Managing heartburn and reflux in primary care.

ABSTRACT: This article describes an algorithmic approach to caring for patients presenting with heartburn and reflux, including empiric treatment with acid-suppression therapy and a data-driven approach to diagnostic testing. This article also reviews the efficacy and safety profile of the widely available and commonly used proton pump inhibitors. Refining our approach to diagnostic testing can reduce time to diagnosis, better control patients' symptoms, and limit complications of longstanding disease.

Child and caregiver reported problems in using asthma medications and question-asking during paediatric asthma visits.

OBJECTIVES: The objectives of the study were to describe the extent to which lay caregivers and children who reported asthma medication problems asked medication questions during their medical visits. METHODS: Children with asthma ages 8 through 16 years and their caregivers were recruited at five paediatric practices and their medical visits were audiotape recorded. Children were interviewed after their medical visits and caregivers completed questionnaires. A home visit was conducted 1 month later. Generalized estimating equations were used to analyse the data. KEY FINDINGS: Two hundred and ninety six families participated. Among those caregivers who reported asthma medication problems, only 35% had asked at least one medication question during the visit. Among children who reported asthma medication problems, only 11% had asked at least one medication question during their consultation. Caregivers and children who reported a problem with their asthma medications were significantly more likely to have asked medication questions if providers had asked more questions about control medications. Children who reported higher asthma management self-efficacy were significantly more likely to have asked an asthma medication question. CONCLUSIONS: Only one in three caregivers and one in 10 children who reported an asthma medication problem asked a question during their medical visits and many still reported these problems 1 month later. Pharmacists should encourage caregivers and children to report problems they may be having using their asthma medications.

Communication about ADHD and its treatment during pediatric asthma visits.

The objectives of the study were to examine provider-family communication about attention deficit disorder during pediatric asthma visits. Children with asthma, aged 8 through 16 and their parents were recruited at five pediatric practices. All medical visits were audio-taped. There were 296 asthmatic children enrolled into the study and 67 of them also had attention deficit hyperactivity disorder (ADHD). ADHD communication elements suggested by national guidelines were discussed infrequently. Providers were more likely to discuss, educate, and ask one or more questions about ADHD medications if the visit was non-asthma related. Providers included child input into the ADHD treatment regimen during 3% of visits and they included parent input during 4.5% of visits. Only one child and three parents asked questions about ADHD. Providers may neglect essential aspects of good ADHD management and communication in children who have ADHD plus another chronic condition such as asthma. Providers should set appropriate treatment expectations, establish target symptoms, and encourage children and parents to ask questions so mutual decision-making can occur.