Assiri Ghadah Asaad, Alanazi Bashayr Mohammed, AlRuthia Yazed
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia.
Healthcare (Basel). 2022 May 7;10(5):867. doi: 10.3390/healthcare10050867.
The quality and safety of prescribed drugs can be assessed using prescribing safety indicators (PSIs). This study aimed to estimate the prevalence of PSIs of oral non-steroidal anti-inflammatory drugs (NSAIDs) at primary care clinics of a tertiary care hospital in Saudi Arabia and to identify the risk factors associated with positive PSIs for patients. In this retrospective chart review study, data from the medical records of 450 patients aged ≥18 years, who were prescribed oral NSAIDs, were reviewed and collected manually. Seven PSIs were chosen and defined as follows: prescription of an oral NSAID to any patient with a peptic ulcer; aged ≥75 years; aged ≥65 years with a glomerular filtration rate <60; heart failure; co-prescribed warfarin; co-prescribed aspirin or clopidogrel; or co-prescribed angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and a diuretic. Patients with positive indicators are at risk of harm from high-risk prescribing. The overall period prevalence of PSIs is 153/450 (34%; 95% CI 29.60−38.39). The overall proportion of PSIs is 202/431 (46.9%; 95% CI 42.12−51.61). The most common safety indicators were for NSAIDs prescribed to patients with heart failure and patients aged ≥65 years with a glomerular filtration rate <60. The elderly and patients using polypharmacy are at increased risk of having at least one positive PSI (OR 5.22; 95% CI 3.32−8.21, p-value < 0.001 and OR 2.97; 95% CI 1.17−7.55, p-value 0.022, respectively). Patients at risk of harm from high-risk NSAID prescriptions are common in primary care. The elderly and patients on polypharmacy are at increased risk of having at least one positive PSI. Therefore, when NSAIDs are prescribed, it is recommended to weigh the benefits versus the risks for high-risk patients, such as the elderly and those with multiple-drug therapy.
可以使用处方安全指标（PSI）来评估处方药的质量和安全性。本研究旨在估算沙特阿拉伯一家三级医院基层医疗诊所口服非甾体抗炎药（NSAIDs）的PSI患病率，并确定与患者PSI阳性相关的风险因素。在这项回顾性病历审查研究中，人工查阅并收集了450名年龄≥18岁、开具了口服NSAIDs处方的患者的病历数据。选择并定义了七个PSI如下：给任何患有消化性溃疡的患者开具口服NSAIDs处方；年龄≥75岁；年龄≥65岁且肾小球滤过率<60；心力衰竭；同时开具华法林；同时开具阿司匹林或氯吡格雷；或同时开具血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂和利尿剂。指标阳性的患者存在因高风险处方而受到伤害的风险。PSI的总体期间患病率为153/450（34%；95%置信区间29.60−38.39）。PSI的总体比例为202/431（46.9%；95%置信区间42.12−51.61）。最常见的安全指标是给心力衰竭患者以及年龄≥65岁且肾小球滤过率<60的患者开具NSAIDs处方。老年人和使用多种药物的患者至少有一项PSI阳性的风险增加（分别为OR 5.22；95%置信区间3.32−8.21，p值<0.001和OR 2.97；95%置信区间1.17−7.55，p值为0.022）。在基层医疗中，因高风险NSAIDs处方而有受到伤害风险的患者很常见。老年人和使用多种药物的患者至少有一项PSI阳性的风险增加。因此，开具NSAIDs时，建议权衡高风险患者（如老年人和接受多种药物治疗的患者）的获益与风险。
