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Evaluation of prescribing patterns of nonsteroidal anti-inflammatory agents in a tertiary setting

Khalil, Viviane MClinPharm, MPharmSc, BPharm, MSHP, AACPA1,2; Wang, Wei PhD3; Charlson, Lauren BPharm1; Blackley, Samantha BPharm1

International Journal of Evidence-Based Healthcare: September 2019 - Volume 17 - Issue 3 - p 164–172
doi: 10.1097/XEB.0000000000000173

Background: Non steroidal anti-inflammatory agents (NSAIDS) are among the most commonly prescribed analgesics despite their adverse effect profile. The main objective of this pilot study is to assess the prescribing patterns of NSAIDs in an Australian hospital and to examine predictors for prescribing patterns.

Method: A retrospective cross sectional study was conducted. Patients’ gastrointestinal and cardiovascular comorbidities were recorded for stratifications according to international guidelines. Pharmacist input was recorded to examine its effect on NSAIDs’ prescribing patterns. Appropriateness of prescribing patterns was determined according to published international prescribing guidelines for NSAIDs. Univariate and multivariate regression analyses were conducted to determine predictors of patients’ variables on prescribing patterns.

Results: A total of 300 patients were eligible to be included in the study. Fifty-five percentage of patients audited were prescribed NSAIDs according to the guidelines. There was an association between the type of NSAIDs prescribed and patients’ gastrointestinal and cardiovascular risks, P less than 0.01. Multiple logistic regression analysis has shown: age more than 75 years, a history of peptic ulcer disease or a moderate gastrointestinal risk were all predictors for receiving a NSAID with a gastroprotectant agent [odds ratio (OR) = 3.54, 95% confidence interval (CI) (1.10–11.79), P < 0.05; OR = 9.51, 95% CI (3.70–26.72), P < 0.01; and OR = 5.04, 95% CI (51.72–15.54), P < 0.01, respectively]. Naproxen was more likely to be prescribed in patients with moderate-to-high gastrointestinal risk [OR = 16.24, 95% CI (2.70–132.70) and OR = 81.47 95% CI (3.38–2436.53), P < 0.01, respectively]. Patients who had their medications reviewed by a pharmacist were prescribed cyclo-oxygenase-2 inhibitors more frequently [OR = 3.36, 95% CI (1.05–15.34), P < 0.05] than any other agent.

Conclusion: About half of the patients audited were prescribed NSAIDs appropriately. Factors affecting the prescribing of NSAIDs included: older age, patients’ gastrointestinal risks as well as pharmacist input. This pilot study presents an opportunity for pharmacists to promote adherence to NSAIDs prescribing guidelines.

1Pharmacy Department, Frankston Hospital, Frankston

2Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Melbourne

3Faculty of Medicine, Nursing and Health Sciences, Peninsula Clinical School, Monash University, Clayton, Victoria, Australia

Correspondence: Ms Viviane Khalil, MClinPharm, MPharmSc, BPharm, MSHP, AACPA, Pharmacy Department, Frankston Hospital, 2 Hastings St, Frankston 3199, VIC, Australia. E-mail:

Online date: June 17, 2019

International Journal of Evidence-Based Healthcare © 2019 The Joanna Briggs Institute
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