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

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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.

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Author information

Authors and Affiliations

  1. Clinical Pharmacy, Landspitali-University Hospital, Hringbraut, 101, Reykjavik, Iceland

    Anna I. Gunnarsdóttir

  2. Lothian Pharmacy Practice Unit, Edinburgh and Department of Pharmaceutical Sciences, University of Strathclyde, Glasgow, Scotland

    Moira Kinnear

Authors
  1. Anna I. Gunnarsdóttir
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  2. Moira Kinnear
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Corresponding author

Correspondence to Anna I. Gunnarsdóttir.

Additional information

*This study was conducted by the lead author when based in NHS Lothian, Scotland, while undertaking a MSc in Clinical Pharmacy at the University of Strathclyde, Glasgow.

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Gunnarsdóttir, A.I., Kinnear, M. Factors that Influence Prescribers in their Selection and use of COX-2 Selective Inhibitors as Opposed to Non-selective NSAIDs*. Pharm World Sci 27, 316–320 (2005). https://doi.org/10.1007/s11096-005-2454-x

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