with progress recorded in a headache diary.
Box 3: Tips for conducting HMRs with autistic patientsBefore your visit:
|
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[post_content] => Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
‘I encourage eligible Australians to protect themselves and their community this winter by getting vaccinated against RSV,’ said Mark Butler, Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme.
PSA National President, Professor Mark Naunton MPS, said the federal government's decision will safeguard the health of many Australians who, without this vaccine, could face severe illness, hospitalisation or death.
‘Older Australians who receive their RSV vaccine will be protected not just this winter, but for many winters, as this vaccine provides protection against this potentially debilitating illness for a number of years,’ he said.
‘Until being added to the NIP, the vaccine was costing older patients around $300. Removing this cost will go a long way toward protecting the respiratory health of those most at-risk of severe RSV and its complications.’
Here are the 6 things pharmacists need to know ahead of the May 2026 rollout.
1. Who is now funded under the NIP?
The NIP has added older Australians, who are significantly at risk of severe complications from RSV infection.
This includes:
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[post_content] => New strains, updated recommendations and funding changes require pharmacists to stay vigilant this season.
Flu season is underway and it’s already taking a toll, with 112 influenza-related deaths recorded this year.
There were 25,430 recorded cases of influenza in the first quarter of 2026 – following a whopping 48,641 cases in Q1 2025, and 1738 deaths caused by influenza
After the ‘worst flu year on record’, patients have been urged to prioritise receiving their flu shot in 2026.
Vaccination urgency is particularly pertinent this season due to new circulating strains, including Subclade K, a branch of the H3N2 influenza family, which is spreading much earlier – and faster – in the flu season.
Here’s what pharmacists need to know about the 2026 influenza season.
There’s been a slow start to flu vaccine uptake
While it’s early in the 2026 flu vaccine rollout, coverage is concerningly low in certain priority groups – with some jurisdictions faring worse than others.
Vaccination rates are highest in older Australians aged 75 years and over, with national coverage sitting at 11.7%. But young children aged 2–4 years, who are at risk of severe complications, hospitalisation and death from influenza, have some of the lowest vaccination rates in the country (1.4%). And in South Australia, Western Australia and Tasmania, vaccine coverage in this age cohort is less than 1%.
Among Aboriginal and Torres Strait Islander children aged 2–4, the national vaccine average sits below 1%.
Not just to protect grandkids: ATAGI warns of pertussis in older adults
Recent guidance from the Australian Technical Advisory Group on Immunisation (ATAGI) reminds health professionals that pertussis is not confined to childhood, with cases increasing among adults in recent years.
Older adults and individuals with chronic illnesses have higher pertussis morbidity and mortality rates in comparison to healthy adults.
While not NIP-funded, ATAGI and the Australian Immunisation Handbook recommends adults >65 receive a dose of dTpa every 10 years.
When administering other vaccines such as influenza COVID-19 to patients in the age cohort, pharmacists should either inquire when they had their last dTpa vaccine or check the Australian Immunisation Register.
Pertussis-containing vaccines can be safely co-administered with the influenza or COVID-19 vaccine.
Remember to accurately record funding source
Along with funded flu vaccines under the National Immunisation Program, various state-based programs funded vaccines have also been announced – so pharmacists must ensure they are using the correct stock and claiming process via the Pharmacy Programs Administrator (PPA).
Various funded state and territory flu vaccination programs include:
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[post_content] => The TGA is reviewing andrographis after hundreds of serious adverse events raise safety concerns.
It’s mid April and flu season is kicking into gear. According to Roy Morgan, almost half (44.5%) of Australians over 14 years of age rely on cold and flu medicines to help manage their symptoms.
While orally ingested phenylephrine products have come under scrutiny in recent years due to efficacy concerns, an ingredient in another cold and flu product has risen to the fore – andrographis paniculata.
The herbal ingredient, found in over 100 locally available products, is unscheduled, and is widely available in pharmacies, supermarkets and health food stores.
But this could potentially change, with the Therapeutic Goods Administration (TGA) proposing swift action following a safety review linking the herb to rare but potentially fatal anaphylaxis.
What did the TGA find?
A consistent pattern of serious allergic reactions over time, including:
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[post_content] => Case scenario
Kurt, a 52-year-old slightly overweight electrician, comes into your pharmacy complaining of a burning feeling in his chest after meals, which has persisted for a few weeks.
[caption id="attachment_28205" align="alignright" width="250"] This CPD activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the speakers and the views expressed are entirely their own.[/caption]
You ask about other symptoms and he describes a burning sensation behind his sternum, generally mild but worse when he lies down after dinner, and the occasional sour taste in the back of the throat 1–2 times a week. He shares that he eats irregularly, is a heavy coffee drinker due to shift work and often has large late-evening meals. He finds late-night snacking, alcohol and spicy takeaways aggravate his symptoms. Kurt takes no other medicines, has no allergies and is a non-smoker.
Learning objectivesAfter reading this article, pharmacists should be able to:
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As accessible primary healthcare providers, community pharmacists are often the first healthcare provider consulted when a patient presents with symptoms of heartburn, regurgitation or reflux.
Globally, the prevalence of heartburn (retrosternal burning or pain), dyspepsia (indigestion, upper abdomen discomfort) and regurgitation (perception of flow of refluxed stomach content into the mouth or hypopharynx) in adults varies widely. Depending on the definition used and geographical location, prevalence ranges from 2.5% to 52.1%.1
While often asymptomatic, it may result in symptoms caused by refluxate flowing backwards into the oesophagus. This condition, termed gastro-oesophageal reflux (GOR, or simply reflux), is a common physiological event that can occur at any age and is generally considered non-erosive.2
Reflux aetiology involves dysfunction of the lower oesophageal sphincter (LOS) and, in some patients, distal oesophageal motility issues.2,3 A pronounced gastric acid pocket – a highly acidic, unbuffered layer of stomach acid forming on top of food in the upper stomach after a meal, acting as a reservoir that can easily backflow into the oesophagus – significantly contributes to reflux symptoms.4
Other components of gastric juice, such as bile, digestive enzymes and microbial pathogens, can also cause oesophageal symptoms.5-7 Pepsin is an endopeptidase activated at low pH to break down proteins, and can play a pivotal role in damaging the oesophageal surface.5-7 Bile is a digestive fluid designed to break down fats. When bile contacts sensitive mucosa, it can cause painful inflammation and the burning sensation associated with heartburn.5-7 The combination of acid, pepsin and bile can collectively act to assault the oesophageal mucosa.5-7
Gastro-oesophageal reflux disease (GORD) is usually associated with defective LOS function.3 It can cause reflux sufficiently severe to damage mucosa and result in oesophagitis or stricture. A meta-analysis of GORD epidemiology suggested global pooled prevalence of 13.9%.8
Laryngopharyngeal reflux (LPR) occurs when refluxate travels to the throat or higher, and may be the underlying cause of atypical reflux symptoms such as hoarse throat, changes in voice quality, excessive throat clearing and coughing.9 Suspicion of atypical reflux or ‘alarm’ symptoms requires medical referral e.g. cardiac-like chest pain, difficulty swallowing, unintended weight loss, severe abdominal pain, sudden onset reflux symptoms in a person ≥65 years, haematemesis or melaena.3
Symptoms across these conditions overlap and do not distinguish non-erosive from erosive pathology, making it difficult to assign a diagnosis without medical investigation such as endoscopy.
As there is no simple, widely accepted screening tool to differentiate between reflux and GORD, and no correlation between the symptom severity and visible changes in the oesophageal mucosa,10 pharmacists must rely on structured history-taking to identify the most appropriate management.
The use of a mnemonic e.g. Chief Complaint History Taking (LOQQSAM),11 together with targeted age or life-event-related questions, are useful to guide symptom description and triage:
The aim of empiric reflux therapy is to control symptoms and improve quality of life. This review focuses on non-pregnant adults and young people, with the management approach dependent on symptom frequency and severity. Options include risk reduction and prevention through lifestyle modification and/or pharmacological treatment.
Lifestyle modifications
The pharmacist’s role includes assessing for reflux risk factors, particularly those that are modifiable, and advising on strategies to prevent or reduce risk. Non-pharmacological strategies to reduce reflux symptom frequency or severity in this cohort include12,13:
A systematic literature review of clinical trial evidence and clinical practice guidelines14 identified that the strongest levels of evidence for non-pharmacological strategies to improve reflux symptoms were for:
Evidence was categorised with a Grade, based on the National Health and Medical Research Council Levels of Evidence for each study type.15,16
Pharmacological treatment
Most national and international guidelines recommend that a formal diagnostic workup beyond patient history is not required to diagnose the majority of patients who present with upper gastrointestinal symptoms.12,14,17-22
Patient safety is not compromised by typical symptoms of acute reflux (or GORD) being initially managed by pharmacists empirically with a short over-the-counter (OTC) trial of acid suppressant and/or alginate medicines. In Australia, the four OTC therapeutic class options available are: antacids, alginates, histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).
Antacids
Antacid formulations contain salts of magnesium, aluminium, calcium or sodium. Antacids neutralise hydrochloric acid secreted by gastric parietal cells, leading to increased pH of gastric contents – with potency generally expressed in terms of acid neutralising capacity (ANC).23
However, onset and duration of action depend on the dose forms (powder and liquid have a higher ANC than tablets) and extent of chewing (for tablets). Onset of action is rapid, often less than a minute, with duration of action ranging from 20–60 minutes to up to 2–3 hours, based on whether taken fasting or 1 hour after a meal, respectively.18 So, antacids need to be taken frequently during the day to provide efficient relief of persistent symptoms.
Antacids provide rapid but temporary symptom relief. In 2013, the World Gastroenterology Organisation developed guidelines for the community-based management of common gastrointestinal symptoms – recommending antacids as an appropriate OTC option for infrequent, mild or moderate symptoms of heartburn.12
While updated with a global focus in 2017, antacid +/- alginate therapy remained an empirical recommendation for self-care in ‘countries with limited resources and low Helicobacter pylori prevalence’.13 They generally have a good safety profile when used below the maximum daily dose.19
Most impact on bowel function is dose-related, with calcium and magnesium salts causing diarrhoea and aluminium salts causing constipation.18 However, due to the potential for systemic adverse effects with sodium bicarbonate, regular use should be avoided in older people, those with renal or liver impairment, or those on a sodium-restricted diet.24,25
Alginates/antacid-alginate combinations
Alginates are seaweed-derived, natural polysaccharides.26 Most formulations consist of three chemical components: sodium alginate, sodium bicarbonate and calcium carbonate. The latter two constituents react with stomach acid to yield carbon dioxide and free calcium ions, respectively.27
The combination produces a low-density viscous gel (‘raft’) that floats on top of the stomach contents, forming a physical barrier to reduce or prevent the postprandial acid pocket from inducing reflux symptoms.27 Alginates can bind bile salts in refluxate, which contributes to their mucoprotective effect.28
Onset of action, symptom relief and duration of action are brand or formulation specific; alginates typically act quickly after administration, and may provide symptom relief for several hours.27–29 Onset of action has been demonstrated to be slower than antacids but faster than either a PPI or H2RA.29 This attribute is particularly useful for nocturnal symptoms and post-meal reflux.
Antacid-alginate combinations have shown to provide rapid and effective relief of mild to moderate reflux symptoms.24 In 2017, Leiman and colleagues30 published a meta-analysis of randomised-controlled trials (RCTs) for treatment of symptomatic GORD (2,095 adult patients – nine studies [N=900] comparing alginate-based products to placebo or antacid, and five studies [N=1195] to PPIs or H2RAs).
Alginate-based products increased the odds of GORD symptom resolution when compared to placebo or antacids (OR:4.42; 95% CI 2.45–7.97), with a moderate degree of heterogeneity between studies (I2=71%, P=0.001). Alginates appeared less effective than PPIs or H2RAs, but the pooled estimate was not statistically significant (OR:0.58; 95% CI 0.27–1.22).30 While, in clinical trials, alginate caused adverse effects with a comparable rate to placebo,30 they are often combined with antacids or contain excipients that may cause adverse effects.
Histamine-2 receptor antagonists (H2RAs)
By blocking the histamine receptor and histamine stimulation of parietal cell acid secretion, H2RAs competitively suppress both stimulated and basal gastric acid secretion induced by histamine.32 H2RAs have good bioavailability.33
Onset of gastric relief is about 60 minutes (decreasing stomach acid production within 1 to 3 hours), with a dose-dependent duration of action of 4 to 12 hours.34 Although less effective than PPIs, H2RAs are useful for mild and/or intermittent symptoms or when PPIs are unsuitable.17,19 Ranitidine is the only H2RA available in short-course Schedule 2 packs, while others are Schedule 4, restricting OTC H2RA options.
Proton pump inhibitors (PPIs)
PPIs are the most potent OTC acid suppression therapy available.21 They are acid-labile pro-drugs. As food can decrease bioavailability, PPIs are best taken on an empty stomach, once daily 30–60 minutes before breakfast.19 Proton pumps become activated during meals, and administration prior to food intake will enhance efficacy.18,19
PPIs are selectively taken up by gastric parietal cells and concentrated within the acidic canalicular space where they become protonated and convert to an active sulfenamide form. The activated compound then covalently binds to cysteine residues on the luminal surface of the hydrogen/potassium ATPase.
By irreversibly inactivating this proton pump, PPIs suppress both basal and stimulated gastric acid secretion. Acid production remains reduced until new pumps are synthesised, a process that may take up to 36 hours.35
Once absorbed, onset of action is about 90 minutes.36 While PPIs have a short elimination half-life (1–2 hours), their pharmacodynamic effect to reliably maintain intragastric pH >4 can last 15 to 21 hours, due to their irreversible covalent bonding to the proton pump. This provides symptom relief for 24 hours or longer, after 1 to 3 days of treatment.37,38
The delay between PPI initiation and inhibition of acid secretion reaching steady state means that patients with frequent reflux symptoms may benefit from concomitant therapy with an agent that provides short-term relief, such as an antacid-alginate, while waiting for the PPI to take effect. Additionally, by co-localising to the postprandial acid pocket to create a mechanical barrier that suppresses gastric reflux at the LOS, and binding bile salts to contribute to the mucoprotective effect, antacid-alginates may be considered as adjunctive therapy in some patients with breakthrough symptoms, and in PPI deprescribing to help manage symptom rebound.39,40
OTC PPIs are indicated for the initial relief of reflux and GORD as:
In contrast, aligned with the Therapeutic Guidelines (TG), pharmacists approved for expanded scope can prescribe 4 weeks of ‘standard dose’ PPI (esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg or rabeprazole 20 mg), 0.5–1 hour before a meal.17
In RCTs, 2–4-weeks of PPIs at doses approved for OTC use are usually effective in the management of those with frequent reflux symptoms.37,42,43 A non-response to a short course of acid-suppressive therapy warrants prompt medical consultation, as it can suggest other diagnoses.
Globally, guideline differences in pharmacist empirical adult management of reflux or GORD largely stem from regulatory limitations, differences in definition of symptom severity and frequency, and whether used for initial or maintenance therapy.
TG recommendations include OTC and prescription options from all four reflux medicines classes. For mild, intermittent symptoms (specified as 1–2 episodes weekly), options are an antacid-alginate, combined magnesium-aluminium antacid or H2RA (all when necessary), or standard dose PPI once daily.17
For frequent or severe typical GORD symptoms, TG recommend a 4–8 week initial course of standard dose PPI; then when symptom control is adequate, step down to maintenance therapy (second daily or half the daily dose to therapy only on days when symptoms arise).17
Unfortunately, TG does not provide guidance when reflux (not GORD) symptoms are more frequent or severe. The Australasian College of Pharmacy guidelines attempt a more nuanced, pharmacist-focused approach to initial management (Figure 1).14
[caption id="attachment_31817" align="alignnone" width="2453"] Sources: Australasian College of Pharmacy. Management of reflux: a guideline for pharmacists. Queensland Health. Queensland Community Pharmacy Gastro-oesophageal Reflux and Gastro-oesophageal Reflux Disease – Clinical Practice Guideline. NSW Health. NSW Pharmacist Practice Standards for gastro-oesophageal reflux and gastro-oesophageal reflux disease.[/caption]
Irrespective of approach, there is general consensus that13,14,17-19:
Australian pharmacists are expanding their scope of practice, with full scope of practice gaining momentum. In 3 years, the vision has evolved from a 2022 Queensland Government election commitment to work with pharmacy stakeholders to design and implement a pilot of pharmacists practicing to their full scope (the Queensland Community Pharmacy Scope of Practice Pilot) to business-as-usual community pharmacy prescribing services.
Since 1 July 2025, pharmacists completing additional training and meeting the requirements of the Extended Practice Authority have been able to provide clinical advice and treatment, which may include prescribing medicines to adults (18–55 years) for a range of specified acute common conditions, in accordance with a tailored clinical practice guideline.44
NSW Health has also introduced Practice Standards (adults ≥18 to ≤50 years) for expanded pharmacist scope, informed by the Queensland Health clinical practice guidelines and NSW Health emergency care assessment and treatment protocols. It is hoped that a national approach will follow, as other states roll out extended scope services.45 Both jurisdictions list gastro-oesophageal reflux and GORD as an included condition and service, with a companion clinical practice guideline and Practice Standard, respectively.46,47
All pharmacists should take advantage of these reflux resources as they provide an evidence-informed framework for patient assessment and management, primarily aligned to the TG.16 Additional expanded scope training is beneficial to improve pharmacists’ clinical skills and confidence. However, a quality and consistent approach to clinical assessment, triage, and referral is embedded in the competency standards for all pharmacists.48
While extended scope imposes formal responsibilities for patient consultation, documentation and follow-up – pharmacists should undertake these quality care strategies. The main prescribing advantages of expanded scope is extending the initial standard dose PPI treatment period from 2–4 weeks, and, in Queensland, access to Schedule 4 H2RAs. Importantly, the Clinical Practice Guideline and Practice Standard both focus heavily on the use of non-pharmacological management options in reflux symptom management.
Pharmacists play a key role in assessing reflux symptoms through structured history-taking, identifying red flags, and selecting appropriate non-pharmacological and pharmacological options based on symptom frequency and severity. Judicious use of antacid–alginate therapy for rapid relief and adjunctive support during PPI initiation or step-down can optimise symptom control while promoting safe, evidence-based self-management.
Effective management of reflux and GORD in pharmacy practice requires a patient-centred approach that integrates lifestyle modification with tailored use of OTC and, where appropriate, expanded-scope prescribing options. By applying current guidelines and supporting timely review and referral, pharmacists can improve symptom outcomes and quality of life.
Case scenario continuedYou explain to Kurt that his lifestyle is likely contributing to his symptoms and offer targeted counselling to reduce modifiable risks. You provide an OTC PPI once daily, taken 30–60 minutes before his first daily meal for 14 days, and an antacid-alginate, to use for 1–3 days before the PPI starts to work and for breakthrough symptoms, especially at night, when needed. You make an appointment with him to return in 2 weeks to check his progress, or earlier to you or his GP if symptoms worsen. At review, Kurt says he is much improved by his medicines and is avoiding his reflux triggers, especially raising the bedhead. He is happy to step-down to use of antacid-alginate when needed, and return if his symptoms worsen in the future. |
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[post_content] => The autistic community accesses pharmacy services frequently. Yet pharmacists often report uncertainty about how best to communicate, counsel and build rapport in ways that are respectful, effective and person-centred.
Autism spectrum disorder is heterogeneous, points out disability specialist pharmacist and 2021 Consultant Pharmacist of the Year, Dr Manya Angley FPS.
Communication needs can vary, not only between individuals, but also for the same person from day to day – influenced by anxiety, illness, sensory processing, circadian rhythms or environmental factors, Dr Angley says.
Ideally, pharmacists should use validating, trauma-informed language that fosters safety, trust and empowerment, reducing the risk of re-traumatising individuals, says credentialed pharmacist and casual NSW academic Penny Beirne MPS – who has performed many Home Medicines Reviews (HMRs) for autistic people.
She says such patients have often had their concerns dismissed or minimised due to implicit bias and communication differences.
Best practice principles of communication – including using clear language, confirming understanding and avoiding overload – apply to all patients, Ms Beirne explains. But they are particularly pertinent when it comes to autistic patients and anyone who might need additional accommodations, such as individuals with cognitive impairment, people who have had a stroke or who have dementia.
Pharmacists in community and consultant settings can improve medicine safety and patient experience by adopting flexible strategies that respect each individual’s preferred mode of communication. Disability pharmacists such as Dr Angley emphasise that supporting autonomy and ensuring direct engagement are central to effective, inclusive care.
Ms Beirne also stresses that prioritising structure, predictability and transparency in interactions with autistic patients can be helpful in reducing anxiety, improving comfort and facilitating better access to healthcare.
Practical guidance
A simple Pharmacist Visit Communication Aid (see Case Study 1, page 61) or handover card can communicate a patient’s needs directly to the pharmacist/pharmacy staff without requiring patients to verbalise them repeatedly.
Further professional guidance will be available from the PSA Spectrum Foundation Program when it is launched later this year, and autism-specific organisations (e.g. Aspect at www.aspect.org.au/about-aspect). Referral to a GP, specialist, speech pathologist, behaviour support practitioner or allied health professional may be needed if medicine management is complex or if additional support is required for safe administration (see boxes, pages 59, 61, 62).
Box 1: Practical advice for communicating with autistic patients
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Box 2: Using AAC to support communication
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Patient BG, aged 25, is non-speaking, autistic, lives with epilepsy (tonic-clonic seizures) and communicates using a Pragmatic Organisation Dynamic Display (PODD) Augmentative and Alternative Communication (AAC) system on their iPad.
Medicines include:
[caption id="attachment_31860" align="alignright" width="300"] Adjunct Professor Manya Angley FPS (CredPharm MMR) Credentialed and Disability PharmacistBG occasionally chooses not to take antiseizure medicines, reporting fatigue, headaches and dizziness related to dosing via their AAC.
To support BG, consultations were conducted in a quiet room using a Pharmacist Visit Communication Aid. The pharmacist collaborated with BG’s disability support worker to use the PODD AAC to:
2. Explain that missing a dose can increase the risk of seizures, which can also result in the same types of symptoms that are often worse, can limit participation in enjoyable activities, and can be associated with risks like falls and injury.
3. Explore an adjusted routine: trying to take antiseizure medicines at the earliest opportunity in the morning to reduce daytime fatigue.
Visual and literal explanations, combined with carer support for medicine administration, allowed BG to engage in decision-making. Liaison with the GP confirmed safety and appropriateness of the adapted schedule.
BG tolerated pharmacy visits with reduced anxiety and adherence improved. The care team reported increased confidence in managing medicines. Using the PODD AAC enabled BG to actively participate in their medication plan, demonstrating the value of flexible, personalised communication strategies.
Pharmacists can enhance safety, trust and autonomy by adopting flexible, person-centred communication strategies. Direct engagement, active listening, environmental adjustments, and collaboration with carers and communication aids like PODD AAC are key.
Tailoring communication to the individual and their specific support needs ensures inclusive, effective and empowering pharmacy care.
Penny Beirne MPSMx Kai (they/them), aged 38, is an autistic person with a new diagnosis of laryngopharyngeal reflux (LPR). Kai’s GP requested an HMR after Kai experienced challenges engaging with the recommended treatment regimen for LPR.
Kai also has a history of chronic migraine, insomnia, avoidant/restrictive food intake disorder (ARFID) and constipation. Kai’s STOP-BANG score, a 0–8 point screening tool for assessing a person’s risk of obstructive sleep apnoea (OSA) also indicated a high risk of OSA (for more on STOP-BANG, visit www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea).
The recommended regimen initially included:
All interventions except the amitriptyline were ceased because of sensory-related challenges.
Kai’s longstanding medicines comprised:
To better manage Kai’s LPR while accommodating sensory preferences, I recommended they trial alternative alginate agents such as the flavourless Gaviscon Infant sachets – two sachets dissolved in 250 mL water after meals and 0.5 hours before bed. Another alternative suggested was Larri oral spray, two sprays to the back of the throat three or four times daily.
For constipation, wheat dextrin (Benefiber) 2 tsp in >1/2 cup water twice daily was suggested as a psyllium alternative, which is flavourless and textureless when dissolved in water. I corrected Kai’s nasal spray technique in the hope that correct use may reduce the unpleasant taste; I recommended the GP change the nasal spray to one with less of a bitter taste if improved technique does not help. I also recommended referral to a neuroaffirming speech pathologist and dietitian. I suggested a sleep study to rule out OSA, and for Kai to consider medicines overuse headache contributing to the chronic migraine, with a 12-week trial of two doses (maximum) of analgesics weekly, with progress recorded in a headache diary.
Box 3: Tips for conducting HMRs with autistic patientsBefore your visit:
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[post_content] => Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
Yesterday (19 April) the federal government announced RSV vaccination will soon be funded for older Australians on the National Immunisation Program (NIP) to ensure protection against this ‘common and potentially deadly virus’.
‘I encourage eligible Australians to protect themselves and their community this winter by getting vaccinated against RSV,’ said Mark Butler, Minister for Health and Ageing and Minister for Disability and the National Disability Insurance Scheme.
PSA National President, Professor Mark Naunton MPS, said the federal government's decision will safeguard the health of many Australians who, without this vaccine, could face severe illness, hospitalisation or death.
‘Older Australians who receive their RSV vaccine will be protected not just this winter, but for many winters, as this vaccine provides protection against this potentially debilitating illness for a number of years,’ he said.
‘Until being added to the NIP, the vaccine was costing older patients around $300. Removing this cost will go a long way toward protecting the respiratory health of those most at-risk of severe RSV and its complications.’
Here are the 6 things pharmacists need to know ahead of the May 2026 rollout.
1. Who is now funded under the NIP?
The NIP has added older Australians, who are significantly at risk of severe complications from RSV infection.
This includes:
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[post_content] => New strains, updated recommendations and funding changes require pharmacists to stay vigilant this season.
Flu season is underway and it’s already taking a toll, with 112 influenza-related deaths recorded this year.
There were 25,430 recorded cases of influenza in the first quarter of 2026 – following a whopping 48,641 cases in Q1 2025, and 1738 deaths caused by influenza
After the ‘worst flu year on record’, patients have been urged to prioritise receiving their flu shot in 2026.
Vaccination urgency is particularly pertinent this season due to new circulating strains, including Subclade K, a branch of the H3N2 influenza family, which is spreading much earlier – and faster – in the flu season.
Here’s what pharmacists need to know about the 2026 influenza season.
There’s been a slow start to flu vaccine uptake
While it’s early in the 2026 flu vaccine rollout, coverage is concerningly low in certain priority groups – with some jurisdictions faring worse than others.
Vaccination rates are highest in older Australians aged 75 years and over, with national coverage sitting at 11.7%. But young children aged 2–4 years, who are at risk of severe complications, hospitalisation and death from influenza, have some of the lowest vaccination rates in the country (1.4%). And in South Australia, Western Australia and Tasmania, vaccine coverage in this age cohort is less than 1%.
Among Aboriginal and Torres Strait Islander children aged 2–4, the national vaccine average sits below 1%.
Not just to protect grandkids: ATAGI warns of pertussis in older adults
Recent guidance from the Australian Technical Advisory Group on Immunisation (ATAGI) reminds health professionals that pertussis is not confined to childhood, with cases increasing among adults in recent years.
Older adults and individuals with chronic illnesses have higher pertussis morbidity and mortality rates in comparison to healthy adults.
While not NIP-funded, ATAGI and the Australian Immunisation Handbook recommends adults >65 receive a dose of dTpa every 10 years.
When administering other vaccines such as influenza COVID-19 to patients in the age cohort, pharmacists should either inquire when they had their last dTpa vaccine or check the Australian Immunisation Register.
Pertussis-containing vaccines can be safely co-administered with the influenza or COVID-19 vaccine.
Remember to accurately record funding source
Along with funded flu vaccines under the National Immunisation Program, various state-based programs funded vaccines have also been announced – so pharmacists must ensure they are using the correct stock and claiming process via the Pharmacy Programs Administrator (PPA).
Various funded state and territory flu vaccination programs include:
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[post_content] => The TGA is reviewing andrographis after hundreds of serious adverse events raise safety concerns.
It’s mid April and flu season is kicking into gear. According to Roy Morgan, almost half (44.5%) of Australians over 14 years of age rely on cold and flu medicines to help manage their symptoms.
While orally ingested phenylephrine products have come under scrutiny in recent years due to efficacy concerns, an ingredient in another cold and flu product has risen to the fore – andrographis paniculata.
The herbal ingredient, found in over 100 locally available products, is unscheduled, and is widely available in pharmacies, supermarkets and health food stores.
But this could potentially change, with the Therapeutic Goods Administration (TGA) proposing swift action following a safety review linking the herb to rare but potentially fatal anaphylaxis.
What did the TGA find?
A consistent pattern of serious allergic reactions over time, including:
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[post_content] => Case scenario
Kurt, a 52-year-old slightly overweight electrician, comes into your pharmacy complaining of a burning feeling in his chest after meals, which has persisted for a few weeks.
[caption id="attachment_28205" align="alignright" width="250"] This CPD activity is sponsored by Reckitt. All content is the true, accurate and independent opinion of the speakers and the views expressed are entirely their own.[/caption]
You ask about other symptoms and he describes a burning sensation behind his sternum, generally mild but worse when he lies down after dinner, and the occasional sour taste in the back of the throat 1–2 times a week. He shares that he eats irregularly, is a heavy coffee drinker due to shift work and often has large late-evening meals. He finds late-night snacking, alcohol and spicy takeaways aggravate his symptoms. Kurt takes no other medicines, has no allergies and is a non-smoker.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
As accessible primary healthcare providers, community pharmacists are often the first healthcare provider consulted when a patient presents with symptoms of heartburn, regurgitation or reflux.
Globally, the prevalence of heartburn (retrosternal burning or pain), dyspepsia (indigestion, upper abdomen discomfort) and regurgitation (perception of flow of refluxed stomach content into the mouth or hypopharynx) in adults varies widely. Depending on the definition used and geographical location, prevalence ranges from 2.5% to 52.1%.1
While often asymptomatic, it may result in symptoms caused by refluxate flowing backwards into the oesophagus. This condition, termed gastro-oesophageal reflux (GOR, or simply reflux), is a common physiological event that can occur at any age and is generally considered non-erosive.2
Reflux aetiology involves dysfunction of the lower oesophageal sphincter (LOS) and, in some patients, distal oesophageal motility issues.2,3 A pronounced gastric acid pocket – a highly acidic, unbuffered layer of stomach acid forming on top of food in the upper stomach after a meal, acting as a reservoir that can easily backflow into the oesophagus – significantly contributes to reflux symptoms.4
Other components of gastric juice, such as bile, digestive enzymes and microbial pathogens, can also cause oesophageal symptoms.5-7 Pepsin is an endopeptidase activated at low pH to break down proteins, and can play a pivotal role in damaging the oesophageal surface.5-7 Bile is a digestive fluid designed to break down fats. When bile contacts sensitive mucosa, it can cause painful inflammation and the burning sensation associated with heartburn.5-7 The combination of acid, pepsin and bile can collectively act to assault the oesophageal mucosa.5-7
Gastro-oesophageal reflux disease (GORD) is usually associated with defective LOS function.3 It can cause reflux sufficiently severe to damage mucosa and result in oesophagitis or stricture. A meta-analysis of GORD epidemiology suggested global pooled prevalence of 13.9%.8
Laryngopharyngeal reflux (LPR) occurs when refluxate travels to the throat or higher, and may be the underlying cause of atypical reflux symptoms such as hoarse throat, changes in voice quality, excessive throat clearing and coughing.9 Suspicion of atypical reflux or ‘alarm’ symptoms requires medical referral e.g. cardiac-like chest pain, difficulty swallowing, unintended weight loss, severe abdominal pain, sudden onset reflux symptoms in a person ≥65 years, haematemesis or melaena.3
Symptoms across these conditions overlap and do not distinguish non-erosive from erosive pathology, making it difficult to assign a diagnosis without medical investigation such as endoscopy.
As there is no simple, widely accepted screening tool to differentiate between reflux and GORD, and no correlation between the symptom severity and visible changes in the oesophageal mucosa,10 pharmacists must rely on structured history-taking to identify the most appropriate management.
The use of a mnemonic e.g. Chief Complaint History Taking (LOQQSAM),11 together with targeted age or life-event-related questions, are useful to guide symptom description and triage:
The aim of empiric reflux therapy is to control symptoms and improve quality of life. This review focuses on non-pregnant adults and young people, with the management approach dependent on symptom frequency and severity. Options include risk reduction and prevention through lifestyle modification and/or pharmacological treatment.
Lifestyle modifications
The pharmacist’s role includes assessing for reflux risk factors, particularly those that are modifiable, and advising on strategies to prevent or reduce risk. Non-pharmacological strategies to reduce reflux symptom frequency or severity in this cohort include12,13:
A systematic literature review of clinical trial evidence and clinical practice guidelines14 identified that the strongest levels of evidence for non-pharmacological strategies to improve reflux symptoms were for:
Evidence was categorised with a Grade, based on the National Health and Medical Research Council Levels of Evidence for each study type.15,16
Pharmacological treatment
Most national and international guidelines recommend that a formal diagnostic workup beyond patient history is not required to diagnose the majority of patients who present with upper gastrointestinal symptoms.12,14,17-22
Patient safety is not compromised by typical symptoms of acute reflux (or GORD) being initially managed by pharmacists empirically with a short over-the-counter (OTC) trial of acid suppressant and/or alginate medicines. In Australia, the four OTC therapeutic class options available are: antacids, alginates, histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).
Antacids
Antacid formulations contain salts of magnesium, aluminium, calcium or sodium. Antacids neutralise hydrochloric acid secreted by gastric parietal cells, leading to increased pH of gastric contents – with potency generally expressed in terms of acid neutralising capacity (ANC).23
However, onset and duration of action depend on the dose forms (powder and liquid have a higher ANC than tablets) and extent of chewing (for tablets). Onset of action is rapid, often less than a minute, with duration of action ranging from 20–60 minutes to up to 2–3 hours, based on whether taken fasting or 1 hour after a meal, respectively.18 So, antacids need to be taken frequently during the day to provide efficient relief of persistent symptoms.
Antacids provide rapid but temporary symptom relief. In 2013, the World Gastroenterology Organisation developed guidelines for the community-based management of common gastrointestinal symptoms – recommending antacids as an appropriate OTC option for infrequent, mild or moderate symptoms of heartburn.12
While updated with a global focus in 2017, antacid +/- alginate therapy remained an empirical recommendation for self-care in ‘countries with limited resources and low Helicobacter pylori prevalence’.13 They generally have a good safety profile when used below the maximum daily dose.19
Most impact on bowel function is dose-related, with calcium and magnesium salts causing diarrhoea and aluminium salts causing constipation.18 However, due to the potential for systemic adverse effects with sodium bicarbonate, regular use should be avoided in older people, those with renal or liver impairment, or those on a sodium-restricted diet.24,25
Alginates/antacid-alginate combinations
Alginates are seaweed-derived, natural polysaccharides.26 Most formulations consist of three chemical components: sodium alginate, sodium bicarbonate and calcium carbonate. The latter two constituents react with stomach acid to yield carbon dioxide and free calcium ions, respectively.27
The combination produces a low-density viscous gel (‘raft’) that floats on top of the stomach contents, forming a physical barrier to reduce or prevent the postprandial acid pocket from inducing reflux symptoms.27 Alginates can bind bile salts in refluxate, which contributes to their mucoprotective effect.28
Onset of action, symptom relief and duration of action are brand or formulation specific; alginates typically act quickly after administration, and may provide symptom relief for several hours.27–29 Onset of action has been demonstrated to be slower than antacids but faster than either a PPI or H2RA.29 This attribute is particularly useful for nocturnal symptoms and post-meal reflux.
Antacid-alginate combinations have shown to provide rapid and effective relief of mild to moderate reflux symptoms.24 In 2017, Leiman and colleagues30 published a meta-analysis of randomised-controlled trials (RCTs) for treatment of symptomatic GORD (2,095 adult patients – nine studies [N=900] comparing alginate-based products to placebo or antacid, and five studies [N=1195] to PPIs or H2RAs).
Alginate-based products increased the odds of GORD symptom resolution when compared to placebo or antacids (OR:4.42; 95% CI 2.45–7.97), with a moderate degree of heterogeneity between studies (I2=71%, P=0.001). Alginates appeared less effective than PPIs or H2RAs, but the pooled estimate was not statistically significant (OR:0.58; 95% CI 0.27–1.22).30 While, in clinical trials, alginate caused adverse effects with a comparable rate to placebo,30 they are often combined with antacids or contain excipients that may cause adverse effects.
Histamine-2 receptor antagonists (H2RAs)
By blocking the histamine receptor and histamine stimulation of parietal cell acid secretion, H2RAs competitively suppress both stimulated and basal gastric acid secretion induced by histamine.32 H2RAs have good bioavailability.33
Onset of gastric relief is about 60 minutes (decreasing stomach acid production within 1 to 3 hours), with a dose-dependent duration of action of 4 to 12 hours.34 Although less effective than PPIs, H2RAs are useful for mild and/or intermittent symptoms or when PPIs are unsuitable.17,19 Ranitidine is the only H2RA available in short-course Schedule 2 packs, while others are Schedule 4, restricting OTC H2RA options.
Proton pump inhibitors (PPIs)
PPIs are the most potent OTC acid suppression therapy available.21 They are acid-labile pro-drugs. As food can decrease bioavailability, PPIs are best taken on an empty stomach, once daily 30–60 minutes before breakfast.19 Proton pumps become activated during meals, and administration prior to food intake will enhance efficacy.18,19
PPIs are selectively taken up by gastric parietal cells and concentrated within the acidic canalicular space where they become protonated and convert to an active sulfenamide form. The activated compound then covalently binds to cysteine residues on the luminal surface of the hydrogen/potassium ATPase.
By irreversibly inactivating this proton pump, PPIs suppress both basal and stimulated gastric acid secretion. Acid production remains reduced until new pumps are synthesised, a process that may take up to 36 hours.35
Once absorbed, onset of action is about 90 minutes.36 While PPIs have a short elimination half-life (1–2 hours), their pharmacodynamic effect to reliably maintain intragastric pH >4 can last 15 to 21 hours, due to their irreversible covalent bonding to the proton pump. This provides symptom relief for 24 hours or longer, after 1 to 3 days of treatment.37,38
The delay between PPI initiation and inhibition of acid secretion reaching steady state means that patients with frequent reflux symptoms may benefit from concomitant therapy with an agent that provides short-term relief, such as an antacid-alginate, while waiting for the PPI to take effect. Additionally, by co-localising to the postprandial acid pocket to create a mechanical barrier that suppresses gastric reflux at the LOS, and binding bile salts to contribute to the mucoprotective effect, antacid-alginates may be considered as adjunctive therapy in some patients with breakthrough symptoms, and in PPI deprescribing to help manage symptom rebound.39,40
OTC PPIs are indicated for the initial relief of reflux and GORD as:
In contrast, aligned with the Therapeutic Guidelines (TG), pharmacists approved for expanded scope can prescribe 4 weeks of ‘standard dose’ PPI (esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg or rabeprazole 20 mg), 0.5–1 hour before a meal.17
In RCTs, 2–4-weeks of PPIs at doses approved for OTC use are usually effective in the management of those with frequent reflux symptoms.37,42,43 A non-response to a short course of acid-suppressive therapy warrants prompt medical consultation, as it can suggest other diagnoses.
Globally, guideline differences in pharmacist empirical adult management of reflux or GORD largely stem from regulatory limitations, differences in definition of symptom severity and frequency, and whether used for initial or maintenance therapy.
TG recommendations include OTC and prescription options from all four reflux medicines classes. For mild, intermittent symptoms (specified as 1–2 episodes weekly), options are an antacid-alginate, combined magnesium-aluminium antacid or H2RA (all when necessary), or standard dose PPI once daily.17
For frequent or severe typical GORD symptoms, TG recommend a 4–8 week initial course of standard dose PPI; then when symptom control is adequate, step down to maintenance therapy (second daily or half the daily dose to therapy only on days when symptoms arise).17
Unfortunately, TG does not provide guidance when reflux (not GORD) symptoms are more frequent or severe. The Australasian College of Pharmacy guidelines attempt a more nuanced, pharmacist-focused approach to initial management (Figure 1).14
[caption id="attachment_31817" align="alignnone" width="2453"] Sources: Australasian College of Pharmacy. Management of reflux: a guideline for pharmacists. Queensland Health. Queensland Community Pharmacy Gastro-oesophageal Reflux and Gastro-oesophageal Reflux Disease – Clinical Practice Guideline. NSW Health. NSW Pharmacist Practice Standards for gastro-oesophageal reflux and gastro-oesophageal reflux disease.[/caption]
Irrespective of approach, there is general consensus that13,14,17-19:
Australian pharmacists are expanding their scope of practice, with full scope of practice gaining momentum. In 3 years, the vision has evolved from a 2022 Queensland Government election commitment to work with pharmacy stakeholders to design and implement a pilot of pharmacists practicing to their full scope (the Queensland Community Pharmacy Scope of Practice Pilot) to business-as-usual community pharmacy prescribing services.
Since 1 July 2025, pharmacists completing additional training and meeting the requirements of the Extended Practice Authority have been able to provide clinical advice and treatment, which may include prescribing medicines to adults (18–55 years) for a range of specified acute common conditions, in accordance with a tailored clinical practice guideline.44
NSW Health has also introduced Practice Standards (adults ≥18 to ≤50 years) for expanded pharmacist scope, informed by the Queensland Health clinical practice guidelines and NSW Health emergency care assessment and treatment protocols. It is hoped that a national approach will follow, as other states roll out extended scope services.45 Both jurisdictions list gastro-oesophageal reflux and GORD as an included condition and service, with a companion clinical practice guideline and Practice Standard, respectively.46,47
All pharmacists should take advantage of these reflux resources as they provide an evidence-informed framework for patient assessment and management, primarily aligned to the TG.16 Additional expanded scope training is beneficial to improve pharmacists’ clinical skills and confidence. However, a quality and consistent approach to clinical assessment, triage, and referral is embedded in the competency standards for all pharmacists.48
While extended scope imposes formal responsibilities for patient consultation, documentation and follow-up – pharmacists should undertake these quality care strategies. The main prescribing advantages of expanded scope is extending the initial standard dose PPI treatment period from 2–4 weeks, and, in Queensland, access to Schedule 4 H2RAs. Importantly, the Clinical Practice Guideline and Practice Standard both focus heavily on the use of non-pharmacological management options in reflux symptom management.
Pharmacists play a key role in assessing reflux symptoms through structured history-taking, identifying red flags, and selecting appropriate non-pharmacological and pharmacological options based on symptom frequency and severity. Judicious use of antacid–alginate therapy for rapid relief and adjunctive support during PPI initiation or step-down can optimise symptom control while promoting safe, evidence-based self-management.
Effective management of reflux and GORD in pharmacy practice requires a patient-centred approach that integrates lifestyle modification with tailored use of OTC and, where appropriate, expanded-scope prescribing options. By applying current guidelines and supporting timely review and referral, pharmacists can improve symptom outcomes and quality of life.
Case scenario continuedYou explain to Kurt that his lifestyle is likely contributing to his symptoms and offer targeted counselling to reduce modifiable risks. You provide an OTC PPI once daily, taken 30–60 minutes before his first daily meal for 14 days, and an antacid-alginate, to use for 1–3 days before the PPI starts to work and for breakthrough symptoms, especially at night, when needed. You make an appointment with him to return in 2 weeks to check his progress, or earlier to you or his GP if symptoms worsen. At review, Kurt says he is much improved by his medicines and is avoiding his reflux triggers, especially raising the bedhead. He is happy to step-down to use of antacid-alginate when needed, and return if his symptoms worsen in the future. |
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
