Background &Aims: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide. Methods: This was a cross-sectional study among veterans prescrib...Background &Aims: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide. Methods: This was a cross-sectional study among veterans prescribed a nonsteroidal anti-inflammatory drug (NSAID) from January 1, 2002, to December 31, 2002. Prescrip tion data were linked to inpatient and outpatient medical records and death file s. The population was characterized as high risk based on the following: age 65 years or older, concurrent corticosteroid or anticoagulant use, history of pepti c ulcer, and high average daily dose of NSAIDs. Adherence was defined as the pre scription of a traditional NSAID with gastroprotection or a coxib in high-risk NSAID users. Univariate and multivariate analyses assessed the potential predict ors of adherence. Results: Three hundred three thousand seven hundred eighty-se ven met our definition of high risk. Most (97.3%) were male; 55.6%were white, 9.6%black, and 34.8%of other/unknown race. Age 65 years or older was the large st high-risk subset (87.1%). Overall, only 27.2%of highrisk veterans (n = 82, 766) were prescribed an adherent strategy. Among veterans with at least 2 risk f actors, adherence was 39.7%; among those with 3 risk factors, adherence was 41. 8%. Predictors of adherence included history of upper gastrointestinal events, anticoagulant use, rheumatologic disease, high Deyo comorbidity index score, use of low-dose salicylates, and concurrent corticosteroid use. Predictors of nona dherence included prescriptions≥90 days and high average daily dose of NSAIDs. Conclusions: Adherence to evidence-based guidelines for safe prescription of NS AIDs in the Department of Veterans Affairs is low (27.2%). The likelihood of ad herence is further decreased if veterans are prescribed NSAIDs for ≥90 days.展开更多
文摘Background &Aims: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide. Methods: This was a cross-sectional study among veterans prescribed a nonsteroidal anti-inflammatory drug (NSAID) from January 1, 2002, to December 31, 2002. Prescrip tion data were linked to inpatient and outpatient medical records and death file s. The population was characterized as high risk based on the following: age 65 years or older, concurrent corticosteroid or anticoagulant use, history of pepti c ulcer, and high average daily dose of NSAIDs. Adherence was defined as the pre scription of a traditional NSAID with gastroprotection or a coxib in high-risk NSAID users. Univariate and multivariate analyses assessed the potential predict ors of adherence. Results: Three hundred three thousand seven hundred eighty-se ven met our definition of high risk. Most (97.3%) were male; 55.6%were white, 9.6%black, and 34.8%of other/unknown race. Age 65 years or older was the large st high-risk subset (87.1%). Overall, only 27.2%of highrisk veterans (n = 82, 766) were prescribed an adherent strategy. Among veterans with at least 2 risk f actors, adherence was 39.7%; among those with 3 risk factors, adherence was 41. 8%. Predictors of adherence included history of upper gastrointestinal events, anticoagulant use, rheumatologic disease, high Deyo comorbidity index score, use of low-dose salicylates, and concurrent corticosteroid use. Predictors of nona dherence included prescriptions≥90 days and high average daily dose of NSAIDs. Conclusions: Adherence to evidence-based guidelines for safe prescription of NS AIDs in the Department of Veterans Affairs is low (27.2%). The likelihood of ad herence is further decreased if veterans are prescribed NSAIDs for ≥90 days.
