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INAPPROPRIATE NSAID PRESCRIBING.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective, they confer a risk for serious gastrointestinal bleeding, particularly in the elderly. To study NSAID prescribing patterns, researchers sent standardized patients to visit 112 Canadian general practitioners and resident physicians who were unaware that these were not "real" patients. Patients were 67 years old and reported type 2 diabetes, hypertension, and a history of peptic ulcer disease.

During 139 visits, the patient described episodic hip pain with a recent exacerbation. In 37 percent of these encounters, physicians prescribed NSAIDs inappropriately (the authors considered acetaminophen, low-dose codeine, or nonpharmacologic therapy to be appropriate options). During 137 visits, the patient reported developing epigastric pain while taking NSAIDs. These physicians recommended continuing NSAIDs in 23 percent of encounters, even though the correct diagnosis was made in most cases.

Comment: Since over one-third of physicians approached declined participation, those studied may not be representative of Canadian general practitioners. However, this study suggests that NSAIDs are often prescribed inappropriately. If these results are confirmed, attention will need to be focused on possible reasons, such as visit duration, physician knowledge and perception of risks and benefits, expert consensus on appropriateness, and patient preferences.

— R Saitz

Published in Journal Watch General Medicine October 3, 1997

Citation(s):

Tamblyn R et al. Unnecessary prescribing of NSAIDs and the management of NSAID-related gastropathy in medical practice. Ann Intern Med 1997 Sep 15 127 429-438.

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