title: Inappropriate nonsteroidal anti-inflammatory drug use: prevalence and predictors.
abstract: BACKGROUND
  Inappropriate nonsteroidal anti-inflammatory drug (NSAID) use can occur by using more than one prescription or over-the-counter NSAID or exceeding the manufacturer's recommended dosage. There are risks associated with inappropriate NSAID use; however, the prevalence and predictors of inappropriate NSAID use are unknown. The study objectives are to estimate the prevalence of inappropriate NSAID use and identify characteristics associated with inappropriate use.
  
  
  METHODS
  We identified 6877 patients at 2 Veterans Affairs Medical Centers through pharmacy records who filled 3 or more NSAID prescriptions in 6 months. We randomly selected 2535 patients and mailed them a survey about NSAIDs, gastroprotective medications, gastrointestinal (GI) symptoms, and pain. Inappropriate NSAID users either took 2 or more NSAIDs for 3 days or more or exceeded the maximum daily recommended dosage of 1 or more NSAID in the past week. Data were also collected from medical records.
  
  
  RESULTS
  Approximately 1572 patients (62%) returned the survey, and 1250 reported NSAID use in the past week. Approximately 32% (n = 400) used NSAIDs inappropriately, including taking 2 or more NSAIDs (n = 173), exceeding the highest daily recommended dosage (n = 161) or both (n = 66). Being a minority (odds ratio = 1.62, P < 0.001) and having an income of $20,000 (odds ratio = 1.70, P < 0.001) or lesser both predicted inappropriate NSAID use. Inappropriate NSAID use was associated with more GI symptoms (β = 0.57, P < 0.001) and higher levels of pain (β = 0.85, P < 0.001).
  
  
  CONCLUSIONS
  Inappropriate NSAID use is prevalent. Providers should consider counseling all patients about NSAID use, especially patients with GI problems or pain problems.
authors: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, North Carolina, USA.
authors: Stacey H
authors: SH
authors: Kovac
authors: Thomas K
authors: TK
authors: Houston
authors: Morris
authors: M
authors: Weinberger
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D057970:Inappropriate Prescribing / Q000639:trends*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D004366:Nonprescription Drugs; D016017:Odds Ratio; D014481:United States
chemical_list: D000893:Anti-Inflammatory Agents; D004366:Nonprescription Drugs