Gastroesophageal Reflux Disease

Before randomization, comprehensive medication reviews were conducted by BCGPs for all participants using participant-reported medical conditions and information on dose, frequency, indication, duration of treatment, tolerability, and adverse drug reactions for all prescription medications, vitamins, and supplements. The BCGP medication review process involved 1) assessing the clinical appropriateness of each medication using the Beers Criteria [13 ] and Medication Appropriateness Index (MAI); [16 (link)] 2) evaluating potential drug-drug and drug-disease interactions in accord with the above and also taking into account prescription label information; and 3) assessing whether medication regimens followed relevant disease-specific evidence-based guidelines [13 , 17 (link), 18 (link)]. Of note, blood laboratory work results, electronic medical records, and previous therapies (e.g., medication failures) were not available to BCGPs when devising baseline recommendations, but were available to the clinician member of the MTM team. Following randomization, the MTM recommendations were only shared with those participants randomized to the intervention group (N = 46). Recommendations for the control group were recorded in the study database but not shared with those participants.
During the INCREASE study period, the pharmacy team of two BCGPs utilized drug and health information resources (e.g., Lexicomp and UpToDate [Wolters Kluwer Health Inc. Riverwoods, IL]), Beers Criteria [13 ], relevant guidelines (e.g., Diabetes Standards of Care [17 (link)] and Clinical Practice Guidelines for Hypertension [18 (link)]), and clinical judgement to justify their recommendations. Each recommendation was reviewed by both BCGPs and a consensus pharmacy recommendation was decided via discussion. Detailed information for each recommendation was then entered into a series of pre-specified study protocol data collection forms, allowing for systematic categorization of recommendations as either: 1) medication discontinuation with or without tapering; 2) switch to a different medication; 3) dose adjustment (e.g., decrease dose, adjust dose for organ function/tolerability, or increase dose); 4) new medication initiation; 5) drug or disease monitoring recommendation (e.g., vital signs, falls risk, sedation); or 6) a non-pharmacologic recommendation (e.g., sleep hygiene, avoiding gastroesophageal reflux triggers, referral for diagnostic workup). Baseline recommendations were also categorized by pharmacologic class and over the counter (OTC) or supplement status of the medication prompting a baseline MTM recommendation. A full schematic for medication categorization is available in the supplementary material (see Supplementary Table S1).

We performed a questionnaire-based cohort study in postmenopausal women recruited within the outpatient consultation at the University Hospital Marburg, Germany. The women visited the gynecological department for numerous medical reasons, but the majority took part in routine checkups or menopausal counseling including bone densitometry (in our hospital performed by the department of gynecological endocrinology). Participants between the ages of 45 and 65 were offered participation, although the last menstruation had to be at least one year ago.
We excluded women with irregular bleeding, smokers, history of any recent sex steroid treatment, including Menopause Hormone Therapy (MHT) or any differential diagnosis that might be connected to chronic cough (e.g. cancer, chronic bronchitis, gastro-esophageal reflux, chronic heart failure, therapy with ace-inhibitors).