Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria

Abstract

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. © 2008 Elsevier España S.L. All rights reserved.