impact of lack of pharmacist contribution on the prescription patterns and the appropriateness of indications of nsaids, a cross-sectional study

ABSTRACT

Non-steroidal anti-inflammatory drugs [NSAIDs] are among the most commonly used medications worldwide. However, recent literature strongly points to gastrointestinal [GI] and cardiovascular [CV] risks associated with NSAIDs use. The current study was carried out in Jordan University Hospital. The main objective was to evaluate the role of pharmacists in directing the current prescription patterns and appropriateness of NSAID therapiesto establish strategies for medication reconciliation in the healthcare systems in the region. This is a prospective cross-sectional qualitative study that enrolled a total of 400 patients over a period of 10 months. The NSAID use was evaluated in patients with and without established CVD and various GI risk stratifications. In addition, 30 physicians were recruited into the study to determine the current prescription patterns. A structured questionnaire was validated and handed to physicians to determine strengths and weaknesses in the current system. NSAID-related drug interactions were evaluated in 200 of the patients. Sixty five percent of the patients without CVD were at moderate GI risk and 12% were at high risk. Sixty nine percent of patients with CVD were at high GI risk and 28% were at moderate risk. Pharmacists were not involved in decision therapies pertaining to NSAIDs, which led to serious drug-related problems in the therapeutic regimens for patients using the NSAIDs. In 64% of the patients without CVD, NSAID therapy did not meet the recommendations of current guidelines. There was no drug therapy monitoring or patient counseling by a proficient clinical pharmacist, which led to virtually no identification of potential drug interactions or optimization of medication therapy. The study unraveled a great opportunity to improve the clinical outcomes in patients on NSAID therapy. The lack of pharmacist involvement puts patients at major health risks. Updating physicians on practice guidelines, including a clinical pharmacist in therapy decisions, and modifying hospital formularies are the most urgent recommendations.