Translating knowledge to benefit the patient: Are you ready? *

OVER THE PAST 10 YEARS I HAVE GIVEN A NUMBER OF TALKS TO pharmacists about gastroesophageal reflux disease (GERD). During that time, I have wondered how well pharmacists have been able to take that knowledge and apply it to making a difference in the care of their patients. I am very much a neophyte when it comes to theoretical and formal education on the topic of knowledge translation. Rather, I am more of an old goat who teaches by experience and knowledge of the literature. My friends who know this area much better have provided me with some references on the science of knowledge translation to guide me. As defined by the Canadian Institutes of Health Research, knowledge translation is “the exchange synthesis and ethically sound application of knowledge — within a complex system of interactions among researchers and users....”1 Those of us who provide education, formally or informally, try to transfer knowledge in such a way that those receiving the information can implement it in their practice. Knowledge translation implies that there is a personal relationship between the information provider and the person targeted to apply that knowledge. This relationship is based on trust. Knowledge translation is more than just continuing education — it focuses on health outcomes and changing behaviours. So why have I chosen to digress down the path of knowledge translation for these guidelines on GERD? Well, my biggest fear is that all the information in this supplement may not be put into practice by the pharmacists who receive it. Ask yourself, do you know patients on chronic acid suppression therapy who sound like good candidates for intermittent or on-demand therapy?2 Everyone dispensing these agents should be able to think of a number of patients who sound like good candidates. Are you going to call the prescribers or talk to the patients to get them to try different therapy? You may run the risk of unhappy physicians or upset patients if you suggest this. My sense of the ambulatory care setting is that physicians may consider on-demand therapy an acceptable option but very few are advising patients to pursue it. It is an excellent area for pharmacists to take a proactive role in optimizing GERD therapy. In order to do that, most pharmacists will need to feel comfortable with the benefits and risks associated with making an active intervention. As knowledge providers, we hope that this supplement and the additional resources we cite will give you sufficient information regarding these benefits and risks, as well as inspire you enough that you will recommend these changes. Besides on-demand therapy, in what other key areas of GERD management can pharmacists take a more proactive role in patient care? First, pharmacists should ensure that patients with signs of serious gastrointestinal pathology obtain timely medical care. How? By talking to the patient and, on occasion, the prescriber. There are many other areas of GERD management (some controversial) that you might also want to ponder, such as: • When can patients on a twice-a-day proton pump inhibitor (PPI) be stepped down to a once-a-day PPI? • Should pharmacists recommend that patients with long-standing GERD talk to their physician about getting an endoscopy to look for Barrett’s esophagus? • Should pharmacists recommend that patients talk to a physician about acid suppressive therapy for asthma, chronic cough or other potential respiratory manifestations of GERD? • What advice should pharmacists give to patients asking about the risk of pneumonia or osteoporosis with PPI use? More than anything, I hope this supplement will inspire you to make an effort to acquire additional knowledge in key areas of GERD management. Hopefully, it will lead to more inspired and confident pharmacists contributing to patient care. ■

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