Physicians’ approaches to the use of gastroprotective strategies in low‐risk non‐steroidal anti‐inflammatory drug users

• Published in: Alimentary pharmacology & therapeutics Vol. 23; no. 9; pp. 1365 - 1372
• Main Authors: MURTHY, S. K., KAULDHER, S., TARGOWNIK, L. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2006; Blackwell
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - economics; Biological and medical sciences; Clinical Competence; Cyclooxygenase 2 Inhibitors - economics; Cyclooxygenase 2 Inhibitors - therapeutic use; Digestive system; Family Practice - standards; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - economics; Gastrointestinal Diseases - prevention & control; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Professional Practice - standards; Proton Pump Inhibitors; Proton Pumps - economics; Risk Factors; Non steroidal antiinflammatory agent; Human; Physician; User; Health staff; Low risk
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2006.02873.x

Summary
Background
Many doctors unnecessarily prescribe gastroprotective strategies to non‐steroidal anti‐inflammatory drugs users at low risk of non‐steroidal anti‐inflammatory drug‐related gastrointestinal complications.
Aim
To identify factors that predict the overuse of gastroprotective strategies in low‐risk non‐steroidal anti‐inflammatory drug users.
Methods
We distributed a questionnaire to family doctors and general internists consisting of a clinical vignette describing a low‐risk hypothetical patient with osteoarthritis who was a candidate for non‐steroidal anti‐inflammatory drug therapy. Respondents were asked whether they would prescribe this patient a gastroprotective strategy and to estimate the annual risk of that patient developing a gastrointestinal complication with non‐steroidal anti‐inflammatory drug use. Respondents inappropriately recommending a gastroprotective strategy were compared with respondents who opted not to use gastroprotection.
Results
We received 340 responses (response rate of 28.3%), of which 278 supplied analysable data. Thirty‐five percent of respondents inappropriately recommended a gastroprotective strategy for the low‐risk subject. Inappropriate prescribers were significantly more likely to overestimate the risk of gastrointestinal complications with traditional non‐steroidal anti‐inflammatory drugs and this was strongly predictive of gastroprotective strategy recommendation in logistic regression.
Conclusions
Many doctors inappropriately recommend gastroprotective strategies in low‐risk non‐steroidal anti‐inflammatory drug users. Improving doctors’ awareness of non‐steroidal anti‐inflammatory drug‐associated gastrointestinal risks may lead to a decrease in inappropriate utilization of gastroprotective strategies in low‐risk patients.