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Audit/feedback and educational materials have little effect on monitoring patients for NSAID toxicity

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious gastrointestinal (GI) problems, high blood pressure, and kidney damage, and can worsen congestive heart failure. Currently, to identify and prevent such problems, it is recommended that physicians use laboratory tests to screen for early GI and kidney toxicity and prescribe cytoprotective agents to patients who are at high risk for GI problems. However, only half of physicians follow these recommendations for NSAID toxicity monitoring, according to a new study supported by the Agency for Healthcare Research and Quality (HS10389).

Researchers at the University of Alabama Center for Education and Research on Therapeutics (CERTs) randomly assigned 85 physicians (internists, family physicians, and rheumatologists) in a large managed care organization to an intervention or control group. Intervention physicians received print and Web-based materials about safe NSAID prescribing practices. They also received feedback on their monitoring of patients treated with NSAIDs compared with the top performing 10 percent of physicians.

Analysis of patients' medical records 10 months before and after the intervention showed an insignificant difference in ordering of complete blood count and creatinine laboratory tests (to monitor for GI and kidney toxicity, respectively) and use of cytoprotective agents. More strongly associated with improved safety practices than the intervention were rheumatology specialty, number of NSAID prescriptions written for patients, number of physician visits, and patient risk factors for NSAID-related toxicity. The researchers note that their findings support the idea that no single intervention or set of interventions has been proven effective to alter physician practice patterns in all settings.

See "A group randomized trial to improve safe use of nonsteroidal anti-inflammatory drugs," by Jeffrey R. Curtis, M.D., M.P.H., Jason Olivieri, M.P.H., Jeroan J. Allison, M.D., and others, in the September 2005 American Journal of Managed Care 11(9), pp. 537-543.

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