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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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co-prescriptionJanuary 21 2015

A pharmacy audit of non-steroidal anti-inflammatory drugs suggests 40% of patients are not being prescribed adequate gastric protection.

Data collected in early 2014 from 1,278 community pharmacies and relating to 16,355 patients found that:

•    6,475 of the patients (40%) had not been prescribed gastric protection products.
•    10% of patients (1,669) were aged over 65 but had not been prescribed gastric protection, despite being at increased risk due to their age of gastro-intestinal damage from the NSAIDs.
•    27.5% of patients (2,838) had been using NSAIDs regularly for more than two months but without taking any medication to protect the gastric lining.

The data has come from the NSAID audit developed by the NHS Specialist Pharmacy Service (SPS) Medicines Use and Safety team along with pharmacy negotiating body, PSNC.

Announcing the study outcome, PSNC said the results mean that “just 73% of prescriptions met the audit standard that all patients regularly prescribed an oral NSAID or COX2 inhibitor for more than two months should be co-prescribed gastro-protection, putting some patients at risk of complications.”

The study found that pharmacies offered 66% of the patients they audited advice on their medicines. They also referred 2,138 patients not prescribed gastro-protection to their GPs.

“The audit is the first of its kind to be carried out on a national scale and the authors of the analysis conclude that it shows that more can be done to improve safety in this patient cohort,” says PSNC. “They also stress the costs to the NHS of avoidable complications from NSAIDs, such as the cost of an admission related to a gastro-intestinal bleed which is estimated to be £6,825.”

Data shows that 21 different NSAIDs were prescribed, eight of which were prescribed to fewer than 15 patients each in the survey. The prescribing rates for the seven most popular NSAIDs were as follows:

•    naproxen 9,713 (59.3%)
•    ibuprofen 3,062 (18.7%)
•    diclofenac Sodium 1,489 (9.1%)
•    meloxicam 498 (3.0%)
•    celecoxib 399 (2.4%)
•    etoricoxib 334 (2.0%)

Proton pump inhibitors (PPIs) were the most commonly prescribed products for gastric protection, prescribed for 56% of patients, and other types of gastric protection were prescribed for 4% of patients.

The authors of the study note: “Over 2,000 patients without gastro-protection were referred to prescribers for review and while the outcomes of the referral are not known, other studies indicate that positive action will result for at least 60%.

“These referrals should prevent well-recognised avoidable harm from NSAIDs and all the subsequent morbidity and associated healthcare cost.”

The survey also found that there were 179 referrals for patients who had been prescribed gastro-protection. “Comments indicated that these referrals were mostly about use of products not licensed for gastro-protection (eg omeprazole 10mg or rabeprazole).

“Occasional issues included poor compliance with gastro-protection, GI symptoms, NSAID dosage queries and other monitoring eg kidney function.”

PSNC’s website carries details of how the NSAID audit has been carried out, with the full methodology available from the SPS website.

Links:

PSNC announcement

‘Community pharmacy Non-Steroidal Anti-Inflammatory Drug safety audit 2014 National data from PharmOutcomes’

NHS Specialist Pharmacy Service (SPS) audit methodology

PSNC NSAID audit

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