[Prescription of cyclooxygenase-2 inhibitors: an intervention strategy in primary care].
OBJECTIVE
To evaluate an intervention designed to rationalize prescription of nonsteroidal anti-inflammatory drugs (NSAIDs), especially cyclooxygenase-2 inhibitors (COXIBs).


METHODS
We performed a before-after intervention study. Face-to-face educational outreach visits were conducted in general practitioners who were heavy prescribers and group intervention for the remaining. Data on prescribing habits were obtained from the pharmacy database of the Catalan Health Institute. The pre-intervention period (period 1) was compared with the immediate postintervention period (period 2, which coincided with the publication of a safety alert on the adverse effects of COXIBs) and the late postintervention period (period 3). The data monitored were: a) expenditure due to COXIBs; b) consumption in daily defined doses (DDD) per 1,000 habitants/day (DHD); c) the percentage of COXIBs/total NSAIDs and the percentage of recommended NSAIDs/total NSAIDs, and d) the mean daily cost of DHD of NSAIDs.


RESULTS
The mean monthly reduction in expenditure on COXIBs was 19,480 euro/month in period 2 and was 18,555 euro/month in period 3. The percentage of reduction in DHD of COXIBs was 35.4% (p < 0.001), which remained stable throughout the study. The percentage of recommended NSAIDs/total NSAIDs increased 14% in the short term and 17% in the long term while the mean daily cost was reduced by 10.1% and 11.2%. The decrease in DHD of COXIBs in the face-to-face intervention group was 39.5% in period 2 and was 42.2% period 3 compared with 19.4% and 12.4% in the group intervention.


CONCLUSIONS
The educational intervention was associated with improvements in prescription of NSAIDs, although some of the improvement was probably due to the safety alert issued during the study period.
Rosich
Isabel
I
Servei d'Atenció Primària Alt Penedès Garraf, Institut Català de la Salut, Vilanova i la Geltrú, Barcelona, España.
Soler
Maria
M
Tomás
Rosa
R
Crusat
Dolors
D
D016907:Adverse Drug Reaction Reporting Systems; D003257:Consumer Product Safety; D003363:Cost Control; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D010821:Physicians, Family / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013030:Spain
D016861:Cyclooxygenase Inhibitors