Prospective assessment of an intervention to rationalize prescribing of nonsteroidal anti-inflammatory drugs.
Guidelines for the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs), drawn in the Health Ministry and published by the Drug Regulatory Agency, were introduced in the emergency department of a university hospital. The main objective was to determine, in this prospective, before-and-after study, whether a teaching program could help doctors improve their NSAID prescribing practices. Correct prescribing included limiting NSAIDs to their most admitted indications, avoiding their prescription to accident-prone patients, and reducing treatment duration and daily dosage. An overall reduction of NSAID prescriptions was also expected. Prescribing errors were divided into violations (prescribing when unwarranted or against a contraindication) and inadequacies (if the compound or treatment schedule was not suited to the condition addressed). We measured the effect of the intervention 45 days after its initiation. Twenty-seven doctors participated in the two study phases (595 and 520 patients) and wrote 50 NSAID prescriptions in each (8.4% and 9. 6% of patients, respectively; P = 0.44). Prescribing errors decreased from 20% to 14% of cases (P = 0.60). There was a trend toward more prescriptions conforming to the Drug Regulatory Agency guidelines (P = 0.08). Treatment duration decreased from 10.4 +/- 5. 4 to 9.0 +/- 4.0 days (P = 0.03). The teaching of guidelines has helped physicians to improve their NSAID prescribing practices; however, it did not succeed in curbing the overall prescription rate. Unrestricted lists that include soft indications may influence younger doctors into prescribing more NSAIDs.
Elkharrat
D
D
Service des Urgences, Hôpital Lariboisière, Paris, France.
Chastang
C
C
Lecorre
A
A
Caulin
C
C
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002983:Clinical Competence; D004363:Drug Utilization / Q000592:standards*; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D010297:Paris; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal