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Pharmacy World and Science

, Volume 27, Issue 4, pp 316–320 | Cite as

Factors that Influence Prescribers in their Selection and use of COX-2 Selective Inhibitors as Opposed to Non-selective NSAIDs*

  • Anna I. GunnarsdóttirEmail author
  • Moira Kinnear
Research Article

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 Scotland 

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References

  1. 1.
    Bolten, WW. 1998Scientific rationale for specific inhibition of COX-2J Rheumatol5127Google Scholar
  2. 2.
    Gabriel, SE, Jaakkimainen, L, Bombardier, C. 1991Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugsAnn Intern Med11578796PubMedGoogle Scholar
  3. 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. 4.
    Seager, JM, Hawkey, CJ. 2001ABC of the upper gastrointestinal tract: indigestion and non-steroidal anti-inflammatory drugsBMJ32312369CrossRefPubMedGoogle Scholar
  5. 5.
    Lipsky, PE. 2001IntroductionAm J Med1101S2SCrossRefGoogle Scholar
  6. 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. 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. 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. 9.
    Avorn, J, Chen, M, Hartley, R. 1982Scientific versus commercial sources of influence on the prescribing behaviour of physiciansAm J Med7348CrossRefGoogle Scholar
  10. 10.
    Green, PE, Rao, VR. 1971Conjoint measurement for quantifying judgmental dataJ Marketing Res835563Google Scholar
  11. 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. 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. 13.
    The Lothian Joint Formulary: overcoming the barriers to formulary success. Pharmacy in Practice September 2002;279–84Google Scholar
  14. 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. 15.
    Strull, WM, Lo, B, Charles, G. 1984Do patients want to participate in medical decision making ?JAMA25229904CrossRefPubMedGoogle Scholar
  16. 16.
    Wazana, A. 2000Physicians and the pharmaceutical industry: is a gift ever just a gift?JAMA28337380CrossRefPubMedGoogle Scholar
  17. 17.
    McCarthy, D. 1998Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definition and epidemiologyAm J Med1053S9SCrossRefPubMedGoogle Scholar
  18. 18.
    Singh, G, Rosen Ramey, D. 1998NSAID induced gastrointestinal complications: the ARAMIS perspective-1997J Rheumatol Suppl.51816PubMedGoogle Scholar
  19. 19.
    Stalnikowicz-Darvazi, R. 1995Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive eventsJ Clin Gastroenterol21136PubMedGoogle Scholar
  20. 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. 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. 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. 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. 24.
    Ryan, M. 1999A role for conjoint analysis in technology assessment in health careInt J of Technol Assess Health Care1544357Google Scholar
  25. 25.
    Weiss, MC, Scott, D. 2000Clinical decision making- an application of judgement analysis and its potential for pharmacyInt J Pharm Pract83341Google Scholar
  26. 26.
    Ryan, M, Farrar, S. 2000Using conjoint analysis to elicit preferences for health careBMJ32015303CrossRefPubMedGoogle Scholar
  27. 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. 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. 29.
    Medicines management team. Survey results and new COX-2 guidelines. Lothian Prescrib Bull 2003; 5:1.Google Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Clinical PharmacyLandspitali-University HospitalHringbrautReykjavikIceland
  2. 2.Lothian Pharmacy Practice Unit, Edinburgh and Department of Pharmaceutical SciencesUniversity of StrathclydeGlasgowScotland

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