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Titolo:
Educational program for physicians to reduce use of non-steroidal anti-inflammatory drugs among community-dwelling elderly persons - A randomized controlled trial
Autore:
Ray, WA; Stein, CM; Byrd, V; Shorr, R; Pichert, JW; Gideon, P; Arnold, K; Brandt, KD; Pincus, T; Griffin, MR;
Indirizzi:
Vanderbilt Univ, Med Ctr, Dept Prevent Med, Med Ctr N,Sch Med, Nashville, TN 37232 USA Vanderbilt Univ Nashville TN USA 37232 N,Sch Med, Nashville, TN 37232 USA Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USA Vanderbilt Univ Nashville TN USA 37212 Dept Med, Nashville, TN 37212 USA Nashville Vet Adm Med Ctr, Ctr Geriatr Res Educ & Clin, Nashville, TN USA Nashville Vet Adm Med Ctr Nashville TN USA duc & Clin, Nashville, TN USA Indiana Univ, Sch Med, Div Rheumatol, Indianapolis, IN 46202 USA Indiana Univ Indianapolis IN USA 46202 umatol, Indianapolis, IN 46202 USA Univ Tennessee, Dept Prevent Med, Memphis, TN USA Univ Tennessee Memphis TN USA nnessee, Dept Prevent Med, Memphis, TN USA
Titolo Testata:
MEDICAL CARE
fascicolo: 5, volume: 39, anno: 2001,
pagine: 425 - 435
SICI:
0025-7079(200105)39:5<425:EPFPTR>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; PEPTIC-ULCER DISEASE; KNEE OSTEOARTHRITIS; MEDICAL-MANAGEMENT; OFFICE PRACTICE; HIP; GUIDELINES; IBUPROFEN; OUTREACH; THERAPY;
Keywords:
pharmacoepidemiology; intervention studies; pain; aged; anti-inflamatory agents; non-steroidal;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Ray, WA Vanderbilt Univ, Med Ctr, Dept Prevent Med, Med Ctr N,Sch Med, A-1124, Nashville, TN 37232 USA Vanderbilt Univ A-1124 Nashville TN USA 37232 hville, TN 37232 USA
Citazione:
W.A. Ray et al., "Educational program for physicians to reduce use of non-steroidal anti-inflammatory drugs among community-dwelling elderly persons - A randomized controlled trial", MED CARE, 39(5), 2001, pp. 425-435

Abstract

CONTEXT. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for patients 65 years of age or older, primarily for musculoskeletal symptoms of osteoarthritis. Because NSAIDs frequentlycause serious gastrointestinal (GI) and other complications among elderly patients, expert guidelines for osteoarthritis recommend acetaminophen-based regimens, which are safer and often as effective as NSAIDs. OBJECTIVE, Evaluate a physician education program that communicated guidelines for management of osteoarthitis in elderly patients that emphasized avoidance of NSAIDs when possible. The program reviewed NSAID risks and benefits and recommended: reevaluating continuous NSAID users, considering substitution of up to 4 gld of acetaminophen for the NSAID, and trying topical agents and nonpharmacologic measures. DESIGN AND SETTING. Randomized controlled trial among community-dwelling Tennessee Medicaid enrollees. SUBJECTS. Study physicians had 5 or more patients who: were community-dwelling Medicaid enrollees 65 years of age or older; had used NSAIDs regularlyfor at least 180 days; had had no medical care encounters during this period suggesting an indication other than osteoarthritis; and had 1 year of baseline and follow-up data. The study thus included 209 physicians (103 intervention/106 control) with 1,566 qualifying regular NSAID users (768/798). INTERVENTIONS. Face-to-face visit to study physicians by another physician, and reminder placements in the charts of patients eligible to have NSAID use reevaluated. OUTCOMES. Change between baseline and follow-up years in: days of prescribed NSAIDs, acetaminophen, other drugs for musculoskeletal disorders, and GIdrugs; outpatient visits and inpatient days of stay; SF36 measures of general health, physical function, and bodily pain (from 40% random patient sample); and over-the-counter NSAIDs (from the sample). RESULTS. Intervention-attributable reduction of 7% (95% CI, 3% to 11%) in days of prescribed NSAIDs use with concomitant increase in acetaminophen use. No significant changes in other study endpoints. The intervention effectwas greater among 75 physicians with a completed study visit, whose 564 patients had a 10% (95% CI, 6% to 14%) attributable reduction in NSAID use. CONCLUSIONS. The educational program modestly reduced NSAID exposure in community-dwelling elderly patients without undesirable substitution of othermedications or detectable worsening of musculoskeletal symptoms.

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Documento generato il 23/01/20 alle ore 06:23:47