TY - JOUR
T1 - High-risk nonsteroidal anti-inflammatory drugs prescribing in primary care
T2 - results from National Medical Care Survey Malaysia
AU - Hwong, Wen Yea
AU - Lim, Yvonne Mei Fong
AU - Khoo, Ee Ming
AU - Sivasampu, Sheamini
N1 - Funding Information:
NMCS is funded by the Malaysian Research Grant, Ministry of Health, Malaysia (Grant No. NMRR-09-842-4718). WYH is supported by the Honours Track of the MSc Epidemiology, University Medical Center Utrecht, the Netherlands, which has been made possible by a grant from the Netherlands Organization for Scientific Research grant (Grant No. 022.005.021). The funders had no role in the study design, analysis and preparation of the manuscript.
Funding Information:
We thank the Director-General of Health, Ministry of Health, Malaysia for his permission to publish this manuscript. Our sincere thanks go to the NMCS team, providers and patients from all participating clinics. We would like to acknowledge the contribution of Norazida Ab Rahman in editing the manuscript. We are also grateful to the Malaysian Research Grant, Ministry of Health, Malaysia for funding the NMCS. NMCS is funded by the Malaysian Research Grant, Ministry of Health, Malaysia (Grant No. NMRR-09-842-4718). WYH is?supported by the Honours Track of the MSc Epidemiology, University Medical Center Utrecht, the Netherlands, which has been made possible by a grant from the?Netherlands Organization for Scientific Research grant (Grant No. 022.005.021). The funders had no role in the study design, analysis and preparation of the manuscript. All authors declare that they have no conflicts of interest. The datasets containing individual level data that were generated and analysed for the current study are not publicly available due to ethical and patient confidentiality restrictions. All requests for access to the data should be addressed to Dr Sheamini Sivasampu at [email protected].
Funding Information:
We thank the Director-General of Health, Ministry of Health, Malaysia for his permission to publish this manuscript. Our sincere thanks go to the NMCS team, providers and patients from all participating clinics. We would like to acknowledge the contribution of Norazida Ab Rahman in editing the manuscript. We are also grateful to the Malaysian Research Grant, Ministry of Health, Malaysia for funding the NMCS.
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background Information on the extent of high-risk prescribing for nonsteroidal anti-inflammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifies associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and proportion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identified with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1–40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8–29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4–18.1%). A total of 22.9% (95% CI 22.6–23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9–48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0–25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7–23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06–1.43) and the number of diagnoses in one visit (OR 2.21,95% CI 1.71–2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35–0.77) and tertiary education (OR 0.39, 95% CI 0.22–0.68) compared to patients without formal education. Patients’ citizenship, indication for NSAID prescriptions and whether a medical certificate was issued were also significantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety.
AB - Background Information on the extent of high-risk prescribing for nonsteroidal anti-inflammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifies associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and proportion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identified with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1–40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8–29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4–18.1%). A total of 22.9% (95% CI 22.6–23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9–48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0–25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7–23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06–1.43) and the number of diagnoses in one visit (OR 2.21,95% CI 1.71–2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35–0.77) and tertiary education (OR 0.39, 95% CI 0.22–0.68) compared to patients without formal education. Patients’ citizenship, indication for NSAID prescriptions and whether a medical certificate was issued were also significantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety.
KW - Drug utilization review
KW - High-risk prescribing
KW - Malaysia
KW - Non-steroidal anti-inflammatory agents
KW - NSAIDs
KW - Primary health care
UR - http://www.scopus.com/inward/record.url?scp=85078281638&partnerID=8YFLogxK
U2 - 10.1007/s11096-020-00966-w
DO - 10.1007/s11096-020-00966-w
M3 - Article
C2 - 31960271
AN - SCOPUS:85078281638
SN - 2210-7703
VL - 42
SP - 489
EP - 499
JO - International journal of clinical pharmacy
JF - International journal of clinical pharmacy
IS - 2
ER -