Changing perceptions and practices regarding aspirin, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs among US primary care providers.
BACKGROUND
Our understanding of the benefits and risks of aspirin non steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) selective NSAIDs and gastro-protective agents (GPAs) continues to expand.


OBJECTIVE
To assess the perceptions and practices of US primary care physicians (PCPs) regarding the use of aspirin, NSAIDs, COX-2 selective NSAIDs and GPA.


METHODS
A 34-question survey was administered to 1000 US PCPs via the internet. Questions addressed issues involving aspirin, NSAIDs, COX-2 selective NSAIDs, and GPAs. Around 491 of 1000 PCPs had participated in a similar survey conducted in 2003.


RESULTS
Eighty-five per cent of PCPs reported that >25% of their patients were taking aspirin for preventive reasons. Nineteen per cent performed a risk calculation when deciding whether to start aspirin for cardioprotection. Fifty-four per cent recommended a proton pump inhibitor (PPI) for a patient with a recently healed ulcer who required ongoing aspirin. Thirty-one per cent reported prescribing NSAIDs more often and 52% were more likely to recommend a GPA with an NSAID than in 2003. Although PCPs were less likely to recommend a COX-2 selective NSAID compared to 2003, only 41% felt that rofecoxib increased cardiovascular risk. One-third felt that celecoxib and traditional NSAIDs were associated with increased cardiac risk.


CONCLUSIONS
This survey identified several areas of ongoing confusion regarding aspirin, NSAIDs, COX-2 selective NSAIDs and GPAs, which should help direct future educational efforts regarding the benefits, risks and appropriate use of these agents.
Elnachef
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Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA.
Scheiman
J M
JM
Fendrick
A M
AM
Howden
C W
CW
Chey
W D
WD
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D011307:Drug Prescriptions; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D001241:Aspirin