Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care

Khaja, Khalid A. J. Al; Veeramuthu, Sindhan; Isa, Husain Ahmed; Sequeira, Reginald P.

doi:10.3233/jrs-170742

Cited by 15 publications

(10 citation statements)

References 43 publications

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“…Observational studies in different settings suggest that between 27 and 81% of PPI use in primary care and 36-63% of use in hospitals could be inappropriate,25354 ie, having no documented indication for its use or prescribed without re-evaluation. Approximately half of older patients in primary care using NSAIDs were prescribed higher than therapeutic doses or double dose regimens of PPIs in a national audit in Bahrain 55. This overuse results in unnecessary healthcare costs and an increased risk of adverse effects, such as hip fracture,56 cardiovascular events,57 Clostridium difficile infection, pneumonia, dementia,58 and gastric cancer in long term users 5960.…”

Section: How Is It Managed?mentioning

confidence: 99%

Peptic ulcer disease

Sverdén

Agréus

Dunn

et al. 2019

BMJ

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Section: How Is It Managed?mentioning

confidence: 99%

Peptic ulcer disease

Sverdén

Agréus

Dunn

et al. 2019

BMJ

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“…Gastroprotective therapy was reported in 30 percent of the total sample of study participants [ 26 ]. Also, in another two studies [ 25 , 27 ] 33.3% respectively 40% of subjects were taking gastroprotective drugs.…”

Section: Discussionmentioning

confidence: 96%

“…Likewise, a quarter of the patients received histamine type-2 receptor antagonists, while approximately half of the patients received proton pump inhibitors (PPIs), much the same in the studies of Moore et al [ 1 ] and Al Khaja et al [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drugs and gastroprotection in primary health care users

Shabani

Murtezani

Tahirbegolli³

et al. 2020

Medicine and Pharmacy Reports

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Objective: The aim of this study is to assess the prevalence of gastroprotection and identify the main factors that influence the taking of protective drugs among the adult population, who are treated with non-steroidal anti-inflammatory drugs (NSAID). Material and Methods: This study was cross-sectional, conducted by including a contingent of 800 users of primary health care services (n=369, 46% males and n=431, 54% females). Included in the study were individuals of both sexes aged 18+ who sought counselling or treatment during the three-month period. The data collection of this study was based on the completion of a structured questionnaire, which included questions related to the use of NSAID and the modalities for the description and application of these drugs, and simultaneous taking of gastroprotective drugs. Results: The prevalence of the gastroprotective drugs use was higher among the elderly, individuals living in urban areas, those with higher education, those with daily use of NSAID, individuals receiving prescriptions from their own doctors, and those suffering side effects from the use of NSAID, as well as subjects that had a longer duration of NSAID use. Conclusion: This paper demonstrates the need to improve the quality of primary health care service through informing and educating patients regarding the need to take gastro-protective drugs for those in high risk of adverse effects manifested by the use of NSAID.

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“…Among PCPs, there is often a lack of awareness of the CV, GI and renal risks associated with the use of NSAIDs. 24 As a result, PCPs may not routinely identify patient risk factors before prescribing NSAIDs. Conversely, there may be an overestimation of NSAID-associated risk, leading to prescription of suboptimal doses for pain relief.…”

Section: Introductionmentioning

confidence: 99%

<p>Practice Advisory on the Appropriate Use of NSAIDs in Primary Care</p>

Ho¹,

Cardosa²,

Chaiamnuay³

et al. 2020

JPR

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Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.

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Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care

Cited by 15 publications

References 43 publications

Peptic ulcer disease

Peptic ulcer disease

Non-steroidal anti-inflammatory drugs and gastroprotection in primary health care users

<p>Practice Advisory on the Appropriate Use of NSAIDs in Primary Care</p>

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