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Trends and determinants of adequate gastroprotection in patients chronically using NSAIDs
Charles W Helsper1, Hugo M Smeets, Mattijs E Numans
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg, 3584 CG Utrecht, The Netherlands. c.helsper@gmail.com
Purpose:
To identify determinants and trends of gastroprotection in patients chronically using NSAIDs.
Design:
retrospective cohort study.
Data Source:
Agis Health Database (AHD) containing annual prescription records of approximately 1.5 million patients.
Patients:
All patients using more than 180 daily defined doses (DDD) annually, of any NSAID from 2001 to 2007.
Main Outcome Measures:
prevalence of NSAID use, adequate prescription of gastroprotective drugs (PPI, misoprostol or COX-2 inhibitor use), determinants of adequate gastroprotection.
Results:
The percentage of patients chronically using NSAIDs rose from 7.3% of the total NSAIDs users in 2001 to 7.5% in 2007. The percentage of patients on NSAIDs receiving adequate gastroprotective medication in line with actual guidelines increased from 39.6% in 2001 to 69.9% in 2007. Age over 70, co-prescription of SSRI, coumarine and steroids and arthritis are the main clinical factors predicting adequate prescription.
Conclusions:
The prevalence of NSAID prescription and the risk of gastric complications is increasing steadily. Although the number of patients receiving gastroprotective medication is also increasing, over 30% of the patients at risk for GI complications were left unprotected in 2007. In order to improve protection rates in patients using NSAIDs and to decrease NSAID related hospital admissions in the future, the implementation of gastroprotection guidelines needs to be improved.
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