Improving Clinical and Economic Outcomes of NSAID Therapy. Abstract, Executive211 Summary and Final Report

摘要

There is growing recognition that NSAIDs, among the most frequently prescribed211u001edrugs for the elderly, have frequent and serious upper gastrointestinal adverse 211u001eeffects in elderly patients, which include gastrointestinal symptoms, ulceration, 211u001ehemorrhage, and death. We conducted a series of studies to provide information 211u001eneeded to improve both clinical and economic outcomes of NSAID therapy. These 211u001eincluded outcomes studies that identified NSAIDs as associated with substantial 211u001eexcess adverse clinical outcomes and costs, demonstrated that these costs could 211u001ebe reduced by increased use of generic medications, and suggested that a safer 211u001etherapeutic modality was more use of acetaminophen and topical medications to 211u001econtrol musculoskeletal symptoms. We then conducted two randomized controlled 211u001etrials (RCT) of an educational program that sought to implement the safer 211u001etherapeutic modalities, decreasing exposure to NSAIDs, in community-dwelling and 211u001enursing elderly users. The first RCT, among community dwelling elderly NSAID 211u001eusers, showed a completed educational visit could produce a 10% (6% to 14%) 211u001eattributable reduction in NSAID use. Even greater reduction was demonstrated for 211u001enursing home patients, where the mean number of days of NSAID use (7 day periods 211u001eprior to and after intervention) deceased from 7.0 to 1.9 days in intervention 211u001ehome subjects compared to a decrease from 7.0 to 6.2 days in control homes 211u001e(P=0.0001).