Use of NSAIDs and patient safety

Abstract

Objective: To assess the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) and propose methods whereby pharmacists can help to improve patient safety when these drugs are used. Method: A psychometrically-evaluated questionnaire was administered to 261 patients aged 18 and over who visited 13 different community pharmacies, 1 from each electoral district in Malta and Gozo, chosen by stratified random sampling. Information about the sociodemographic status, symptoms and disease states and the drugs taken in the past 6 months was collected. Analysis of data was carried out using Microsoft Office Excel 2007 and the Biomedical Data Package (BMDP ) Software. Key findings: Results show a high prevalence of analgesic (>80% per district) and NSAID use (about 50% per district). The first drug of choice to relieve analgesia was paracetamol (67.1%) followed by diclofenac (37.2%). Ibuprofen was the fourth drug of choice (7.3%). About 65% of patients who took diclofenac stated that they self-prescribe the medication. Statistical analysis of data showed an association between the use of NSAIDs, musculoskeletal pain and menstrual pain (both p=0.010). A number of patients at risk of gastro-intestinal bleeds, cardiovascular events and those suffering from asthma reported taking NSAIDs occasionally. The presence of risks of drug interactions was identified with various drugs. Conclusion: NSAIDs are overused in Malta and are often administered indiscriminately. Pharmacist intervention could ensure the rational and safe use of NSAIDs. This could be achieved by having a shared protocol between pharmacists and prescribers for appropriate prescribing and dispensing and by identifying scenarios where pharmacist prescribing can be carried out to ensure that the analgesic used is appropriate for the individual patient.