Physicians' approaches to the use of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users.
BACKGROUND
Many doctors unnecessarily prescribe gastroprotective strategies to non-steroidal anti-inflammatory drugs users at low risk of non-steroidal anti-inflammatory drug-related gastrointestinal complications.


OBJECTIVE
To identify factors that predict the overuse of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users.


METHODS
We distributed a questionnaire to family doctors and general internists consisting of a clinical vignette describing a low-risk hypothetical patient with osteoarthritis who was a candidate for non-steroidal anti-inflammatory drug therapy. Respondents were asked whether they would prescribe this patient a gastroprotective strategy and to estimate the annual risk of that patient developing a gastrointestinal complication with non-steroidal anti-inflammatory drug use. Respondents inappropriately recommending a gastroprotective strategy were compared with respondents who opted not to use gastroprotection.


RESULTS
We received 340 responses (response rate of 28.3%), of which 278 supplied analysable data. Thirty-five percent of respondents inappropriately recommended a gastroprotective strategy for the low-risk subject. Inappropriate prescribers were significantly more likely to overestimate the risk of gastrointestinal complications with traditional non-steroidal anti-inflammatory drugs and this was strongly predictive of gastroprotective strategy recommendation in logistic regression.


CONCLUSIONS
Many doctors inappropriately recommend gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users. Improving doctors' awareness of non-steroidal anti-inflammatory drug-associated gastrointestinal risks may lead to a decrease in inappropriate utilization of gastroprotective strategies in low-risk patients.
Murthy
S K
SK
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Kauldher
S
S
Targownik
L E
LE
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics; D002983:Clinical Competence; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics / Q000627:therapeutic use*; D005194:Family Practice / Q000592:standards; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice / Q000592:standards*; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000191:economics; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D054328:Proton Pump Inhibitors; D017494:Proton Pumps