Hospital physicians' influence on gastrointestinal protection during treatment with non-steroidal anti-inflammatory drugs and acetylsalicylic acid and the impact on prescribing in primary care.

BACKGROUND: The aim of this study was to describe the use of gastrointestinal (GI) protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA. METHODS: This study included all elderly patients (75+) admitted to hospital in the period of 1(st) April 2010 to 31(st) March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay. RESULTS: In total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0%) and 597 of 1994 user of low-dose ASA (29.9%) had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0%) and 647 of 961 (67.3%) were initiated without concomitant use of GI protection. When hospital physicians initiated GI protection, 26.8-51.0% were continued in primary care after discharge. CONCLUSIONS: During hospital stay, the use of GI protection increases, but when new treatment with NSAIDs or low-dose ASA is initiated in hospital, the use of gastrointestinal protection is low. The low use of GI protection is carried on in primary care after discharge

Numbers and prevalence rates of concurrent use of GI protection for users of NSAID and low-dose ASA treatment initiated by hospital physicians during hospital stay.

<p>The following continuation of these treatment strategies in primary care is indicated by arrows.</p

Prevalence rate of concurrent use of GI protection for users of NSAIDs or low-dose ASA before hospital admission, and for new patients starting NSAID or low-dose ASA during hospital stay.

<p>Data are given in numbers, percentages and with 95% confidence intervals unless otherwise indicated.</p

Numbers and prevalence rates of concurrent use of GI protection for users of NSAID and low-dose ASA across hospitalisation.

<p>The following continuation of these treatment strategies in primary care is indicated by arrows.</p

The longitudinal flow for patients treated with NSAID and the use of GI protection (PPI, misoprostol or H2RA).

<p>The longitudinal flow for patients treated with NSAID and the use of GI protection (PPI, misoprostol or H2RA).</p