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Gastro-protective treatment in patients using NSAIDs. Development of appropriateness criteria by a multidisciplinary
H J Stoevelaar1, J McDonnell, H Stals
1Institute for Health Care Policy and Management, Erasmus University Medical Center Rotterdam, The Netherlands, stoevelaar@bmg.eur.nl
Objective:
To refine the appropriate indications for gastro-protective treatment in patients using non-steroidal anti-inflammatory drugs (NSAIDs).
Methods:
Using the RAND Appropriateness Method, a multidisciplinary expert panel was asked to rate the appropriateness of gastro-protection for 4608 different cases. Logistic regression was used to construct a decision framework to identify patients for whom gastro-protective medication should be considered.
Results:
Complete consensus existed on the appropriate use of gastro-protection in patients with a history of (un)complicated peptic ulcer. For other patients. agreement was found for 39% over 1536 cases. Logistic regression demonstrated strong consistency of the panel ratings (Hosmer Lemeshow coefficient 0.92), allowing the development of a comprehensive decision support model.
Conclusions:
Using the RAND Appropriateness Method, we were able to develop a clear and internally consistent decision framework for the appropriate use of gastro-protection in patients taking NSAIDs. The validity of this model should be tested in further studies and practice.
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