The best clinician advice or patient instructions don’t matter if they aren’t followed correctly.

The effectiveness of a treatment plan depends on patients following it exactly as prescribed. In the United States, about half of all medications are not taken correctly due to mistakes in dosage, frequency, timing, and duration. Poor adherence to medication, especially for chronic conditions, presents a major public health challenge. This can lead to worse health outcomes, more hospital visits, higher rates of illness and death, and increased healthcare costs.(1)

This is just as true for reflux as it is for other chronic conditions. This issue was on the radar of one of Restech’s customers over a decade ago. A busy ENT practice noticed something extraordinary when they reviewed their patients’ charts with them. The patients who had Dx-pH testing seemed to have better outcomes than those diagnosed by signs and symptoms alone, even after being prescribed the same course of treatment. 

The practice conducted a review of their patient data.(2)  Two groups were defined: Group I, consisting of 73 patients who had undergone pH testing, and Group II, consisting of 70 patients who were treated empirically based on signs and symptoms. The results were telling:

• Medication Compliance: 68.5% vs. 50.0%
• Lifestyle Modification Compliance: 82.2% vs. 25.7%
• Symptom Improvement: 150% greater in Group I (36.6% vs. 24.4%, P = .023)

In their conclusions, the authors commented “among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.”

How did a simple Restech pH test achieve this? By presenting visual and tangible data, a Dx-pH study enables patients to clearly see the severity of their reflux. This visual evidence, combined with educational discussions, helps patients understand their condition and empowers them to take control of their health. When patients can see their reflux patterns, it becomes easier for them to connect their symptoms to the condition and realize the impact of their actions. This understanding encourages them to adjust their behavior and follow the prescribed treatment plan, leading to better health outcomes. Follow up pH testing after a prescribed course of therapy (whether medication, lifestyle modifications, or a combination of those) can reinforce the value of adherence by confirming a response to treatment.

Now, let’s dive into why adherence to a treatment protocol is crucial for success and how some fundamental behavioral science principles reinforce that adherence.

Importance of Compliance
Compliance is crucial for successful treatment outcomes, especially for patients with LPR, as some symptoms may take a long time to resolve. Challenges to achieving optimal compliance rates include both unintentional lapses and intentional non-adherence driven by economic, belief, adverse effect, or expectation-related reasons. To enhance patient compliance, integrating key behavioral science principles can be highly effective. Here’s how the Dx-pH system aligns with these principles to improve adherence:

• Feedback Loop: Providing a full day’s worth of data about patients’ pH levels and how their behaviors (like diet and medication adherence) affect these levels helps patients visualize the impact of their actions. This immediate feedback encourages healthier choices and better adherence to treatment recommendations.
• Self-Efficacy: The Dx-pH system boosts patients’ confidence in managing their LPR by showing how their efforts lead to measurable health improvements. When patients see positive results from following medical advice, their belief in their ability to influence their health outcomes strengthens, enhancing compliance.
• Goal-Setting Theory: Using data from the Dx-pH system, healthcare providers can set specific, achievable health goals for patients. Clear, personalized goals (e.g., reducing acidic episodes by altering diet or medication) motivate patients to engage in their treatment and make necessary lifestyle adjustments.
• Health Belief Model: The Dx-pH system provides tangible evidence that reinforces the perceived susceptibility and severity of LPR. It clearly demonstrates the benefits of adhering to treatment plans and how lifestyle changes can mitigate symptoms. Understanding these factors makes patients more likely to follow through with prescribed actions when they see that the benefits outweigh the barriers.

By integrating these behavioral science principles, the Dx-pH system not only aids in designing effective treatment plans but also ensures that patients adhere to them, ultimately enhancing overall treatment outcomes.

Who should get a pH test? Identifying Ideal Candidates for Dx-pH Monitoring
While it would be helpful to have the results of a 24-hour pH test in your hands when making a treatment decision, it’s not always practical. The patients who would benefit most from pH monitoring are those with persistent or atypical symptoms with no other likely etiology, and those who have not responded to a course of standard therapy.

• Chronic Symptoms: Patients who have had LPR symptoms for an extended period, especially those whose symptoms have not responded to standard treatments, are prime candidates. Chronic symptoms often indicate a deeper, possibly misdiagnosed issue that pH monitoring could help clarify.
• Non-Responders to Standard Therapy: Patients who have not responded to typical empirical treatments such as proton pump inhibitors (PPIs) may benefit. The lack of response could be due to an incorrect diagnosis or suboptimal treatment.
• Partial Symptom Resolution: Patients who have seen some improvement but have not achieved complete symptom resolution may have complex or mixed reflux patterns that standard treatments do not adequately address.
• Additional GI Disorders: Individuals with other gastrointestinal disorders like GERD can benefit from the Dx-pH system to differentiate the contributions of various disorders to the symptomatology.
• Atypical Symptoms: Patients experiencing symptoms not typical of LPR, such as asthma-like symptoms, chronic cough, or unexplained dental erosion, might be undergoing reflux episodes that only pH monitoring can conclusively diagnose.
• Inconclusive Diagnoses: Patients whose diagnostic assessments have been inconclusive or who have overlapping symptoms with other conditions might benefit from the objective clarity provided by Dx-pH monitoring.
• Lifestyle-Responsive Symptoms: Patients whose symptoms significantly fluctuate with lifestyle changes are ideal candidates, as pH monitoring can help correlate specific behaviors with reflux episodes, providing clear targets for behavioral modification.

This thorough assessment not only enhances the precision of LPR management but also maximizes the health benefits for patients suffering from this challenging condition.

Maximizing the Utility of the Dx-pH System in a Clinical Setting 

Educate and Engage Patients

Explain what specifically you hope to uncover from the pH study, and emphasize the importance of following instructions closely to ensure accurate data collection. Use Restech’s patient video to help patients get a thorough preview of what to expect from the Dx-pH study process – it will help to answer many frequently asked questions ahead of time! 

After the study is complete, use the graph to discuss the results of the patient’s study with them. Provide a copy for them to keep. Placing their study graph on the refrigerator or bathroom mirror can serve as a frequent reminder of the changes they’re trying to make. 

Employ motivational interviewing to help patients identify personal goals and the benefits of compliance. Motivational interviewing is a counseling approach that helps patients find their motivation to change behavior. Here’s an example:

Scenario: A patient with LPR is struggling to adhere to dietary recommendations.

Provider: “I understand that making changes to your diet can be challenging. Can you tell me more about what makes it difficult for you?”

Patient: “I find it hard to avoid certain foods because they’re part of my daily routine.”

Provider: “That’s completely understandable. Let’s look at your pH monitoring data together. Do you see how certain foods correlate with drops in your pH levels? If we could find alternatives that you enjoy just as much, do you think that might help you manage your symptoms better?”

Patient: “Yes, seeing the data helps. I’m willing to try some alternatives.”

Customize Interventions
-Use pH data to tailor treatment plans based on individual reflux patterns. For example, if you identify diurnal and nocturnal reflux patterns, you can appropriately adjust their dosing regimen. -Schedule regular follow-ups to assess symptom resolution and adjust treatment plans as necessary. It can take a long time to achieve complete symptom resolution, so periodic check-ins with a nurse or other HCP can provide helpful reassurance that progress is being made. 

Collaborative Care
-Involve specialists like Speech Language Pathologists, dietitians, and behavioral therapists for a holistic approach.
-Utilize nurses and patient educators for ongoing support and education.

Ongoing Training and Quality Improvement
-Join Restech’s mailing list and follow our social media channels to stay up to date with any changes to the device, and learn about any new research as soon as it’s available.
-Work with customer service to conduct regular reviews and quality improvement projects to enhance the utilization and outcomes of the Dx-pH System in your practice.
-Appoint a technology champion in your office. This person can be the go-to when there are questions about the day-to-day use of the system, and can help arrange training when a new staff member joins your team.

By implementing these strategies, healthcare providers can maximize the effectiveness of the Dx-pH System, leading to improved diagnostic accuracy, more efficient management of LPR, and better patient outcomes. This proactive and informed approach can transform the standard of care for patients experiencing reflux symptoms, ensuring they receive the most effective and personalized treatment possible.

Explore more about the Dx-pH System or contact Restech for further information and training. Need resources for your practice? Contact us at contact@restech.com or 800.352.1512 to make a request.

References: 

1. Oliveira CJ, José HMG, Costa EIMTD. Medication Adherence in Adults with Chronic Diseases in Primary Healthcare: A Quality Improvement Project. Nurs Rep. 2024;14(3):1735-1749. Published 2024 Jul 17.
2. Friedman M, Maley A, Kelley K, et al. Impact of pH monitoring on laryngopharyngeal reflux treatment: improved compliance and symptom resolution. Otolaryngol Head Neck Surg. 2011;144(4):558-562.