Knowledge and perceptions of the risks of non-steroidal anti-inflammatory drugs among orthopaedic patients in Thailand

Abstract

Background There is a high incidence of adverse effects from non-steroidal antiinflammatory drugs (NSAIDs) in Thailand, but patients' perceptions and knowledge of NSAID risks is unknown. Objective This study aims to assess patients' perceptions and knowledge of NSAID risks and factors affecting them. Setting University hospital in North-East of Thailand. Method A Cross-sectional study conducted over 4 months, using a self-administered questionnaire. Patients prescribed NSAIDs for at least one month duration from orthopaedic clinic were recruited using systematic random sampling. Main outcome measure Patients' perceptions on NSAID risks, knowledge on risk factors, and their associated factors. Results A total of 474 questionnaires were assessed. Overall perceptions of risks was low (scoring below five on a 0-10 visual analogue scale), with risks associated with the renal system scoring highest. Perceived risk of gastrointestinal problems differed between patients using non-selective and selective NSAIDs (3.47 ± 2.75 vs 2.06 ± 2.98; P < 0.001). Receiving side effect information from a health professional was associated with higher risk perception. Most patients (80 %) identified high doses, renal disease and gastrointestinal ulcer increased risks of NSAIDs, but fewer than half recognized that use in the elderly, multiple NSAID use, drinking, hypertension and cardiovascular disease also increased risk of adverse events. Having underlying diseases and receiving side effect information were associated with 1.6-2.0 fold increased knowledge of NSAID risks. Conclusion Perceptions and knowledge concerning NSAID risks was generally low in Thai patients, but higher in those who had received side effect information. Risk-related information should be widely provided, especially in high-risk patients.

Practices of healthcare professionals in communicating with nonsteroidal anti-inflammatory drug users in Thailand: a qualitative study

“…This practice may lead the public to believe that selective NSAIDs are better and safer to use. Clearly type of NSAID was a factor affecting other aspects of information provision, again confirming some of our survey results . CV side effects were only mentioned by a few participants in relation to selective NSAIDs and not with non‐selective drugs, despite similar risks .…”

“…[19] Patients on the other hand have indicated that, while the majority receive information about how to use NSAIDs and their indication, fewer than half report receiving information about side effects and they perceive the risks of NSAIDs as generally low. [20] The findings from this survey do, however, concur with those of health professionals, in that attitudes towards receiving written information in the form of PILs were positive. [21] Such leaflets are not, however, widely available in Thailand, despite evidence that they can improve patient knowledge of medicines.…”

“…They were also less likely to provide information and advice about side effects with supply of selective NSAIDs than for non‐selective drugs . Patients on the other hand have indicated that, while the majority receive information about how to use NSAIDs and their indication, fewer than half report receiving information about side effects and they perceive the risks of NSAIDs as generally low . The findings from this survey do, however, concur with those of health professionals, in that attitudes towards receiving written information in the form of PILs were positive .…”

“…Explaining the need to avoid duplicating NSAIDs was mentioned by only two interviewees, despite the potentially dangerous combination of prescription and non‐prescription NSAIDs being widespread . Few interviewees referred to the need to avoid NSAIDs or use them short term in older people or to exercise caution in patients with risk factors or concomitant drug use which could increase their chances of adverse events . The potential for acute effects on the kidney was only discussed in long‐term users.…”

“…These include work setting, number of work colleagues, time available for direct patient contact and gender . Our patient survey also found that the duration of NSAID use and age were factors which affected whether or not they had received information about potential side effects and how to avoid or manage these . Some of the practices appeared inappropriate in the light of current knowledge of NSAID risks.…”