title: GI risk factors and use of GI protective agents among patients receiving nonsteroidal antiinflammatory drugs.
abstract: BACKGROUND
  Patient characteristics increase the risk of gastrointestinal (GI) complications associated with nonsteroidal antiinflammatory drugs (NSAIDs). Patients at risk may not be prescribed protective therapies that might mitigate their risk of NSAID-associated GI complications.
  
  
  OBJECTIVE
  To assess GI risk among Veterans Affairs (VA) patients on NSAID therapy, determine whether therapy conformed to VA guidelines for lessening the risk of GI complications, and identify patient risk factors associated with conformance.
  
  
  METHODS
  Using databases from 3 VA medical centers, we retrospectively identified patients receiving NSAIDs and obtained data regarding age, history of GI bleed over 8 years, GI adverse effects associated with NSAIDs, diagnoses, and medication history over one year. We inferred health status from age-adjusted Charlson comorbidity index values. Each patient's risk of developing GI complications over one year was calculated using these data. Among patients at significant or substantial risk, we assessed conformance to VA guidelines. We used logistic regression to identify risk factors associated with conformance and determine adjusted ORs (AORs) with 95% CIs for each risk factor.
  
  
  RESULTS
  There were 19 122 patients receiving NSAIDs. Of 4589 patients at significant risk and 1246 at substantial risk, 1161 (25.3%) and 356 (28.6%), respectively, were prescribed guideline-conformant therapy. Risk factors associated with conformance (p < or = 0.001) among patients at significant risk were rheumatoid arthritis (AOR 1.34; 95% CI 1.13 to 1.58) and GI adverse effects (AOR 1.53; 95% CI 1.42 to 1.64). For substantial risk patients, risk factors associated with conformance (p < or = 0.031) were rheumatoid arthritis (AOR 1.65; 95% CI 1.37 to 1.98), concomitant corticosteroids (AOR 1.21; 95% CI 1.02 to 1.43), GI hospitalization (AOR 2.01; 95% CI 1.57 to 2.59), and GI adverse effects (AOR 1.79; 95% CI 1.47 to 2.18).
  
  
  CONCLUSIONS
  Many patients at risk for GI adverse events do not receive guideline-conformant therapy. Educational interventions to improve conformance could focus on specific risk factors for GI complications.
authors.affiliation: Pharmaceutical Management and Research, Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, NM 87106-4180, USA. crystal.harris@csp.research.med.va.gov
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Harris
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Upendra
authors.initials: U
authors.lastname: Abhyankar
authors.forename: Shalaka
authors.initials: S
authors.lastname: Marfatia
authors.forename: Heather M
authors.initials: HM
authors.lastname: Campbell
authors.forename: Mike R
authors.initials: MR
authors.lastname: Sather
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D020011:Protective Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D020011:Protective Agents