Pharmacist-Led Provider Education on Inappropriate NSAID Prescribing Rates

Whitner, Jangus B; Fabiili, Nicole A; Siewart, Jordan; Akasaka, Karen; Nelson, Anna

doi:10.22454/fammed.2020.147410

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…This finding is congruent with other research that found a decrease in the rate of NSAID use and inappropriate NSAID prescribing after pharmacist intervention. 11,12 While discontinuation rates of oral NSAIDs were notable in our cohort, the number of patients on topical NSAIDs remained the same (23 patients). However, deprescribing of NSAIDs was still successful in this category, as all patients who were originally on diclofenac gel 10% eventually reduced their dose to diclofenac gel 2.32%.…”

Section: Discussionmentioning

confidence: 77%

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Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting

Dawson¹,

Mok

Wong

et al. 2023

Can Pharm J

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Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for management of pain and inflammation. However, these medications are associated with adverse outcomes such as dyspepsia and acute myocardial infarction, especially with long-term uses. Objective: We sought to determine the effect of a pharmacist-led deprescribing intervention on oral NSAID use among patients in federal custody. Methods: Clinical pharmacists from Correctional Services Canada (CSC) conducted a prospective case series of adult patients with chronic noncancer pain who were on long-term NSAIDs (defined as >90 days supply in the past 120 days) in 3 CSC institutions in British Columbia, Canada. CSC clinical pharmacists met with patients to perform medication reviews and identify drug-related problems, with a focus on analgesic therapy. Pharmacist-led interventions were implemented in consultation with the primary care team to address these drug-related problems. Patient progress was monitored weekly for 3 months. Function, quality of life and pain severity scores (modified SPAASMS, Patient-Specific Functional Scale [PSFS] and visual analog scale [VAS] scores) were compared at baseline, 6 weeks and 3 months postintervention. Patient satisfaction survey results were also collected at 3 months. Results: A total of 53 patients received clinical pharmacist interventions. Modified SPAASMS, PSFS and VAS scores were collected at baseline, 6 weeks and 3 months from 38 patients (some were lost to follow-up when released back into the community). All 38 patients demonstrated clinically significant improvements to all 3 pain scales at 3 months (mean SPAASMS scores decreased by 7 points, mean PSFS scores increased by 2 points, mean VAS scores decreased by 2 points). Twenty-four of 31 patients who completed the patient satisfaction survey agreed that their overall health and well-being improved because of the visit they received from the pharmacist. Conclusion: Clinical pharmacist-led interventions in CSC have shown to reduce oral NSAID use as well as contribute positively to patient pain scores.

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Section: Discussionmentioning

confidence: 77%

“…The mean (SD) age of patients included was 53 (11) years. The mean (SD) number of medications each patient took was 6.6 (4.5).…”

Section: Resultsmentioning

confidence: 99%

Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting

Dawson¹,

Mok

Wong

et al. 2023

Can Pharm J

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“…These measures have shown to improve the quality of care in CKD (i.e., proper use of ACEIs, ARBs, statins and avoidance of NSAIDs). [15][16][17] Similarly, the importance of following GFR trends and the recognition of proteinuria as a marker of adverse renal and cardiovascular outcomes needs to be disseminated among primary care providers.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease recognition amongst physicians and advanced practice providers

2021

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Objective Chronic kidney disease is a worldwide public health issue, with increasing prevalence resulting in high morbidity and mortality. As a result, recognizing and treating it early can lead to improved outcomes. We hypothesized that some providers might be more comfortable making this diagnosis than others. Methods Retrospective study of 380 patients with chronic kidney disease seen between 2012 and 2016 in an outpatient setting. Results Three hundred and sixteen patients were treated by physicians and sixty-four by advanced practice providers. Chronic kidney disease was identified by the primary care providers in 318 patients (83.6%). Patients recognized with chronic kidney disease were older, 76 ± 8.8 vs 72 ± 7.45 years, p = 0.001; had lower GFR, 37 [29, 46] vs 57 [37, 76] ml/min/1.73 m 2 , p < 0.0001 and were more likely to be seen by a physician compared to an advanced practice provider: 272/316 (86%) vs 46/64 (71.8%), p = 0.008. In multivariate analyses, care by a physician, OR = 2.27 (1.13–4.58), p = 0.02 was associated with increased recognition of chronic kidney disease. On the other hand, higher GFR was associated with decreased diagnosis of chronic kidney disease, OR = 0.95 (0.93–0.96), p < 0.0001. Conclusion The odds of chronic kidney disease recognition were higher amongst physicians in comparison to non-physician providers.

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“…Some recommended tackling this issue from the patient's level by "empowering patients to make the right treatment decisions" (13). In the USA, pharmacists gave education to primary care providers on safe NSAID 9 habits in high-risk patient populations and it had a "signi cant impact on minimizing inappropriate prescribing patterns" (17). A study on this same issue done in Thailand recommended that physicians prescribe NSAIDs with the shortest duration and lowest effective dose (18).…”

Section: Introductionmentioning

confidence: 99%

“…The US study suggested having pharmacists do medication reviews to coordinate medical records across clinical settings (17). A study done in Mexico that studied Computerized clinical decision support systems (CCDSS) found that 40% of physicians thought that it would allow them to improve their daily practice as it "solved their doubts and above all it provided them with new options to solve their prescription problems" (20).…”

Section: Introductionmentioning

confidence: 99%

The prevalence and contributing factors of NSAIDs Prescription among Chronic Kidney Disease Patients in Primary Care: A mixed methods study from Kingdom of Bahrain

Husain,

Moosa,

Awadh

et al. 2024

Preprint

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Background The prevalence of Non-steroidal Anti-Inflammatory Drugs (NSAIDs) prescription and its contributory factors among chronic kidney disease (CKD) patients are unknown in the Kingdom of Bahrain – though NSAIDs are known to cause significant renal impairment. This study will determine the prevalence of NSAIDs prescription among CKD patients and the contributory factors to this behavior from the perspective of primary care physicians in Bahrain.Methodology: A sequential mixed-method design study comprising of a retrospective cross-sectional survey drawn from patients’ electronic medical records (EMR) and qualitative in-depth interviews with primary care physicians (PCPs) was conducted between December 2022 and January 2023 – with an EMR data lookback from 1st June 2021 to 1st June 2022 Quantitative descriptive analysis was conducted to estimate the prevalence of NSAIDs and their associations with sociodemographic and service delivery indicators. An Ishikawa diagram was used to describe contributory factors to NSAID prescription among CKD patients drawing from the literature and was used to guide a deductive thematic analysis of the qualitative data.Result Of the enrolled CKD patient population (4,380 patients), 17.4% had at least one inappropriate NSAID prescription. 80% of these patients had moderate renal impairment, while 19.3% had severe impairment. Most of the prescriptions were in 24-hour health centers (48.5%). A Bivariate relationship between the prescription and the sociodemographic factors showed a significant P value regarding age (P-value 0.008*) and the severity of the renal impairment (P-value < 0.001*). The contributory factors were divided into five themes: patient factors, physician factors, health team factors, I SEHA factors and system factors. Of these themes, patients and PCPs were identified by the primary care physicians as some of the most important reasons for NSAIDs prescription among CKD patients.Conclusion The prevalence of NSAIDs prescription among CKD patients is relatively high in the kingdom of Bahrain – largely due to patient and physician factors as identified by primary care physicians. Possible solutions for addressing these factors include raising awareness among patients, PCPs, and other healthcare workers and activating the Swiss Cheese Model that involves patients, PCPs, and other health team members to ensure appropriate medication practice and patients’ safety.

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Pharmacist-Led Provider Education on Inappropriate NSAID Prescribing Rates

Cited by 4 publications

References 3 publications

Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting

Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting

Chronic kidney disease recognition amongst physicians and advanced practice providers

The prevalence and contributing factors of NSAIDs Prescription among Chronic Kidney Disease Patients in Primary Care: A mixed methods study from Kingdom of Bahrain

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