# Treatment of Heartburn: A Survey of Ontario and Québec Community Pharmacists

## TL;DR

This study surveys Canadian pharmacists on how they treat heartburn after proton pump inhibitors became available without a prescription.

## Contribution

The study reveals regional and case-specific differences in pharmacist treatment choices for heartburn in Ontario and Québec.

## Key findings

- Ontario pharmacists preferred combination H2RA + antacid for mild heartburn, while Québec pharmacists favored solo H2RA.
- For severe heartburn, both regions commonly chose nonRx H2RA followed by nonRx PPI.
- Pharmacists often recommended switching medications or referring patients if symptoms persisted after seven days.

## Abstract

The shift of proton pump inhibitors (PPIs) from prescription to nonprescription (nonRx) status in Canada has altered pharmacist treatment options for heartburn. This report examines pharmacist approaches to therapy based on case severity; pharmacist confidence and consult duration were also explored. A 2022 online survey gathered data from Ontario and Québec pharmacists regarding their therapeutic approaches for two hypothetical heartburn cases. A total of 715 pharmacists participated, with most having 1–10 years of experience. In Ontario, common choices for the milder case included a solo histamine-2 receptor antagonist (H2RA) (21.2%), combination H2RA + antacid (29.4%), and nonRx PPI (22.3%). For the more severe case, common choices for Québec were switches to nonRx H2RA (22.1%), combination H2RA + antacid (13.4%), a nonRx PPI (24.9%), or prescription PPI (22.5%). Pharmacists often recommended switching medications or referring patients with recurring symptoms after seven days. The approaches varied significantly between cases and provinces. The Ontario pharmacists favoured a combination H2RA + antacid for the milder case, while the Québec pharmacists preferred a solo H2RA. For the more severe case, both groups often chose nonRx H2RA followed by nonRx PPI. Despite the differences, the pharmacists demonstrated confidence in managing these situations. These findings highlight potential debates regarding optimal therapeutic approaches and the impact of drug scheduling on patient care.