Underutilization of gastroprotective measures in patients receiving nonsteroidal antiinflammatory drugs.
OBJECTIVE
To determine the frequency of use of recommended gastroprotective strategies in a cohort of patients receiving recurrent treatment with nonsteroidal antiinflammatory drugs (NSAIDs).


METHODS
A cross-sectional study was performed using administrative data from the Tennessee Medicaid (TennCare) program. The study population consisted of 76,765 recurrent recipients of NSAIDs (NSAID users), comprising 24% of the 319,402 persons ages 50 years or older enrolled in the TennCare program from January 1999 through June 2000. Frequency of use of either of 2 recommended gastroprotective strategies, involving either traditional NSAIDs combined with recommended anti-ulcer cotherapy or use of a selective cyclooxygenase 2-inhibiting drug (coxib), was measured and categorized by risk for ulcer complication.


RESULTS
Among this cohort of recurrent NSAID users, 16% received 1 of the 2 recommended gastroprotective therapies: 10% received traditional NSAIDs along with antiulcer drugs at the recommended doses and 6% received coxibs. Among those patients with > or=2 risk factors for ulcer complications (age 75 years or older, peptic ulcer or gastrointestinal bleeding in the past year, or concurrent use of oral anticoagulants or corticosteroids), 30% received such gastroprotective therapy.


CONCLUSIONS
Use of recommended strategies to decrease ulcer complications in vulnerable populations is relatively uncommon.
Smalley
Walter
W
Vanderbilt University, Nashville, Tennessee 37232, USA. walter.smalley@mcmail.vanderbilt.edu
Stein
C Michael
CM
Arbogast
Patrick G
PG
Eisen
Glenn
G
Ray
Wayne A
WA
Griffin
Marie
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004064:Digestive System / Q000187:drug effects* / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D016861:Cyclooxygenase Inhibitors