title: Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelines.
abstract: BACKGROUND
  Protective co-therapy is recommended in NSAID users with GI risk factors, but adherence is poor.
  
  
  OBJECTIVE
  To assess the proportion of NSAID users receiving co-therapy and strategies to improve adherence.
  
  
  METHODS
  Arthritis patients > or =50 years of age received etoricoxib or diclofenac in a double-blind randomized trial. Reminders that high-risk patients (age > or = 65; previous ulcer/haemorrhage; corticosteroid, anticoagulant, aspirin use) should receive co-therapy were given at study initiation. Free PPI was provided. An intervention midway through the study included a written reminder and required written response regarding co-therapy.
  
  
  RESULTS
  16,244/23,504 (69%) patients had GI risk factors. Pre-intervention, co-therapy was most common with previous ulcer/haemorrhage [706/1107 (64%)] and 3-4 risk factors [331/519 (64%)]. In the 10,026 patients enrolled pre-intervention and remaining in the study > or =6 months after, co-therapy in high-risk patients increased from 2958/6843 (43%) to 4177/6843 (61%) (difference = 18%; 95% CI 16%,19%). The increase was greater outside the US (22%; 19%,24%) than in the US (15%; 13%,17%).
  
  
  CONCLUSIONS
  Less than 50% of NSAID users with GI risk factors are given protective co-therapy--even if prescribers are given reminders and cost is not an issue. Direct communication requiring written response significantly increased adherence to guidelines, but achieving higher levels of adherence will require additional strategies.
authors: Division of Gastrointestinal & Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. llaine@usc.edu
authors: L
authors: L
authors: Laine
authors: L
authors: L
authors: Connors
authors: M R
authors: MR
authors: Griffin
authors: S P
authors: SP
authors: Curtis
authors: A
authors: A
authors: Kaur
authors: C P
authors: CP
authors: Cannon
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents