Gastro-protective treatment in patients using NSAIDs. Development of appropriateness criteria by a multidisciplinary expert panel.
OBJECTIVE
To refine the appropriate indications for gastro-protective treatment in patients using non-steroidal anti-inflammatory drugs (NSAIDs).


METHODS
Using the RAND Appropriateness Method, a multidisciplinary expert panel was asked to rate the appropriateness of gastro-protection for 4608 different cases. Logistic regression was used to construct a decision framework to identify patients for whom gastro-protective medication should be considered.


RESULTS
Complete consensus existed on the appropriate use of gastro-protection in patients with a history of (un)complicated peptic ulcer. For other patients. agreement was found for 39% over 1536 cases. Logistic regression demonstrated strong consistency of the panel ratings (Hosmer Lemeshow coefficient 0.92), allowing the development of a comprehensive decision support model.


CONCLUSIONS
Using the RAND Appropriateness Method, we were able to develop a clear and internally consistent decision framework for the appropriate use of gastro-protection in patients taking NSAIDs. The validity of this model should be tested in further studies and practice.
Stoevelaar
H J
HJ
Institute for Health Care Policy and Management, Erasmus University Medical Center Rotterdam, The Netherlands, stoevelaar@bmg.eur.nl
McDonnell
J
J
Stals
H
H
Smets
L
L
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy; D003661:Decision Support Techniques; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D010347:Patient Care Planning; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012044:Regression Analysis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D020011:Protective Agents