title: Time-trends in gastroprotection with nonsteroidal anti-inflammatory drugs (NSAIDs).
abstract: BACKGROUND
  Preventive strategies are advocated in patients at risk of upper-gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  OBJECTIVE
  To examine time-trends in preventive strategies.
  
  
  METHODS
  In a study population comprising 50 126 NSAID users > or =50 years from the Integrated Primary Care Information database, we considered two preventive strategies: co-prescription of gastroprotective agents and prescription of a cyclooxygenase-2-selective inhibitor. In patients with > or =1 risk factor (history of upper-gastrointestinal bleeding/ulceration, age >65 years, use of anticoagulants, aspirin, or corticosteroids), correct prescription was defined as the presence of a preventive strategy and under-prescription as the absence of one. In patients with no risk factors, correct prescription was defined as the lack of a preventive strategy, and over-prescription as the presence of one.
  
  
  RESULTS
  Correct prescription rose from 6.9% in 1996 to 39.4% in 2006 (P < 0.01) in high-risk NSAID users. Under-prescription fell from 93.1% to 59.9% (P < 0.01). In the complete cohort, over-prescription rose from 2.9% to 12.3% (P < 0.01).
  
  
  CONCLUSIONS
  Under-prescription of preventive strategies has steadily decreased between 1996 and 2006; however, 60% of NSAID users at increased risk of NSAID complications still do not receive adequate protection.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. v.valkhoff@erasmusmc.nl <v.valkhoff@erasmusmc.nl>
authors.forename: V E
authors.initials: VE
authors.lastname: Valkhoff
authors.forename: E M
authors.initials: EM
authors.lastname: van Soest
authors.forename: M C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D041742:Upper Gastrointestinal Tract / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors