Teichert Martina, Griens Fabienne, Buijs Edgar, Wensing Michel, De Smet Peter A G M
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Royal Dutch Pharmacists Association (KNMP), The Hague, the Netherlands.
Pharmacoepidemiol Drug Saf. 2014 Apr;23(4):382-9. doi: 10.1002/pds.3587. Epub 2014 Feb 18.
Upper gastrointestinal (UGI) complications in elderly users of nonselective nonsteroidal anti-inflammatory drugs (ns-NSAIDs) without concomitant use of gastroprotective agents (GPAs) were a leading cause of potentially avoidable drug-related hospital admissions in the Netherlands. We aimed to determine the effectiveness of community pharmacists' interventions to improve safety in ns-NSAID use in patients at UGI risk.
In this prospective cohort study, pharmacists in participating pharmacies (intervention group, IG) received feedback on drug dispensing in ns-NSAID users of ≥60 years of age at risk for UGI damage and were instructed to select patients to improve ns-NSAID prescribing, in collaboration with primary care physicians. Ns-NSAID users from other pharmacies without concomitant GPA use were followed in parallel as a control group (CG). Changes in the UGI risk of ns-NSAID users between baseline and follow-up measurement, assessed either by the addition of GPAs or the cessation of ns-NSAIDs, were compared between the two study arms.
At baseline, 14% of ns-NSAID users at UGI risk did not receive GPAs. Persistent ns-NSAID users from the selected IG patients had an additional 7% likelihood of reduced UGI risk at follow-up (odds ratio 0.93, 95% confidence interval 0.89-0.97) compared with CG patients. In the IG, 91% of selected IG patients at UGI risk from ns-NSAIDs at baseline were no longer at increased risk at follow-up because of cessation of ns-NSAIDS or to concomitant GPA use.
Although concomitant gastroprotection use in susceptible ns-NSAID users in the Netherlands is high, pharmacist-led interventions could further improve prescribing of ns-NSAIDs.
在荷兰，未同时使用胃保护剂（GPA）的非选择性非甾体抗炎药（ns-NSAIDs）老年使用者的上消化道（UGI）并发症是导致潜在可避免的药物相关住院的主要原因。我们旨在确定社区药剂师干预措施对改善UGI风险患者使用ns-NSAIDs安全性的有效性。
在这项前瞻性队列研究中，参与研究的药房（干预组，IG）的药剂师收到了关于≥60岁有UGI损伤风险的ns-NSAIDs使用者药物配药的反馈，并被指示与初级保健医生合作，挑选患者以改善ns-NSAIDs的处方。来自其他未同时使用GPA的药房的ns-NSAIDs使用者作为对照组（CG）进行平行随访。比较两个研究组在基线和随访测量之间ns-NSAIDs使用者UGI风险的变化，评估方法为添加GPA或停用ns-NSAIDs。
在基线时，14%有UGI风险的ns-NSAIDs使用者未接受GPA。与CG患者相比，来自选定IG患者的持续使用ns-NSAIDs的患者在随访时UGI风险降低的可能性增加了7%（优势比0.93，95%置信区间0.89 - 0.97）。在IG中，基线时因使用ns-NSAIDs有UGI风险的选定IG患者中，91%在随访时因停用ns-NSAIDs或同时使用GPA而不再有风险增加的情况。
尽管在荷兰易患UGI的ns-NSAIDs使用者中同时使用胃保护剂的比例很高，但由药剂师主导的干预措施可进一步改善ns-NSAIDs的处方。
