Evaluation of a laryngopharyngeal reflux management protocol

Purpose: To evaluate the effectiveness of a protocol for management of patients with laryngopharyngeal reflux (LPR) in a multi-provider clinic. Materials and Methods: This is a retrospective cohort study of 188 patients treated for LPR. A standardized clinical protocol for diagnosis and management was instituted in 2012. Two cohorts were established: those managed according to the protocol, and those who were not. For patients managed with the LPR protocol, diagnosis was made using clinical judgment, guided by the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were treated with proton pump inhibitors (PPI) with the goal of weaning therapy after symptom resolution. Response to therapy was rated using a global rating scale with three response levels: no response, partial response, and complete response. The primary outcome measure was complete response to therapy and the secondary outcome measures were any response (complete or partial) and successful wean off PPI therapy. Results: The patients treated with the LPR protocol had higher rates of complete response (p < 0.001). There was no statistically significant difference in rates of any response (complete or partial) between the two groups (p = 0.08). Patients treated using the LPR protocol were more likely to be successfully weaned off PPI therapy (p = 0.006). Conclusions: The use of an LPR protocol improved treatment effectiveness in our clinic, highlighting the role of clinical protocols in reducing variability in care, thereby improving patient outcomes. (c) 2016 Elsevier Inc. All rights reserved.