Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents: a randomized controlled trial.
BACKGROUND
The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients.


OBJECTIVE
To determine the effects of an educational program on NSAID use and clinical outcomes in nursing homes.


METHODS
Randomized controlled study. Ten pairs of Tennessee nursing homes with > or = 8% of residents receiving NSAIDs were randomized to intervention or control.


METHODS
Nursing home residents (intervention n = 76 and control n = 71) aged 65 years and older taking NSAIDs regularly.


METHODS
An educational program for physicians and nursing home staff that included the risks and benefits of NSAIDs in the elderly and an algorithm that substituted acetaminophen, topical agents, and nonpharmacologic measures for the treatment of noninflammatory musculoskeletal pain. Intervention and control subjects were assessed at baseline and 3 months later.


METHODS
Differences in NSAID and acetaminophen use, and pain, function, and disability scores in intervention and control nursing home subjects.


RESULTS
The intervention was effective resulting in markedly decreased NSAID use and increased acetaminophen use. Mean number of days of NSAID use in the 7 day periods before the baseline and 3 month assessments decreased from 7.0 to 1.9 days in intervention home subjects compared with a decrease from 7.0 to 6.2 days in control homes (P = 0.0001). Acetaminophen use in the 7 days immediately before the 3 month assessment increased by 3.1 days in intervention home subjects compared with 0.31 days in control homes (P = 0.0001). A similar proportion of subjects in control (32.5%) and intervention (35.4%) groups had worsening of their arthritis pain score (P = 0.81).


CONCLUSIONS
An educational intervention effectively reduced NSAID use in nursing homes without worsening of arthritis pain.
Stein
C M
CM
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Griffin
M R
MR
Taylor
J A
JA
Pichert
J W
JW
Brandt
K D
KD
Ray
W A
WA
D000082:Acetaminophen / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003663:Decision Trees; D006233:Persons with Disabilities; D004363:Drug Utilization; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D008503:Medical Staff / Q000193:education*; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education*; D010003:Osteoarthritis / Q000188:drug therapy*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012307:Risk Factors; D013714:Tennessee; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen