Gastroprotective Agent Underuse in High-Risk Older Daily Nonsteroidal Anti-Inflammatory Drug Users over Time

BACKGROUND/ OBJECTIVES: Non-steroidal anti-inflammatory drug (NSAID) use is a major risk factor for peptic ulcer disease (PUD) in older adults; thus, a gastroprotective agent is recommended in high-risk patients. This study of older daily NSAID users examined whether gastroprotective agent underuse decreased over time. DESIGN: Before-after study. SETTING: Health, Aging and Body Composition study. PARTICIPANTS: Daily users of an NSAID (prescription and over-the-counter [OTC]) at the 2002–03 (pre-period; n=404) and 2006–07 (post-period; n=172) visits. The sample had a mean (standard deviation [±SD]) age of 78.2 [±2.7] years and 81.9 [±2.7] years at the visits, respectively. The majority were white, women and with ≥12 years of education. MEASUREMENTS: Underusers were defined as: (1) persons taking non-selective NSAIDs at risk of PUD (due to current warfarin or glucocorticoid use, or history of PUD) and not using a proton pump inhibitor, or (2) COX-2 selective NSAID users taking aspirin at risk of PUD (i.e., having at least one risk factor) and not using a proton pump inhibitor. RESULTS: Daily NSAID use decreased from 17.6% to 11.3% (p<0.001), and gastroprotective agent underuse decreased from 23.5% and 15.1% (p=0.008) over time. Controlling for important covariates, having prescription insurance was somewhat protective from underuse in the pre-period (adjusted odds ratio [AOR] 0.78, 95% confidence interval [CI] 0.46–1.34; p=0.37), but more so and significantly in the post-period (AOR 0.41, 95% CI 0.18–0.93; p=0.03). Over time, having prescription insurance was more protective in the post versus pre-period (i.e., less gastroprotective agent underuse; adjusted ratio of OR 0.53, 95% CI 0.22–1.29; p=0.16), but this increased protection was not statistically significant. CONCLUSION: Among high-risk older daily NSAID users, having prescription insurance and adequate gastroprotective use was more common in the post than in the pre-period

New Initiation of Long-Acting Opioids in Long-Stay Nursing Home Residents

OBJECTIVES: To estimate the prevalence of new initiation of long-acting opioids since introduction of national efforts to increase prescriber and public awareness on safe use of transdermal fentanyl patches. DESIGN: Cross-sectional. SETTING: U.S. nursing homes (NHs). PARTICIPANTS: Medicare-enrolled long-stay NH residents (N = 22,253). MEASUREMENTS: Minimum Data Set 3.0 was linked with Medicare enrollment, hospital claims, and prescription drug transaction data (January-December 2011) and used to determine the prevalence of new initiation of a long-acting opioid prescribed to residents in NHs. RESULTS: Of NH residents prescribed a long-acting opioid within 30 days of NH admission (n = 12,278), 9.4% (95% confidence interval = 8.9-9.9%) lacked a prescription drug claim for a short-acting opioid in the previous 60 days. The most common initial prescriptions of long-acting opioids were fentanyl patch (51.9% of opioid-naive NH residents), morphine sulfate (28.1%), and oxycodone (17.2%). CONCLUSION: New initiation of long-acting opioids-especially fentanyl patches, which have been the subject of safety communications-persists in NHs