A study of general practitioners’ awareness of the National Institute for Health and Care Excellence guidelines regarding the use of nonsteroidal anti-inflammatory drugs

Abstract

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for their analgesic, anti-pyretic and anti-inflammatory effects. There is no doubt regarding their benefits; however the importance of their side effects including gastrointestinal complications cannot be emphasized enough especially in high risk groups. Objectives This study assessed the awareness of general practitioners (GPs) working within Maltese health centres of the National Institute for Health and Care Excellence (NICE) guidelines on the proper prescription of NSAIDs, especially the co-prescription of gastroprotective agents in high risk groups. Method An online questionnaire based on the NICE guidelines on NSAID Prescribing Issues revised in July 2015 was distributed to doctors working within health centres across Malta. Results Trauma was the most popular reason for NSAID prescription (75%), with the commonest patient age group being that below 45 years of age. Diclofenac was the most popular NSAID choice (55.4%) with COX-2 inhibitors being the preferred choice for 23.2%. Most doctors were aware of factors that need to be considered when initiating NSAIDs, being least aware of liver comorbidities and fertility issues. The majority use licensed gastroprotective agents both in drug choice and in dose. More awareness is required on high risk patient groups especially patients with arthritis and patients on selective serotonin reuptake inhibitors (SSRIs). Conclusion There is room for improvement in awareness on proper NSAID use and gastroprotection especially in identifying high risk groups, drug interactions and choice of gastroprotective agents. The importance of gastroprotection, side effect monitoring, prevention of unnecessary chronic NSAID use and promotion of coxib use over standard NSAIDs needs to be emphasized further especially in high risk groups.