Primary care physician perceptions of non-steroidal anti-inflammatory drug and aspirin-associated toxicity: results of a national survey.
OBJECTIVE
To assess primary care physician perceptions of non-steroidal anti-inflammatory drug (NSAID) and aspirin-associated toxicity.


METHODS
A group of gastroenterologists and internal medicine physicians created a survey, which was administered via the Internet to a large number of primary care physicians from across the US.


RESULTS
One thousand primary care physicians participated. Almost one-third of primary care physicians recommended 325 mg rather than 81 mg of aspirin/day for cardioprotection. Fifty-nine percent thought enteric-coated or buffered aspirin reduced the risk of upper gastrointestinal (GI) bleeding. Seventy-six percent believed that Helicobacter pylori infection increased the risk of NSAID ulcers but fewer than 25% tested NSAID users for this infection. More than two-thirds were aware that aspirin co-therapy decreased the GI safety benefits of the cyclo-oxygenase 2 selective NSAIDs. However, 84% felt that aspirin with a cyclo-oxygenase 2 selective NSAID was safer than aspirin with a non-selective NSAID. When presented a patient at high risk for NSAID-related GI toxicity, almost 50% of primary care physicians recommended a proton pump inhibitor and cyclo-oxygenase 2 selective NSAID.


CONCLUSIONS
This survey has identified areas of misinformation regarding the risk-benefit of NSAIDs and aspirin and the utilization of gastroprotective strategies. Further education on NSAIDs for primary care physicians is warranted.
Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA. wchey@umich.edu
W D
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Chey
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Eswaren
C W
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Howden
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Inadomi
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Fendrick
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Scheiman
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D019538:Health Care Surveys; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced / Q000150:complications; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care; D054328:Proton Pump Inhibitors; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002316:Cardiotonic Agents; D052246:Cyclooxygenase 2 Inhibitors; D054328:Proton Pump Inhibitors; D001241:Aspirin