Guidelines for monitoring of NSAIDS - Who listened?

The side effects of nonsteroidal anti-inflammatory drugs (NSAID) include pr oblems involving peptic ulceration, renal function, and. liver disease. Pub lications have stressed the need to monitor patients for these problems and the rheumatology community across the country has echoed these concerns in continuing education activities to physicians over the years. The American College of Rheumatology (ACR) disseminated recommendations for nonsteroida l anti-inflammatory drugs (NSAID) monitoring in rheumatoid arthritis (RA) p atients. We used this as an example of expert opinion for monitoring of NSA ID and compared it with the frequency of monitoring by primary care physici ans using NSAID for various diseases. We asked whether the rheumatology community's efforts were successful over time to enhance NSAID monitoring by primary care physicians. Physicians acr oss the United States, using a computerized medical record, allowed data to be extracted from their medical practices. Dates of NSAID prescriptions an d laboratory test monitoring for any diagnosis were analyzed. Those tests i ncluded a CBC, hepatic panel, and renal tests. The frequency of baseline te sts performed within 3 months before starting a NSAID by internists was 30% compared with 6% by family practitioners in private practice and 1% in aca demic family practice centers before publication of the ACR guideline. Afte r dissemination of the guidelines in 1996, the frequency of baseline testin g by these groups was lower. Follow-up monitoring within 3 months of starti ng a NSAID was also low (24, 3, and 2% respectively) and did not improve af ter ACR guideline publication. Publication and dissemination of the ACR guidelines, and other efforts, did not improve rates of monitoring. The rheumatology community needs to re-ev aluate the effectiveness of programs that teach safe use of rheumatologic m edications by primary care physicians.