A nurse-delivered advice intervention can reduce chronic non-steroidal anti-inflammatory drug use in general practice: a randomized controlled trial.
OBJECTIVE
To find out whether a nurse-delivered educational package can reduce chronic oral non-steroidal anti-inflammatory drug (NSAID) usage in general practice.


METHODS
A prospective randomized controlled trial with assessment of economic cost/benefits was carried out in five general practices in Nottinghamshire with computerized prescribing systems, representing a mix of rural/urban and fundholding/non-fundholding practices. Patients suffering from non-malignant, non-inflammatory musculoskeletal pain received repeat prescriptions for oral NSAIDs. Two hundred and twenty-two patients were randomized to a control group (simple advice regarding NSAID use) or an intervention group (asked to withdraw their NSAIDs and employ appropriate alternative drug and non-drug therapies). All advice was supported by patient literature and delivered by a nurse practitioner trained in musculoskeletal assessment. The primary outcome measure was change in NSAID use 6 months after the intervention. Secondary outcome measures were changes in health and quality of life (SF-36 and EQ-5D questionnaires) and drug, health service and patient costs.


RESULTS
An extra 28% of patients in the intervention group either stopped taking oral NSAIDs or reduced dosage by > or =50% at 6 months compared with controls. There was no detrimental effect on health and well-being. Oral NSAID prescription costs were significantly lowered in the intervention group but not in the control group. A non-significant increase in total drug prescription costs occurred in both groups.


CONCLUSIONS
Nurse-based intervention can reduce chronic NSAID usage and costs in primary care and would be cost-effective if maintained in the long term. This intervention package would be readily applicable in primary care.
Jones
A C
AC
Division of Public Health Medicine and Epidemiology, Nottingham University, Nottingham, NG5 1PB, UK.
Coulson
L
L
Muir
K
K
Tolley
K
K
Lophatananon
A
A
Everitt
L
L
Pringle
M
M
Doherty
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000191:economics*; D017046:Cost Savings / Q000706:statistics & numerical data; D004363:Drug Utilization; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D009722:Nurse Practitioners; D009732:Nursing Care; D010353:Patient Education as Topic / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D006113:United Kingdom
D000894:Anti-Inflammatory Agents, Non-Steroidal