A Very High Rate of Inappropriate Use of Gastroprotection for Nonsteroidal Anti-inflammatory Drug Therapy in Primary Care A Cross-Sectional Study

Aim: To assess the appropriateness of gastroprotection in nonsteroidal anti-inflammatory drug (NSAID) users by primary care physicians. Background: A gastroprotective therapy is advised in NSAID users who are at a high risk for developing gastrointestinal side effects. However, an inappropriate (overuse/underuse) prescription of gastroprotection has been reported. Study: This was a cross-sectional study in which a questionnaire was administered to consecutive NSAID users who visited routine primary care during a 1-week period. The presence of risk factors for NSAID-related gastrointestinal side effects and the eventual gastroprotective strategy used were registered. Gastroprotective therapy was considered appropriate/inappropriate according to the current guidelines. Results: Overall, 869 (25.3%) of 3,433 patients were on chronic NSAID therapy. Gastroprotection was performed in 593 (68.2%) NSAID users, and it was appropriate in only 299 (34.4%) cases. Specifically, an underuse of gastroprotective therapy was observed in 30.6% of >= 65-year-old, whereas an overuse occurred in 57.5% of <65-year-old patients without any risk factor. Concomitant therapy with either steroids [odds ratio (OR): 4.3] or anticoagulants (OR: 3.9), and > 72 years of age (OR: 1.67) were significant predictive factors of inappropriate gastroprotection. Conclusions: Appropriate use of gastroprotective therapy for NSAID users by primary care physicians needs to be promptly implemented, as its inappropriate use is noticeably increasing ethical and economic concerns.