Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting

BMC Musculoskeletal Disorders

Research

Navjot Kaur¹  Elsie Rizk¹  Phuong Y Duong¹  Bader M. Alghamdi¹  Joshua T. Swan²  Eleazar Flores³  Anthony E. Brown³  Sudha Nagaraj³  Nathan Spence⁴  Sharla Tajchman⁴ 

[1] Department of Pharmacy, Houston Methodist, Houston, TX, USA;Department of Surgery, Houston Methodist, Houston, TX, USA;Department of Pharmacy, Houston Methodist, Houston, TX, USA;Department of Surgery, Houston Methodist, Houston, TX, USA;Center for Outcomes Research, Houston Methodist, Houston, TX, USA;Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA;Pfizer, Inc, New York, NY, USA;

关键词: Osteoarthritis;    Pain;    Quality indicators;    Primary care;    NSAIDs;   

DOI  :  10.1186/s12891-023-06904-x

 received in 2023-03-16, accepted in 2023-09-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD).MethodsThis retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort).ResultsAmong 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74–83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%.ConclusionA substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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