title: Effectiveness of interventions by community pharmacists to reduce risk of gastrointestinal side effects in nonselective nonsteroidal anti-inflammatory drug users.
abstract: OBJECTIVE
  Upper gastrointestinal (UGI) complications in elderly users of nonselective nonsteroidal anti-inflammatory drugs (ns-NSAIDs) without concomitant use of gastroprotective agents (GPAs) were a leading cause of potentially avoidable drug-related hospital admissions in the Netherlands. We aimed to determine the effectiveness of community pharmacists' interventions to improve safety in ns-NSAID use in patients at UGI risk.
  
  
  METHODS
  In this prospective cohort study, pharmacists in participating pharmacies (intervention group, IG) received feedback on drug dispensing in ns-NSAID users of ≥60 years of age at risk for UGI damage and were instructed to select patients to improve ns-NSAID prescribing, in collaboration with primary care physicians. Ns-NSAID users from other pharmacies without concomitant GPA use were followed in parallel as a control group (CG). Changes in the UGI risk of ns-NSAID users between baseline and follow-up measurement, assessed either by the addition of GPAs or the cessation of ns-NSAIDs, were compared between the two study arms.
  
  
  RESULTS
  At baseline, 14% of ns-NSAID users at UGI risk did not receive GPAs. Persistent ns-NSAID users from the selected IG patients had an additional 7% likelihood of reduced UGI risk at follow-up (odds ratio 0.93, 95% confidence interval 0.89-0.97) compared with CG patients. In the IG, 91% of selected IG patients at UGI risk from ns-NSAIDs at baseline were no longer at increased risk at follow-up because of cessation of ns-NSAIDS or to concomitant GPA use.
  
  
  CONCLUSIONS
  Although concomitant gastroprotection use in susceptible ns-NSAID users in the Netherlands is high, pharmacist-led interventions could further improve prescribing of ns-NSAIDs.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Royal Dutch Pharmacists Association (KNMP), The Hague, the Netherlands.
authors.forename: Martina
authors.initials: M
authors.lastname: Teichert
authors.forename: Fabienne
authors.initials: F
authors.lastname: Griens
authors.forename: Edgar
authors.initials: E
authors.lastname: Buijs
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D024382:Professional Role; D011446:Prospective Studies; D012306:Risk; D041742:Upper Gastrointestinal Tract / Q000187:drug effects / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: NSAID; drug safety; gastrointestinal side effects; gastroprotection; pharmacoepidemiology