Non-Steroidal Anti-Inflammatory Drugs Prescription in Elderly Ambulatory Patients

Abstract

Non-steroidal antiinflammatory drugs (NSAID) are widely used medications in elderly ambulatory patients despite their numerous side effects. The NSAID prescription by 6 general practitioners (GPs) working in a single center to ambulatory patients aged 65 years or older was retrospectively evaluated. Individual interviews of the 6 GPs were performed by means of qualitative questionnaires to determine NSAID prescription habits, knowledge of NSAID by doctors, knowledge of Good Clinical Practice (GCP) recommendations. We then conducted a retrospective observational study in 154 patients aged 65 years or older who received at least one NSAID given orally between October 1st and December 31st of 2014, by means of a questionnaire including 34 validated evaluation criteria according to the current guidelines. The 6 GPs did not frequently prescribe NSAID in their patients aged 65 years or older, due to the high number of co-prescribed drugs, renal or liver insufficiency, and the high risk of side effects in these patients. Their knowledge regarding the side effects, contra-indications and warnings of the various available NSAIDs are heterogeneous and none of the interviewed GPs were aware of available GCP recommendations regarding NSAIDs prescription and side effects prevention in older patients. 10.5% of the 154 patients had a prescription of at least one NSAID. However, this prescription was in agreement with the market authorization recommendation in only 72% of cases. Numerous gaps were identified between daily practice of these GPs and the available GCP recommendations, except for the recommendations regarding gastrointestinal side effects and contra-indications of the NSAID, which were highly respected. GCP recommendations for NSAIDs prescription are unknown from prescribers and respect of these recommendations should be improved by means of a patient-dedicated follow-up file designed to optimize the management and prevention of NSAID-related side effects in daily practice.