Factors that Influence Prescribers in their Selection and use of COX-2 Selective Inhibitors as Opposed to Non-selective NSAIDs*
- 58 Downloads
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 wordsCase series COX-2 selective inhibitors Medical decision making Non-steroidal anti-inflammatory drugs (NSAIDs) Prescribing Questionnaire Scotland
Unable to display preview. Download preview PDF.
- 1.Bolten, WW. 1998Scientific rationale for specific inhibition of COX-2J Rheumatol5127Google 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
- 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).
- 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
- 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
- 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
- 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
- 29.Medicines management team. Survey results and new COX-2 guidelines. Lothian Prescrib Bull 2003; 5:1.Google Scholar