[Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care]. / Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria.

OBJECTIVE: To assess whether prescribing non-steroidal anti-inflammatory drugs (NSAIDs) is adequate for gastrointestinal protection associated with NSAID use. DESIGN: Cross-sectional descriptive study. SETTING: Primary Care Centre in La Mina, Barcelona, Spain. PARTICIPANTS: A random sample of 500 patients, stratified by doctor was selected from a total of 4504 patients with an NSAID prescription. MAIN MEASUREMENTS: The dependent variables were the adequacy of NSAID prescription and gastrointestinal protection. The independent variables were: age, sex, concomitant treatments, type and number of NSAIDs. The variables were collected from the clinical history. RESULTS: The 476 patients included with an NSAID prescription had a mean age of 47.9 (18.1) years, and 63.4% were women. The NSAIDs most prescribed were, ibuprofen (60.3%), diclofenac (23.1%), and naproxen (4.0%). The most common reason for prescribing the NSAID was locomotor system pathology; 45.4%. The prescription was adequate in 44.7% (95% CI, 40.2-49.3), and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patients over 65 years, while in under 65 year-olds 16.5% were inadequate. Gastrointestinal protection was inadequate in 28.2% (95% CI, 22.7-35.7); 12.8% excessive and 16% insufficient. In the multivariate analysis, the inadequacy probability of NSAIDs is 5.45 times greater in patients of 65 or more years than in younger patients. CONCLUSIONS: NSAID prescribing and gastrointestinal protection can be considered to be inadequate in 25% of patients. Advanced age is a major risk factor in inadequate prescribing.

Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria / Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care

Objetivo. Valorar la adecuación de laprescripción de antiinflamatorios noesteroideos (AINE) y la gastroprotecciónasociada a su uso.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de Atención Primariade La Mina (Barcelona).Participantes. De las 4.054 personas conprescripción de AINE, se seleccionó unamuestra aleatoria estratificada por facultativode 500 pacientes.Mediciones principales. Las variablesdependientes fueron la adecuación de laprescripción de AINE y gastroprotección.Las variables independientes fueron: edad,sexo, enfermedades previas, tratamientosconcomitantes, tipo y número de AINE,motivo y tipo de prescripción del AINE. Lasvariables se recogieron de la historia clínica.Resultados. Se incluyó a 476 pacientescon prescripción de AINE. El 63,4% eranmujeres y la media ± desviación estándarde edad fue 47,9 ± 18,1 años. Los AINEmás prescritos fueron ibuprofeno (60,3%),diclofenaco (23,1%) y naproxeno (4%). Elmotivo de prescripción más frecuente fue laafección del aparato locomotor (45,4%). Lasprescripciones fueron adecuadas en el 44,7%(intervalo de confianza [IC] del 95%, 40,2-49,3) e inadecuadas en el 23,5% (IC del 95%,19,8-27,6). La inadecuación en mayores de65 años fue del 49,5%, mientras que enmenores de 65 años fue del 15,6%. Lagastroprotección fue inadecuada en el 28,2%(IC del 95%, 22,7-35,7); el 12,8% por excesoy el 16% por defecto. En el análisismultivariable, la probabilidad deinadecuación de los AINE es 5,45 vecesmayor en los pacientes de 65 años o másque en los menores.Conclusiones. La prescripción de AINEy la gastroprotección pueden considerarseinadecuadas en una cuarta parte de lospacientes. La edad avanzada es el principalfactor de riesgo de prescripción inadecuada

Objective. To assess whether prescribingnon-steroidal anti-inflammatory drugs(NSAIDs) is adequate for gastrointestinalprotection associated with NSAID use.Design. Cross-sectional descriptive study.Setting. Primary Care Centre in La Mina,Barcelona, Spain.Participants. A random sample of 500patients, stratified by doctor was selectedfrom a total of 4504 patients with anNSAID prescription.Main measurements. The dependent variableswere the adequacy of NSAID prescriptionand gastrointestinal protection. Theindependent variables were: age, sex,concomitant treatments, type and numberof NSAIDs. The variables were collectedfrom the clinical history.Results. The 476 patients included with anNSAID prescription had a mean age of 47.9(18.1) years, and 63.4% were women. TheNSAIDs most prescribed were, ibuprofen(60.3%), diclofenac (23.1%), and naproxen(4.0%). The most common reason forprescribing the NSAID was locomotorsystem pathology; 45.4%. The prescriptionwas adequate in 44.7% (95% CI, 40.2-49.3),and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patientsover 65 years, while in under 65 year-olds16.5% were inadequate. Gastrointestinalprotection was inadequate in 28.2% (95%CI, 22.7-35.7); 12.8% excessive and 16%insufficient. In the multivariate analysis, theinadequacy probability of NSAIDs is 5.45times greater in patients of 65 or more yearsthan in younger patients.Conclusions. NSAID prescribing andgastrointestinal protection can be consideredto be inadequate in 25% of patients.Advanced age is a major risk factorin inadequate prescribing