Department of Medicine, Clinical Hospital Rebro, Zagreb, Croatia.
Clin Drug Investig. 2005;25(4):265-70. doi: 10.2165/00044011-200525040-00006.
Little is known about the factors that influence the decision to use NSAIDs in combination with gastroprotective drugs. The aims of this observational study were to evaluate the extent to which NSAID users are prescribed concomitant gastroprotective drug regimens ('preventive strategies'), and to determine how patient risk factors for NSAID-associated gastrointestinal toxicity and physician prescribing preferences influenced the decision to prescribe a gastroprotective drug in combination with an NSAID.
The study was conducted on 29 June 2004 and comprised 109 eligible adult patients hospitalised at the Clinical Hospital Center, Zagreb. Use of NSAIDs and gastroprotective drugs, risk factors for NSAID-associated gastrointestinal toxicity, and physician prescribing preferences were monitored throughout the study.
Sixty-six percent of patients receiving proton pump inhibitors or histamine H(2)-receptor antagonists with NSAIDs had no risk factors for gastrointestinal toxicity. Furthermore, 29% of patients who used NSAIDs had risk factors for gastrointestinal toxicity but were not receiving gastroprotective drugs. Even though patients at risk of NSAID-associated gastrointestinal complications had higher odds of receiving preventive strategies (odds ratio 1.25), the absolute rate of utilisation of these therapies in at-risk populations was unacceptably low (69%). However, the strongest independent correlation for gastroprotective drug use was the prescribing physician, with an odds ratio of 6.40.
This study demonstrates that an individual physician's prescribing style largely determines the odds of receiving preventive strategies with NSAID treatment and is more important than the patient's risk factors for gastrointestinal toxicity.
对于影响 NSAIDs 与胃保护药物联合使用的决策的因素，人们知之甚少。本观察性研究的目的是评估 NSAIDs 使用者接受伴随胃保护药物方案（“预防策略”）的程度，并确定 NSAID 相关胃肠道毒性的患者风险因素和医生处方偏好如何影响联合使用胃保护药物的决定。
该研究于 2004 年 6 月 29 日进行，共纳入 109 名在萨格勒布临床中心住院的合格成年患者。在整个研究过程中监测 NSAIDs 和胃保护药物的使用、NSAID 相关胃肠道毒性的风险因素以及医生的处方偏好。
接受质子泵抑制剂或组胺 H2-受体拮抗剂联合 NSAIDs 的患者中，有 66%没有胃肠道毒性的风险因素。此外，有 29%使用 NSAIDs 的患者有胃肠道毒性的风险因素，但未接受胃保护药物。尽管有 NSAID 相关胃肠道并发症风险的患者接受预防策略的可能性更高（比值比 1.25），但高危人群中这些治疗方法的实际使用率低得令人无法接受（69%）。然而，胃保护药物使用的最强独立相关性是处方医生，比值比为 6.40。
本研究表明，个体医生的处方风格在很大程度上决定了 NSAID 治疗中接受预防策略的可能性，并且比患者胃肠道毒性的风险因素更为重要。
