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December in the News
Inappropriate Prescription Of Nsaids Rampant In Canada
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among
the most prescribed drugs in the world today. It is estimated that 70
million prescriptions are filled each year in the United States for these
drugs. Corresponding figures for Great Britain and Canada are 20 million and
10 million respectively.
Numerous studies have shown that the use of NSAIDs
increases the risk of hospitalization or death from gastrointestinal
bleeding. In Canada 365 people die and 3900 people are hospitalized every
year from taking NSAIDs. The corresponding numbers for the United States are
7600 deaths and 76,000 hospitalizations. It has also been estimated that one
third of the cost of treating arthritis patients relates to treatment of the
side-effects of NSAIDs.
In the mid-1980s physicians were advised against
prescribing NSAIDs to elderly people and people with a history of peptic
(gastric and duodenal) ulcers. However, a recent survey carried out by a
team of American and Canadian researchers clearly shows that this warning
has largely gone unheeded.
The blinded study involved 112 practicing physicians in Montreal. Each
physician was visited by one or more of eight elderly, "standardized"
patients - four of which had osteoarthritis in the hip and a history of
peptic ulcer while the other four had current stomach (midepigastric) pain
and pain and stiffness in the right hip. The diagnoses and prescription
patterns of the participating physicians were evaluated by an expert panel.
The panel concluded that unnecessary prescriptions for NSAIDs and other
drugs were written during 41.7 per cent of all visits. Naproxen was the most
commonly prescribed NSAID with diclofenac a close second. The physicians did
correctly diagnose gastropathy (disease involving the stomach) in 93.4 per
cent of the visits by the stomach pain patients, but managed it incorrectly
in 23 per cent of the cases. The hip patients were diagnosed correctly
(osteoarthritis) in 90.6 per cent of cases and were prescribed acceptable
treatment in 58.3 per cent of the cases while the suggested treatment for
the remaining 41.7 per cent of the patients was deemed to be either
suboptimal or clearly unsafe (22.3 per cent).
The researchers conducting the
study found that physicians were more likely to mismanage a case the less
time they spent with the patient. Studies have shown that elderly patients
and patients with peptic ulcers have a greatly increased risk of serious
complications if taking NSAIDs. It was therefore particularly disturbing
that the patients' risk factors were not assessed at all during 19 of the 57
visits during which NSAIDs were prescribed. The researchers conclude that
unnecessary prescription of NSAIDs and incorrect management of NSAID-related
side-effects are common and may contribute significantly to avoidable
gastrointestinal disease in elderly people.
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