title: Use of NSAIDs for osteoarthritis amongst older-aged primary care patients: engagement with information and perceptions of risk.
abstract: BACKGROUND
  non-steroidal anti-inflammatory drugs (NSAIDs) are used commonly to treat osteoarthritis in older patients.
  
  
  OBJECTIVE
  to explore the understandings of risk that older-aged primary care patients have in the context of the use of oral NSAIDs to treat osteoarthritis.
  
  
  METHODS
  semi-structured interviews were conducted with 15 patients who were recruited from four general practices located in Sydney, Australia. Patients were aged at least 65 years and were currently taking, or in the past 2 years had taken, an NSAID for osteoarthritis. Emergent themes were identified from the transcripts and were compared within and across transcripts to develop more abstract concepts.
  
  
  RESULTS
  patients demonstrated three key 'modes of disengagement' from medication-specific risk information, each of which could also be a mode of modulating a sense of danger and each of which would demand a unique clinical response. These were: 'transference of responsibility'-transferring the responsibility to their GP, 'general versus specific risk'-considering the risk of taking medicine in general as opposed to the specific risk of taking an NSAID, and 'personal immunity'-some patients with a long history of NSAID use without apparent toxicity believed they were, therefore, not at risk of future adverse effects, while a few patients believed they were immune to adverse effects of drugs in general.
  
  
  CONCLUSIONS
  there is a need for greater recognition of these 'modes of disengagement'/'hazard modulation' in order to attain a clinical response leading to safer, more effective and more ethical use of medicines.
authors.affiliation: Clinical Pharmacology and Toxicology, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Tamara Y
authors.initials: TY
authors.lastname: Milder
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Williams
authors.forename: Jan E
authors.initials: JE
authors.lastname: Ritchie
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Lipworth
authors.forename: Richard O
authors.initials: RO
authors.lastname: Day
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001364:Awareness; D032882:Comprehension; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009517:New South Wales; D010003:Osteoarthritis / Q000188:drug therapy*; D010353:Patient Education as Topic; D010465:Perception; D011320:Primary Health Care; D036301:Qualitative Research; D018570:Risk Assessment; D014167:Transference, Psychology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal