Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting
Abstract Background Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06904-x |
| _version_ | 1827725149151952896 |
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| author | Joshua T. Swan Elsie Rizk Phuong Y Duong Bader M. Alghamdi Navjot Kaur Sudha Nagaraj Anthony E. Brown Eleazar Flores Nathan Spence Sharla Tajchman |
| author_facet | Joshua T. Swan Elsie Rizk Phuong Y Duong Bader M. Alghamdi Navjot Kaur Sudha Nagaraj Anthony E. Brown Eleazar Flores Nathan Spence Sharla Tajchman |
| author_sort | Joshua T. Swan |
| collection | DOAJ |
| description | Abstract Background Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). Methods This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). Results Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74–83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. Conclusion A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits. |
| first_indexed | 2024-03-10T22:25:23Z |
| format | Article |
| id | doaj.art-b42c7cef2baa4d88a6e4395c398bb9ac |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-10T22:25:23Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-b42c7cef2baa4d88a6e4395c398bb9ac2023-11-19T12:08:10ZengBMCBMC Musculoskeletal Disorders1471-24742023-09-012411710.1186/s12891-023-06904-xSpecification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care settingJoshua T. Swan0Elsie Rizk1Phuong Y Duong2Bader M. Alghamdi3Navjot Kaur4Sudha Nagaraj5Anthony E. Brown6Eleazar Flores7Nathan Spence8Sharla Tajchman9Department of Pharmacy, Houston MethodistDepartment of Pharmacy, Houston MethodistDepartment of Pharmacy, Houston MethodistDepartment of Pharmacy, Houston MethodistDepartment of Pharmacy, Houston MethodistHouston Methodist Primary Care Group, Houston MethodistHouston Methodist Primary Care Group, Houston MethodistHouston Methodist Primary Care Group, Houston MethodistPfizer, IncPfizer, IncAbstract Background Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). Methods This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). Results Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74–83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. Conclusion A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits.https://doi.org/10.1186/s12891-023-06904-xOsteoarthritisPainQuality indicatorsPrimary careNSAIDs |
| spellingShingle | Joshua T. Swan Elsie Rizk Phuong Y Duong Bader M. Alghamdi Navjot Kaur Sudha Nagaraj Anthony E. Brown Eleazar Flores Nathan Spence Sharla Tajchman Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting BMC Musculoskeletal Disorders Osteoarthritis Pain Quality indicators Primary care NSAIDs |
| title | Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| title_full | Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| title_fullStr | Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| title_full_unstemmed | Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| title_short | Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| title_sort | specification validation and adherence of quality indicators to optimize the safe use of nonsteroidal anti inflammatory drugs for knee osteoarthritis pain in the primary care setting |
| topic | Osteoarthritis Pain Quality indicators Primary care NSAIDs |
| url | https://doi.org/10.1186/s12891-023-06904-x |
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