Factors that Influence Prescribers in their Selection and use of COX-2 Selective Inhibitors as Opposed to Non-selective NSAIDs*
- 61 Downloads
- 3 Citations
Abstract
Objective: To identify factors that influence prescribers in their selection and use of cyclo-oxygenase-2 (COX-2) selective inhibitors as opposed to non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and report the tendency to co-prescribe gastro-protection with these agents.
Setting: All 579 general practitioners (GPs) in one geographical area, Lothian, Scotland, UK.
Method: Postal questionnaires; simple and factorial designed case series questionnaire.
Main outcome measures: Categorisation of responses to clinical and non-clinical factors into highly, partially or not influential. The quantitative influence of the most prominent clinical factors on prescribing choice and the tendency of co-prescription of gastro-protection with these agents.
Results: Responses from 229 (40%) GPs suggested the following as most influential: Drug Evaluation Panel recommendations, Lothian Joint Formulary, local practice formulary, history of peptic ulcer disease (PUD), history of gastro-intestinal (GI) adverse effects with NSAIDs and advanced age. Advice from other physicians, patient demand, history of alcohol gastritis, history of gastro-oesophageal reflux disease, history of functional dyspepsia, concomitant use of low dose aspirin and concomitant use of gastro-protective agents were regarded to have moderate influence. Information directly from pharmaceutical industry and regular smoking were regarded as having weak influence. An 18% response to the factorial designed questionnaire using the most prominent clinical factors suggested that history of either GI adverse effects associated with non-selective NSAIDs or PUD resulted in more pronounced increase in the frequency (15%) of decision to prescribe COX-2 selective inhibitors than advanced age (10%). Concomitant use of low dose aspirin had little effect on GPs’ decisions. The mean percentage of GPs choosing to co-prescribe gastro-protection was higher with non-selective NSAIDs (64%) than with COX-2 selective inhibitors (22%).
Conclusion: Local authoritative guidance and history of GI complications highly influenced the GPs in their use and choice of either COX-2 selective inhibitors or non-selective NSAIDs. As expected the use of gastro-protection was more frequently chosen with non-selective NSAIDs than COX-2 selective inhibitors.
Key words
Case series COX-2 selective inhibitors Medical decision making Non-steroidal anti-inflammatory drugs (NSAIDs) Prescribing Questionnaire ScotlandPreview
Unable to display preview. Download preview PDF.
References
- 1.Bolten, WW. 1998Scientific rationale for specific inhibition of COX-2J Rheumatol5127Google Scholar
- 2.Gabriel, SE, Jaakkimainen, L, Bombardier, C. 1991Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugsAnn Intern Med11578796PubMedGoogle Scholar
- 3.Blower, AL, Brooks, A, Fenn, GC, Hills, A, Pearce, MY, Morant, S, et al. 1997Emergency admissions for upper gastrointestinal disease and their relation to NSAID useAliment Pharmacol Ther1128391CrossRefPubMedGoogle Scholar
- 4.Seager, JM, Hawkey, CJ. 2001ABC of the upper gastrointestinal tract: indigestion and non-steroidal anti-inflammatory drugsBMJ32312369CrossRefPubMedGoogle Scholar
- 5.Lipsky, PE. 2001IntroductionAm J Med1101S2SCrossRefGoogle Scholar
- 6.Teeling, M, Bennett, K, Feely, J. 2004Have COX-2 inhibitors influenced the co-prescription of anti-ulcer drugs with NSAIDs?Br J Clin Pharmacol5733743CrossRefPubMedGoogle Scholar
- 7.National Institute for Clinical Excellence. Guidance on the use of cyclo-oxygenase (COX) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthritis. Technology appraisal guidance-no.27 July 2001. http://www.nice.org.uk (March 2003).
- 8.Aström, K, Duggan, C, Bates, I. 2002Influences on prescribing: the perception of general practitioners in two primary care trustsInt J Pharm Pract10(suppl)R10Google Scholar
- 9.Avorn, J, Chen, M, Hartley, R. 1982Scientific versus commercial sources of influence on the prescribing behaviour of physiciansAm J Med7348CrossRefGoogle Scholar
- 10.Green, PE, Rao, VR. 1971Conjoint measurement for quantifying judgmental dataJ Marketing Res835563Google Scholar
- 11.Pol, M, Ryan, M. 1995Methodological issues involved in carrying out a conjoint analysis study: an application to consumer preferences for fruit and vegetables Health. Economics Research Unit Discussion paper no 04/95University of AberdeenAberdeenGoogle Scholar
- 12.Ryan, M, Hughes, J. 1995Using conjoint analysis to value surgical versus medical management of miscarriage. Health Economics Research Unit Discussion paper no 06/95University of AberdeenAberdeenGoogle Scholar
- 13.The Lothian Joint Formulary: overcoming the barriers to formulary success. Pharmacy in Practice September 2002;279–84Google Scholar
- 14.The Lothian Joint Formulary. Drugs used in rheumatic diseases and gout (chapter 10.1). National Health Service (NHS) Lothian. http://www.ljf.scot.nhs.uk (December 2004).
- 15.Strull, WM, Lo, B, Charles, G. 1984Do patients want to participate in medical decision making ?JAMA25229904CrossRefPubMedGoogle Scholar
- 16.Wazana, A. 2000Physicians and the pharmaceutical industry: is a gift ever just a gift?JAMA28337380CrossRefPubMedGoogle Scholar
- 17.McCarthy, D. 1998Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definition and epidemiologyAm J Med1053S9SCrossRefPubMedGoogle Scholar
- 18.Singh, G, Rosen Ramey, D. 1998NSAID induced gastrointestinal complications: the ARAMIS perspective-1997J Rheumatol Suppl.51816PubMedGoogle Scholar
- 19.Stalnikowicz-Darvazi, R. 1995Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive eventsJ Clin Gastroenterol21136PubMedGoogle Scholar
- 20.Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B et al. for the VIGOR study group. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. NEJM 2000; 343: 1520–8. Google Scholar
- 21.Silverstein, EF, Faich, G, Goldstein, JL, Simon, LS, Pincus, T, Whelton, A, et al. 2000Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS studyJAMA284124755CrossRefPubMedGoogle Scholar
- 22.Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E, McGowan J. Prevention of NSAID induced gastroduodenal ulcers. The Cochrane Database of Systematic Reviews, Issue 4, 2004.Google Scholar
- 23.Hooper, L, Brown, TJ, Elliott, RA, Payne, K, Roberts, C, Symmons, D. 2004The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic reviewBMJ32994852CrossRefPubMedGoogle Scholar
- 24.Ryan, M. 1999A role for conjoint analysis in technology assessment in health careInt J of Technol Assess Health Care1544357Google Scholar
- 25.Weiss, MC, Scott, D. 2000Clinical decision making- an application of judgement analysis and its potential for pharmacyInt J Pharm Pract83341Google Scholar
- 26.Ryan, M, Farrar, S. 2000Using conjoint analysis to elicit preferences for health careBMJ32015303CrossRefPubMedGoogle Scholar
- 27.Pearmain D, Swanson J, Kroes E, Bradley M. Stated Preferences Technique. A Guide To Practice (2nd edition). Steer Davies Gleave and Hague Consulting Group, 1991.Google Scholar
- 28.Edwards, P, Roberts, I, Clarke, M, DiGuiseppi, C, Pratap, S, Wentz, R, et al. 2002Increasing response rates to postal questionnaires: systematic reviewBMJ32119CrossRefGoogle Scholar
- 29.Medicines management team. Survey results and new COX-2 guidelines. Lothian Prescrib Bull 2003; 5:1.Google Scholar