Prescribing nonsteroidal anti-rheumatics in family medicine

Uvod: Prema izvješću Hrvatske agencije za lijekove i medicinske proizvode (HALMED), za 2012. prema potrošnji lijekova, po terapijskim skupinama nesteroidni antireumatici (NSAIR) (M01) zauzimaju 8. mjesto sa 42,43 DDD/1000 stanovnika/dan. Cilj: Istražiti propisivanje NSAIR u ordinaciji obiteljske medicine s obzirom na: indikacije, duljinu terapije, nepoželjne komorbiditetne bolesti i nepoželjne kombinacije lijekova, adjuvantnu terapiju, te njihovu potrošnju. Ispitanici i metode: U tri ordinacije obiteljske medicine koje u skrbi imaju 5.716 ispitanika, provedeno je retrospektivno longitudinalno istraživanje u razdoblju od 1. 1. 2011 do 31. 12. 2011. Uzorak je činilo 1194 ispitanika kojima je propisan NSAIR. Sastavljen je upitnik koji je sadržavao demografske podatke, kliničke podatke, te podatke o dnevno definiranim dozama (DDD) NSAIR. Podaci za upitnik, te podaci o potrošnji NSAIR i ukupnoj potrošnji dobiveni su iz e-kartona u medicinskom informatičkom sustavu Medicus.net. Rezultati: NSAIR je propisan kod 21% (1194) ispitanika. Dva ili više NSAIR dobilo je 14% ispitanika. Najčešći razlog propisivanja NSAIR su koštano-mišićne bolesti (67,8%). Prosječna duljina trajanja terapije je 49,2 DDD (st. dev 62,0). Duljina terapije povećava se sa starošću ispitanika. Najčešće propisivan NSAIR je ibuprofen (31,6%). Najčešći nepoželjni komorbiditet su kardiovaskularne bolesti 38,4%), a nepoželjna interakcija s diureticima (34,1%). Od adjuvantne terapije benzodiazepini su propisani u 43%, a opioidni analgetici u 15,8% ispitnika. Inhibitori protonske pumpe (IPP) su propisani tek u 13,5% ispitnika. Udio nesteroidnih antireumatika u ukupnoj potrošnji iznosi oko 2%. Zaključak:NSAIR su propisani prečesto svakom petom ispitaniku i predugo. Preko polovine ispitanika imalo je nepoželjnu komorbiditetnu dijagnozu za primjenu NSAIR i koristilo lijekove s nepoželjnom interakcijom s NSAIR. Preporuke za daljnje istraživanje je istražiti mjere ishoda propisivanja NSAIR –a kod bolesnika s nepoželjnim komorbiditetima i nepoželjnim interakcijama, te temeljem toga izračunati stvarnu cijenu koju generira propisivanja NSAIR-a.According to HALMED (Croatian agency for medical products and medical devices) the consumption of NSAID (M01) occupied eighth place with 42.43 DDD/1000 inhabitants/day in 2012. Objective: To investigate the frequency of NSAIDs in GP offices regarding: participation in drug expenditure, indications, duration of therapy, unwanted comorbid diseases and drug interactions. Patients and methods: Retrospective longitudinal study of a sample of 5,716 patients from three GP offices was carried out in a one-year period (1.1.2011-31.12.2011). The sample included 1,194 patients with prescribed NSAID. A questionnaire designed for this investigation included questions about patients\u27 demographic and social characteristics, clinical information and the pattern of NSAID prescription (subgroup and DDD). Data were taken from computerized medical records in the information system Medicus.net. Results: NSAIDs were prescribed to 21% of patients. Musculoskeletal diseases (67.8 %) were the most common reason to prescribe NSAID. The average duration of the therapy was 49.2 DDD (SD 62.0). The most commonly prescribed NSAID was ibuprofen (31.6%). Two or more NSAIDs were prescribed to 14 % of respondents. The most common unwanted comorbidities were cardiovascular (38.4 %), and then gastrointestinal (17%) followed by renal diseases (1%). The most common unwanted drug interaction was with diuretics (34.1%). NSAIDs participated with about 2 % in total drug expenditure in GP offices. Conclusion: NSAIDs were prescribed to every fifth patient too often and too long. More than a half of the patients had unwanted comorbid diagnoses. The recommendation for further investigation is to investigate the outcome measures of prescribed NSAID among patients with unwanted diseases and drug interactions and to calculate real expenditure which generated NSAID prescription