Development of NSAIDs prescription indicators based on health outcomes

Abstract

Objective: To explore the relationship between prescribing indicators aimed at assessing the prescribing quality of general practitioners (GPs) and indicators of health outcomes at the population level. Design: Ecological study. Setting: Aljarafe Primary Health Care Area (population 321,034), part of the Andalusian Public Health Care Service, Spain. A total of 162 GPs, representing 95.29% of the total GPs in the study area, participated in the analysis. Methods: The prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) was determined using evidence-based indicators chosen by the consensus group technique. Admissions to hospitals in the study area due to digestive ulcer, bleeding or perforation were recorded. Multivariate regression analysis was then carried out to determine both the amount of variation in hospital admissions that can be explained by a combination of prescribing indicators and the strength and direction of independent associations with individual indicators. Results: The higher prescription of NSAIDs adjusted for patients and working days (p=0.002) and the higher relative prescription of gastroprotective agents versus NSAIDs (p<0.001) were associated with a higher number of adjusted hospital admissions due to gastrointestinal adverse events (coefficient of correlation R=0.378). In addition, the higher number of prescriptions for analgesics than for NSAIDs was related to fewer admissions (p=0.028). There were fewer patients of GPs with postgraduate training admitted to hospital for these complaints (p=0.049). Conclusions: The risk of hospitalization for serious gastrointestinal adverse events can be partially linked to the prescribing of NSAIDs based on an analysis of the prescribing indicators. A higher prescribing of NSAIDs was associated with significantly higher admissions. This relationship was not found for indicators based on the relative use of some NSAIDs versus total NSAIDs or on the use of gastroprotective drugs. © 2007 Springer-Verlag.