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Health Research Scientist, Center for Health Services Research in Primary Care, Veterans Affairs Medical Center (VAMC), Durham, NC; Assistant Research Professor, Department of Medicine; Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center, Raleigh, NC
Associate Director, Center for Health Services Research in Primary Care, VAMC, Durham; Associate Research Professor, Department of Medicine and Department of Psychiatry and Behavioral Sciences; Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center
Statistician, Center for Health Services Research in Primary Care, VAMC, Durham
Senior Statistician, Center for Health Services Research in Primary Care, VAMC, Durham; Assistant Research Professor, Department of Biostatistics and Bioinformatics, Duke University Medical Center
Director, Center for Health Services Research in Primary Care, VAMC, Durham; Chief, Division of General Internal Medicine; Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center
Program Director, Health Disparities Research, Office of Minority Health and Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Research Professor, Department of Medicine, Duke University Medical Center
Reprints: Kelli L Dominick PhD, Durham Veterans Affairs Medical Center (152), Center for Health Services Research in Primary Care, 508 Fulton St., Durham, NC 27705-3897, fax 919/416-5836, domin004{at}mc.duke.edu
BACKGROUND: Previous studies have suggested that recommended gastroprotective strategies such as gastroprotective agents (GPAs) and cyclooxygenase (COX) 2 inhibitors may be underutilized among individuals at risk for nonsteroidal antiinflammatory drug (NSAID)-related gastrointestinal (GI) bleeding.
OBJECTIVE: To examine the use of traditional NSAIDs, COX-2 inhibitors, and GPAs among patients recently hospitalized for GI bleeding.
METHODS: This was a retrospective cohort study of a national sample of 4338 veterans hospitalized for GI bleeding between January and June 1999. Prescription drug use was examined for 6 months following hospitalization. We examined relationships of subject characteristics (age, race, gender, geographic region, diagnosis of arthritis) to prescription of a high-risk NSAID, defined as a traditional NSAID but no GPA within 60 days before or after the NSAID.
RESULTS: Approximately 20% of subjects were prescribed an NSAID or COX-2 inhibitor, but only 5% were prescribed a traditional NSAID with no GPA. In a multivariable analysis, subjects <65 years of age and those with arthritis were more likely to be prescribed a traditional NSAID without a GPA. No other subject characteristics were related to receipt of a high-risk prescription.
CONCLUSIONS: In a national sample of veterans with a recent hospitalization for GI bleeding, high-risk NSAID prescriptions were uncommon. Underuse of gastroprotective strategies may be more common in patients with less recent GI bleeding–related hospitalization. Strategies to remind physicians and pharmacists to screen for GI risk factors may help to sustain appropriate prescribing and reduce NSAID-related adverse events.
Key Words: anti-ulcer agents, nonsteroidal antiinflammatory drugs, pharmacoepidemiology
Published Online, June 8, 2004. www.theannals.com, DOI 10.1345/aph.1E052
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