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Prescription of and adherence to non-steroidal anti-inflammatory drugs and gastroprotective agents in at-risk gastrointestinal patients.

Lanas A, Polo-Tomás M, Roncales P, Gonzalez MA, Zapardiel J - Am. J. Gastroenterol. (2012)

Bottom Line: Multivariate logistic regression analysis was used to determine factors associated with non-adherence.History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs.Short-term treatment and adverse events were associated with poor adherence for both therapies.

View Article: PubMed Central - PubMed

Affiliation: University of Zaragoza, Zaragoza, Spain. angel.lanas@gmail.com

ABSTRACT

Objectives: Patients with gastrointestinal (GI) risk factors who take non-steroidal anti-inflammatory drugs (NSAIDs) should also take gastroprotective agents (GPAs). No studies have evaluated adherence and reasons for non-adherence to GPA and NSAID therapies.

Methods: This was a prospective, multicenter, observational, longitudinal study. Patients attending rheumatology/orthopedic clinics who were co-prescribed NSAID plus GPA for at least 15 days and had risk factors for GI complications were followed up by telephone call. Optimal adherence was defined as taking the drug for ≥ 80% of prescribed days. Multivariate logistic regression analysis was used to determine factors associated with non-adherence.

Results: Of 1,232 patients interviewed, 192 were excluded because of inaccurate data. Of the remaining 1,040 patients, 74 % were prescribed low-dose NSAIDs and 99.8 % were prescribed a standard or high-dose GPA. In all, 70 % of NSAIDs and 63.1 % of GPA prescriptions were short term (< 30 days). The majority of patients who were prescribed either an NSAID (92.5 % ) or GPA (85.9 % ) started therapy. Optimal adherence to GPA or NSAIDs was reported by 79.7 % (95 % confidence interval (CI): 76.9-82.2 % ) and 84.1 % (95 % CI: 81.7-86.3 % ) of patients, respectively. More adverse events occurred among patients who reported non-optimal adherence than among patients with optimal adherence to GPA (22.1 vs. 1.9 % , P < 0.0001). As reasons for non-adherence, patients most frequently cited infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Adverse events and short-term treatment were independent factors associated with poor adherence for both NSAIDs and GPAs. History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs.

Conclusions: Most frequent reasons for non-adherence are infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Short-term treatment and adverse events were associated with poor adherence for both therapies.

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Related in: MedlinePlus

Study flow. Investigators collected consecutive patients who met inclusion and exclusion criteria and who agreed to participate in the study. After data collection, the anonymized information was sent to the coordinating center. Patients were followed up with telephone calls at two different times and the follow-up information was added to the database. GI, gastrointestinal.
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fig1: Study flow. Investigators collected consecutive patients who met inclusion and exclusion criteria and who agreed to participate in the study. After data collection, the anonymized information was sent to the coordinating center. Patients were followed up with telephone calls at two different times and the follow-up information was added to the database. GI, gastrointestinal.

Mentions: Patients were followed up with telephone calls at a maximum of two different times. The first contact was an early call within 15–18 days after the medical visit. If the prescription of the NSAID plus GPA was for 30−60 days or longer, then the patients received a second call within a window of 60±7 days. Two independent and trained investigators (MPT and PR) carried out the calls and completed a structured questionnaire that was originally validated in a small group of patients to assess the feasibility of the questions. The questions focused on adherence to NSAID plus GPA therapy and evaluated levels of adherence and reasons for not taking the pills. In general, the call lasted ∼10 min and patients were asked to provide the number of prescriptions obtained and the number of pills that remained in the package or to be refilled at the end of the interview. The study flow is summarized in Figure 1.


Prescription of and adherence to non-steroidal anti-inflammatory drugs and gastroprotective agents in at-risk gastrointestinal patients.

Lanas A, Polo-Tomás M, Roncales P, Gonzalez MA, Zapardiel J - Am. J. Gastroenterol. (2012)

Study flow. Investigators collected consecutive patients who met inclusion and exclusion criteria and who agreed to participate in the study. After data collection, the anonymized information was sent to the coordinating center. Patients were followed up with telephone calls at two different times and the follow-up information was added to the database. GI, gastrointestinal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368233&req=5

fig1: Study flow. Investigators collected consecutive patients who met inclusion and exclusion criteria and who agreed to participate in the study. After data collection, the anonymized information was sent to the coordinating center. Patients were followed up with telephone calls at two different times and the follow-up information was added to the database. GI, gastrointestinal.
Mentions: Patients were followed up with telephone calls at a maximum of two different times. The first contact was an early call within 15–18 days after the medical visit. If the prescription of the NSAID plus GPA was for 30−60 days or longer, then the patients received a second call within a window of 60±7 days. Two independent and trained investigators (MPT and PR) carried out the calls and completed a structured questionnaire that was originally validated in a small group of patients to assess the feasibility of the questions. The questions focused on adherence to NSAID plus GPA therapy and evaluated levels of adherence and reasons for not taking the pills. In general, the call lasted ∼10 min and patients were asked to provide the number of prescriptions obtained and the number of pills that remained in the package or to be refilled at the end of the interview. The study flow is summarized in Figure 1.

Bottom Line: Multivariate logistic regression analysis was used to determine factors associated with non-adherence.History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs.Short-term treatment and adverse events were associated with poor adherence for both therapies.

View Article: PubMed Central - PubMed

Affiliation: University of Zaragoza, Zaragoza, Spain. angel.lanas@gmail.com

ABSTRACT

Objectives: Patients with gastrointestinal (GI) risk factors who take non-steroidal anti-inflammatory drugs (NSAIDs) should also take gastroprotective agents (GPAs). No studies have evaluated adherence and reasons for non-adherence to GPA and NSAID therapies.

Methods: This was a prospective, multicenter, observational, longitudinal study. Patients attending rheumatology/orthopedic clinics who were co-prescribed NSAID plus GPA for at least 15 days and had risk factors for GI complications were followed up by telephone call. Optimal adherence was defined as taking the drug for ≥ 80% of prescribed days. Multivariate logistic regression analysis was used to determine factors associated with non-adherence.

Results: Of 1,232 patients interviewed, 192 were excluded because of inaccurate data. Of the remaining 1,040 patients, 74 % were prescribed low-dose NSAIDs and 99.8 % were prescribed a standard or high-dose GPA. In all, 70 % of NSAIDs and 63.1 % of GPA prescriptions were short term (< 30 days). The majority of patients who were prescribed either an NSAID (92.5 % ) or GPA (85.9 % ) started therapy. Optimal adherence to GPA or NSAIDs was reported by 79.7 % (95 % confidence interval (CI): 76.9-82.2 % ) and 84.1 % (95 % CI: 81.7-86.3 % ) of patients, respectively. More adverse events occurred among patients who reported non-optimal adherence than among patients with optimal adherence to GPA (22.1 vs. 1.9 % , P < 0.0001). As reasons for non-adherence, patients most frequently cited infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Adverse events and short-term treatment were independent factors associated with poor adherence for both NSAIDs and GPAs. History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs.

Conclusions: Most frequent reasons for non-adherence are infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Short-term treatment and adverse events were associated with poor adherence for both therapies.

Show MeSH
Related in: MedlinePlus