Underutilization of gastrointestinal prophylaxis in high-risk chronic nonsteroidal anti-inflammatory drug users in Korea
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RESEARCH ARTICLE
Underutilization of gastrointestinal prophylaxis in high‑risk chronic nonsteroidal anti‑inflammatory drug users in Korea Woo‑Youn Kim1 · Suhyun Lee1 · Kwanghee Jun1 · Young‑Mi Ah2 · Ju‑Yeun Lee1 Received: 4 May 2020 / Accepted: 9 October 2020 © Springer Nature Switzerland AG 2020
Abstract Background The increasing use of antithrombotic therapies in older patients has led to an increased risk of gastrointestinal (GI) bleeding in chronic nonsteroidal anti-inflammatory drug (NSAID) users. Therefore, there is a pressing need for GI prophylaxis in these high-risk patients. Objective To analyze prescribing patterns and factors associated with the use of gastroprotective agents (GPAs) among high-risk, chronic NSAID users. Setting National claims database including 20% of the total Korean population aged ≥ 65 years. Method In this cross-sectional study, we identified older adults prescribed traditional NSAIDs for > 90 days and classified them into high- and ultra-high-risk groups if they had one or two or more GI risk factors, respectively. Proton pump inhibitors or misoprostol prescribed for more than 80% of traditional NSAID treatment days was regarded as appropriate GI prophylaxis. Main outcome measure Prevalence and associated factors with appropriate GI prophylaxis. Results Among 69,992 chronic traditional NSAID users, 38.8% and 9.4% belonged to the high and ultra-high-risk groups; 13.2% and 19.9% received appropriate GI prophylaxis, respectively. The most frequently used GPA was histamine H 2 antagonists. Multiple NSAID use, concomitant antiplatelets and anticoagulants, and prior GI ulcer history increased the likelihood of receiving appropriate GI prophylaxis. Advanced age (≥ 85 years), indications other than arthritis, and neurology specialists negatively affected appropriate GI prophylaxis use. Conclusion Approximately one in five chronic NSAID users, considered ultra-high risk, are prescribed appropriate GI prophylaxis in Korea. Advanced age, indications, and specialties of the prescriber all need to be considered when selecting target populations for interventions. Keywords Gastroprotective agent · Histamine H2 antagonist · Nonsteroidal anti-inflammatory drugs · Older patients · Proton pump inhibitor
Impacts on practice • The observed low utilization rate of appropriate gastro-
intestinal prophylaxis in high-risk chronic nonsteroidal anti-inflammatory drug users demonstrated the signifi-
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11096-020-01176-0) contains supplementary material, which is available to authorized users. * Ju‑Yeun Lee [email protected] 1
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak‑ro, Seoul 08826, Republic of Korea
College of Pharmacy, Yeungnam University, Gyeongsangbuk‑do, Republic of Korea
2
cant inconsistency between practice patterns and global standards of care. • The development of intervention strategies for clinical pharmacists and pr
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