Non-steroidal anti-inflammatory drugs and gastroprotection in primary health care users (original) (raw)
Related papers
Journal of Clinical Gastroenterology, 2011
Aim: To assess the appropriateness of gastroprotection in nonsteroidal anti-inflammatory drug (NSAID) users by primary care physicians. Background: A gastroprotective therapy is advised in NSAID users who are at a high risk for developing gastrointestinal side effects. However, an inappropriate (overuse/underuse) prescription of gastroprotection has been reported. Study: This was a cross-sectional study in which a questionnaire was administered to consecutive NSAID users who visited routine primary care during a 1-week period. The presence of risk factors for NSAID-related gastrointestinal side effects and the eventual gastroprotective strategy used were registered. Gastroprotective therapy was considered appropriate/inappropriate according to the current guidelines. Results: Overall, 869 (25.3%) of 3,433 patients were on chronic NSAID therapy. Gastroprotection was performed in 593 (68.2%) NSAID users, and it was appropriate in only 299 (34.4%) cases. Specifically, an underuse of gastroprotective therapy was observed in 30.6% of Z65-year-old, whereas an overuse occurred in 57.5% of <65-year-old patients without any risk factor. Concomitant therapy with either steroids [odds ratio (OR): 4.3] or anticoagulants (OR: 3.9), and >72 years of age (OR: 1.67) were significant predictive factors of inappropriate gastroprotection. Conclusions: Appropriate use of gastroprotective therapy for NSAID users by primary care physicians needs to be promptly implemented, as its inappropriate use is noticeably increasing ethical and economic concerns.
International Journal of Clinical Pharmacy, 2011
Objective To assess the appropriateness of gastroprotective agents (GPA)\ NSAID use in patients' access medication through community pharmacy and the factors associated with any inappropriateness found. Methods A cross-sectional study in which patients requesting NSAIDs through community pharmacy was undertaken. Information was collected through a structured questionnaire included data of patients' pharmacotherapy and gastropathy risk factors. Patients were classified as ''overprotected'' or ''underprotected'' according to the use of gastroprotective-drugs and presence/absence of gastropathy risk factors. We calculated the risk for under-or over-protection using logistic regression controlling for potential confounders. Results Twenty-seven community pharmacies of Southeast of Spain participated in the study. Out of 670 NSAID users recruited in the study, 243 (36.3%) were not appropriately protected: 197(81.1%) patients were underprotected, and 46 (18.9%) patients were overprotected. Compared to patients with ulcer history, patients with cardiovascular disease or chronic morbidity (aOR 18.55; 95% CI l 3.68-93.52, P \ 0.001) and aged over 60 years (aOR 23.97; 95% CI 3.93-145.9) were associated with underuse of gastroprotective-drugs. OTC-NSAID-users were more likely to be underprotected than those with medical prescription (aOR 3.47; 95% CI l 1.84-6.55). Conclusions Inappropriate GPA use is relatively frequent among NSAD users, especially in those using OTC-NSAIDs. Community pharmacists should be aware of factors contributing to NSAID-induced GI complications and assess its presence in the consumer when dispensing an OTC-NSAID. Keywords Community pharmacy Á Gastroprotective drugs Á Non Steroidal Antiinflammatory Drugs Á OTCdrugs Á Risk factors Á Spain Impact of findings on practice • 36.3% of NSAID users in Spain are not appropriately protected against potential gastrointestinal toxicity: 29.4% are underprotected and 6. 9% are overprotected. • Self-medication users tend to be underprotected while medical prescription users have more risk of being overprotected. • Educational programmes for doctors and pharmacists are needed to improve the use of gastroprotection with NSAID use, where appropriate. • Community pharmacists should ultimately be responsible for the educational programs, especially with regard to the self-medication of patients.
Use of Non-Steroidal Anti-Inflammatory Drugs and Associated Gastroprotection in a Cohort of Workers
International Journal of Environmental Research and Public Health
Background: This study describes the prevalence of non-steroidal anti-inflammatory drug (NSAID) use, and analyses prescribing patterns of NSAIDs and associated gastroprotection. Methods: The study population consisted of 5650 workers at the General Motors automobile assembly plant in Zaragoza, Spain. NSAID prescription data for 2014 were obtained from the prescription database of Aragon (Spain). NSAID consumption was determined based on the number of defined daily doses purchased per year. Heavy NSAIDs users were identified using Lorenz curves. Results: NSAID use in the cohort was high (40.7% of workers, 95% CI 39.4–41.9). The prescription of proton pump inhibitors increased with age. Gastrointestinal protection was lacking in some participants who were being treated with drugs associated with a high risk of gastrointestinal bleeding. Heavy NSAID users (defined as those above the 95th percentile of consumption), accounted for 26% of total DDDs, and consumed a greater proportion of c...
British journal of clinical pharmacology, 2015
Low-dose aspirin (LDA) and non-steroidal-anti-inflammatory drugs (NSAIDs) both increase the risk of upper gastrointestinal events (UGIEs). In the Netherlands recommendations regarding the prescription of gastroprotective agents (GPA) in LDA users were first issued in 2009 in the HARM-Wrestling consensus. National guidelines on gastroprotective strategies in NSAID users were already issued in the first part of the decade. To examine time-trends in gastroprotective strategies in patients initiating LDA and patients initiating NSAIDs between 2000 and 2012. Within a large electronic primary health care database, two cohorts were selected: (i) patients newly prescribed LDA and (ii) patients newly prescribed NSAIDs between 2000 and 2012. Excluded were patients who had been prescribed a GPA in the six months prior. For both cohorts, patients' risk of a UGIE was classified as low, moderate or high, based on the HARM-Wrestling consensus, and the presence of an adequate gastroprotective s...
European Journal of Clinical Pharmacology, 2004
There has been an increase of anti-ulcer drug consumption in Spain. A high proportion of this consumption may be due to the use of those drugs as gastroprotective agents when co-prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to learn how these treatments are being used: the prevalence of use, the type of drug and the main features of patients. A sample of patients going to pharmacies with a NSAID prescription, with or without a gastroprotective agent, was obtained. A survey questionnaire was distributed to learn clinical and demographic data of the patients. Of the 942 patients interviewed, 41.6% were co-treated with a gastroprotective agent in addition to the NSAID. Most of these patients received proton-pump inhibitors and, to a lesser extent, histamine-2-receptor antagonists, antacids and prostaglandin analogues. The use of gastroprotective agents increased with age, treatment duration and illness chronicity; specialists prescribed a higher proportion of those co-treatments than did general practitioners. There was a high prescription rate of gastroprotective agents; in general, these were used according to recommendations. However, the type of gastroprotective agents being used does not seem to be justified by the current guidelines: histamine-2receptor antagonists and antacid drugs have not proved their efficacy in this indication. The fact that one in four treatments with gastroprotective drugs was issued to patients without associated risk factors identifies a possible problem where an intervention could be appropriate.
PloS one, 2013
The aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA. This study included all elderly patients (75+) admitted to hospital in the period of 1(st) April 2010 to 31(st) March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay. In total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0%) and 597 of 1994 user of low-dose ASA (29.9%) had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0%) a...
Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care
International Journal of Risk & Safety in Medicine, 2017
BACKGROUND: The use of non-steroidal anti-inflammatory drug (NSAIDs) is deemed a major risk factor for peptic ulcer disease in elderly population that requires concomitant therapy with gastroprotective agents (GPAs). OBJECTIVE: This study evaluated the rational prescribing of NSAIDs and GPAs, and extent of adherence to the guideline recommendations in primary care. METHODS: Nationwide audit of prescriptions issued to elderly patients (≥65 years) with hypertension or diabetic hypertension in primary care. RESULTS: Among 2090 elderly, 45.9% were on low-dose aspirin, and 13.5% on other NSAIDs. Diclofenac-XR was the most frequently prescribed NSAIDs to three-quarter patients whereas naproxen, the safest NSAID for patients with high cardiovascular (CV) risk, was rarely prescribed. Among those on NSAID, 82.9% were on a scheduled dosing regimen; of these 78.8% received long-term NSAID therapy (3.9 ± 0.9 months). The prescription rate of GPAs was low: 29.2% for aspirin and 33.3% for other NSAIDs. A quarter of the patients on histamine type-2 receptor antagonists received ranitidine at subtherapeutic single-dose for gastroprotection. Approximately half of the patients on proton pump inhibitors (PPIs) were prescribed supra-therapeutic double-dose regimen: omeprazole and esomeprazole accounted for 63.2% of overall prescribed PPIs. CONCLUSIONS: The rational choice of NSAIDs and physicians' adherence to gastroprotective measures was suboptimal in primary care. The choice of NSAIDs and gastroprotective strategy in elderly be guided by the CV and gastrointestinal adverse events likelihood due to the NSAIDs and risk profile of patients for such adverse events.