title: A very high rate of inappropriate use of gastroprotection for nonsteroidal anti-inflammatory drug therapy in primary care: a cross-sectional study.
abstract: OBJECTIVE
  To assess the appropriateness of gastroprotection in nonsteroidal anti-inflammatory drug (NSAID) users by primary care physicians.
  
  
  BACKGROUND
  A gastroprotective therapy is advised in NSAID users who are at a high risk for developing gastrointestinal side effects. However, an inappropriate (overuse/underuse) prescription of gastroprotection has been reported.
  
  
  METHODS
  This was a cross-sectional study in which a questionnaire was administered to consecutive NSAID users who visited routine primary care during a 1-week period. The presence of risk factors for NSAID-related gastrointestinal side effects and the eventual gastroprotective strategy used were registered. Gastroprotective therapy was considered appropriate/inappropriate according to the current guidelines.
  
  
  RESULTS
  Overall, 869 (25.3%) of 3,433 patients were on chronic NSAID therapy. Gastroprotection was performed in 593 (68.2%) NSAID users, and it was appropriate in only 299 (34.4%) cases. Specifically, an underuse of gastroprotective therapy was observed in 30.6% of ≥65-year-old, whereas an overuse occurred in 57.5% of <65-year-old patients without any risk factor. Concomitant therapy with either steroids [odds ratio (OR): 4.3] or anticoagulants (OR: 3.9), and >72 years of age (OR: 1.67) were significant predictive factors of inappropriate gastroprotection.
  
  
  CONCLUSIONS
  Appropriate use of gastroprotective therapy for NSAID users by primary care physicians needs to be promptly implemented, as its inappropriate use is noticeably increasing ethical and economic concerns.
authors.affiliation: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. sergio.morini@gmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Morini
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Diodato
authors.initials: D
authors.lastname: Oliveti
authors.forename: Alberto
authors.initials: A
authors.lastname: Chiriatti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Diana A E
authors.initials: DA
authors.lastname: Chiuri
authors.forename: Gemma
authors.initials: G
authors.lastname: Marotti
authors.forename: Lara
authors.initials: L
authors.lastname: Morelli
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents