Less than half of NSAID patients with GI risk factors prescribed GI prophylaxes

Increasing use of NSAIDs makes identifying candidates for prophylaxis even more important. by Gina Brockenbrough

SAN FRANCISCO — A new study shows that while physicians commonly prescribe NSAIDs for patients with arthritis, there are low rates of application of gastrointestinal prophylaxis in conjunction with these drugs.

In a retrospective study, Khaled J. Saleh, MD, MSc, FRCSC, and colleagues reviewed medical data obtained from three health plans to pilot test a quality measure assessing whether patients who were prescribed NSAIDs and were at high-risk for gastrointestinal bleeding (GI) were also prescribed GI prophylaxis. They discovered that 12.1% of patients in the commercial population and 25.9% of Medicare patients were prescribed NSAIDs and that 0.79% of patients in the general population and 19.8% of

Medicare patients were at-high risk for GI bleeding.

However, the pilot investigation revealed that only 35.9% of all patients with GI risk factors who had a prescription for an NSAID were also prescribed a GI prophylaxis or Cox-2 selective NSAID, the investigators wrote in their abstract.

The study was presented at the 75th Annual Meeting of the American Academy of Orthopedic Surgeons.

Protection

"I think that the take-home message is that we use NSAIDs to decrease pain and to improve function and this use has increased as result of the cardiovascular issues recently identified with the Cox-2 inhibitors," Saleh told Orthopedics Today. He noted that the study was conducted before some of the Cox-2 inhibitors were removed from the market. "Now that NSAIDs are increasingly being used, it makes the finding even more important for patients with an increased risk for GI bleeding and we need to identify these individuals as candidates for prophylaxis."

Saleh and his colleagues studied the type of NSAID and GI prophylaxis prescribed, aspirin use and risk factors for GI bleeding noted in the enrollment data of three HMOs with 150,000 to almost one million members.

Primary measure

He cited the use of documentation in the existing health plan charts and the retrospective nature of the research as study limitations. However, he noted that the large numbers of physicians and patients involved in the research may increase the validity of the findings.

"These findings are also being considered as a quality indicator [in] terms of care and may become a pay-for-performance measure at some point," Saleh said."

For more information:
Khaled J. Saleh MD, MSc (HSRP), FRCSC, FACS, can be reached at the University of Virginia Health System, PO Box 800159, Charlottesville VA 22908-0159; 434-243-0067; email: saleh@virginia.edu. He receives: institutional support, miscellaneous support and is a consultant for Aesculap/B. Braun and Stryker; institutional support and royalties from Smith & Nephew; institutional support from Johnson & Johnson; and miscellaneous funding and is a consultant for Genzyme, Innomed, Kinamed and Zimmer.
Saleh KJ, Sampsel S, MacLean C, et al. Physician compliance with high-risk NSAID treatment protocols — A cause for concern. Paper #218. Presented at 75th Annual Meeting of the American Academy of Orthopedic Surgeons. March 5-9, 2008. San Francisco.