Murthy S K, Kauldher S, Targownik L E
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Aliment Pharmacol Ther. 2006 May 1;23(9):1365-72. doi: 10.1111/j.1365-2036.2006.02873.x.
Many doctors unnecessarily prescribe gastroprotective strategies to non-steroidal anti-inflammatory drugs users at low risk of non-steroidal anti-inflammatory drug-related gastrointestinal complications.
To identify factors that predict the overuse of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users.
We distributed a questionnaire to family doctors and general internists consisting of a clinical vignette describing a low-risk hypothetical patient with osteoarthritis who was a candidate for non-steroidal anti-inflammatory drug therapy. Respondents were asked whether they would prescribe this patient a gastroprotective strategy and to estimate the annual risk of that patient developing a gastrointestinal complication with non-steroidal anti-inflammatory drug use. Respondents inappropriately recommending a gastroprotective strategy were compared with respondents who opted not to use gastroprotection.
We received 340 responses (response rate of 28.3%), of which 278 supplied analysable data. Thirty-five percent of respondents inappropriately recommended a gastroprotective strategy for the low-risk subject. Inappropriate prescribers were significantly more likely to overestimate the risk of gastrointestinal complications with traditional non-steroidal anti-inflammatory drugs and this was strongly predictive of gastroprotective strategy recommendation in logistic regression.
Many doctors inappropriately recommend gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users. Improving doctors' awareness of non-steroidal anti-inflammatory drug-associated gastrointestinal risks may lead to a decrease in inappropriate utilization of gastroprotective strategies in low-risk patients.
许多医生不必要地为非甾体抗炎药相关胃肠道并发症低风险的非甾体抗炎药使用者开具胃保护策略。
确定预测低风险非甾体抗炎药使用者过度使用胃保护策略的因素。
我们向家庭医生和普通内科医生发放了一份问卷，其中包含一个临床案例，描述了一名低风险的假设性骨关节炎患者，该患者是非甾体抗炎药治疗的候选者。询问受访者是否会为该患者开具胃保护策略，并估计该患者使用非甾体抗炎药发生胃肠道并发症的年度风险。将不恰当地推荐胃保护策略的受访者与选择不使用胃保护的受访者进行比较。
我们收到了340份回复（回复率为28.3%），其中278份提供了可分析的数据。35%的受访者不恰当地为低风险受试者推荐了胃保护策略。不恰当的开药者更有可能高估传统非甾体抗炎药导致胃肠道并发症的风险，在逻辑回归中，这强烈预测了胃保护策略的推荐。
许多医生在低风险非甾体抗炎药使用者中不恰当地推荐胃保护策略。提高医生对非甾体抗炎药相关胃肠道风险的认识可能会减少低风险患者不恰当使用胃保护策略的情况。
