Abstract
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in primary care despite being a high-risk drug group causing significant adverse events, yet little is known about GPs’ perceptions of NSAID risks and benefits.AimTo explore GPs’ experiences with NSAID prescribing and views about the risks and benefits of this group of medicines.Design & settingA qualitative, inductive study in general practice.MethodIndividual interviews with 15 GPs using a semi-structured interview guide. Interviews were audiorecorded and transcribed. An inductive, thematic approach was used for analysis. Sampling continued until data saturation was achieved.ResultsThree main themes illustrate GPs’ key concerns with managing NSAID risks. The first theme was perceptions of risks and benefits of NSAIDs: GPs expressed differing attitudes towards prescribing medication generally. GPs were aware of the general risks of NSAIDs but weighed these up against specific risk factors and potential benefits for particular patients. They were most concerned about long-term use, risks for children, older people, and patients with comorbidities. The second theme was assessing and mitigating risks when prescribing NSAIDs: GPs considered gastric, cardiac, and renal risks of patients as well as drug interactions. Mitigation strategies included alternative treatment, choice and dose of NSAID, and use of gastroprotective agents. The final theme was other factors impacting on NSAID risks: particularly patient expectations and over-the-counter (OTC) availability.ConclusionNSAID prescribing is a complex balance between pragmatism and potential adverse events. Given the costs of morbidity, hospitalisation, and patient demand there is an urgent need to secure a more detailed evidence base and develop practical pathways to support safer prescribing.
Highlights
NSAIDs can be useful in the management of pain and inflammation.[1]
Oral NSAIDs are well known for being a high-risk drug group, especially with regard to gastric, cardiac, and renal adverse events.[7]
NSAIDs are extensively prescribed in primary care and continue to be linked to high numbers of adverse drug events both in primary care and requiring hospital admission.[9,10,11,12]
Summary
NSAIDs can be useful in the management of pain and inflammation.[1]. They are used in a range of clinical conditions across all age groups; for example, to manage pain and fever in children, musculoskeletal conditions, gout flares, and osteoarthritis.[2,3,4,5,6]Alongside their potential usefulness, oral NSAIDs are well known for being a high-risk drug group, especially with regard to gastric, cardiac, and renal adverse events.[7]. NSAIDs are extensively prescribed in primary care and continue to be linked to high numbers of adverse drug events both in primary care and requiring hospital admission.[9,10,11,12] For example, a survey of 1000 UK GPs found almost all (97%) had had patients who experienced gastrointestinal symptoms from NSAID use, 38% had had patients hospitalised, and 4% reported a patient dying from adverse events due to NSAIDs.[13] In addition to prescribed NSAIDs, in many countries, some can be purchased OTC at pharmacies or other retail outlets including supermarkets. This contributes to ease of availability, wide use, and potential risk, retail purchase of NSAIDs is beyond the control of GPs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
