Use of gastrointestinal prophylaxis in NSAID patients: a cross sectional study in community pharmacies

Objective To assess the appropriateness of gastroprotective agents (GPA)\ NSAID use in patients’ access medication through community pharmacy and the factors associated with any inappropriateness found. Methods A cross-sectional study in which patients requesting NSAIDs through community pharmacy was undertaken. Information was collected through a structured questionnaire included data of patients’ pharmacotherapy and gastropathy risk factors. Patients were classified as “overprotected” or “underprotected” according to the use of gastroprotective-drugs and presence/absence of gastropathy risk factors. We calculated the risk for under-or over-protection using logistic regression controlling for potential confounders. Results Twenty-seven community pharmacies of Southeast of Spain participated in the study. Out of 670 NSAID users recruited in the study, 243 (36.3%) were not appropriately protected: 197(81.1%) patients were underprotected, and 46 (18.9%) patients were overprotected. Compared to patients with ulcer history, patients with cardiovascular disease or chronic morbidity (aOR 18.55; 95% CI l 3.68–93.52, P < 0.001) and aged over 60 years (aOR 23.97; 95% CI 3.93–145.9) were associated with underuse of gastroprotective-drugs. OTC-NSAID-users were more likely to be underprotected than those with medical prescription (aOR 3.47; 95% CI l 1.84–6.55). Conclusions Inappropriate GPA use is relatively frequent among NSAD users, especially in those using OTC-NSAIDs. Community pharmacists should be aware of factors contributing to NSAID-induced GI complications and assess its presence in the consumer when dispensing an OTC-NSAID.