Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices

Aim: To investigate the pharmacoepidemiology of NSAID usage in Nottingham g eneral practices. Design: Questionnaire sent to 1137 consecutive recipients of an NSAID presc ription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice re cords. Setting: General practices in and around Nottingham, selected to reflect lo cal variations in number of partners, list size, geographical location, dep rivation, prescribing burden and prescribing rate. Subjects: Unselected patients receiving NSAIDs prescribed for all indicatio ns. Main outcome measures: Indication for treatment, differences in prescribing to different age groups, compliance and overall scheme drug exposure, drug effectiveness and tolerability, possible drug-related adverse events, pati ents' overall satisfaction with treatment and estimated costs of care. Results: NSAIDs were used for a wide range of conditions and only a small n umber of patients had rheumatoid arthritis. The main drugs used were ibupro fen, diclofenac and naproxen. Patients making short-term use of NSAIDs had low compliance if they experienced adverse drug effects, whilst conversely in long-term users, those with high compliance reported more adverse drug e ffects. Calculated compliance did not vary with age although older patients (over 65 years) claimed in their questionnaires to be more compliant than younger patients. Half the patients reported good or complete symptom relief. Half of those q uestions (and two thirds of those with good or complete symptom relief) rat ed their NSAID as the best treatment they had received for their current co ndition. The frequency of gastrointestinal adverse events was higher in the young and the old, which correlated with the use of anti-ulcer drugs, and increased with the total number of medications used. Conclusions: NSAIDs are used for a wide-range of conditions. They give symp tom relief to, and are perceived as effective by, most patients taking them .