Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting

Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gast...

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Bibliographic Details
Published in:BMC musculoskeletal disorders Vol. 24; no. 1; pp. 1 - 761
Main Authors: Swan, Joshua T, Rizk, Elsie, Duong, Phuong Y, Alghamdi, Bader M, Kaur, Navjot, Nagaraj, Sudha, Brown, Anthony E, Flores, Eleazar, Spence, Nathan, Tajchman, Sharla
Format: Journal Article
Language:English
Published: London BioMed Central Ltd 27-09-2023
BioMed Central
BMC
Subjects:
Anti-inflammatory agents
Anti-inflammatory drugs
Anticoagulants
Arthritis
Aspirin
Care and treatment
Creatinine
Development and progression
Dosage and administration
Drug therapy
Electronic health records
Esophagus
Evaluation
Gastroenterology
Inflammation
Kidney diseases
Knee
Knee pain
Methods
Musculoskeletal diseases
Nonsteroidal anti-inflammatory drugs
NSAIDs
Osteoarthritis
Pain
Pain management
Patients
Primary care
Primary health care
Proton pump inhibitors
Quality indicators
Risk factors
Small intestine
Ulcers
United States
United States > US
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Summary:Background Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). Methods This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). Results Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74-83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. Conclusion A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits. Keywords: Osteoarthritis, Pain, Quality indicators, Primary care, NSAIDs
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ISSN:1471-2474
1471-2474
DOI:10.1186/s12891-023-06904-x