PMID- 37759196
OWN - NLM
STAT- MEDLINE
DCOM- 20231004
LR  - 20231121
IS  - 1471-2474 (Electronic)
IS  - 1471-2474 (Linking)
VI  - 24
IP  - 1
DP  - 2023 Sep 27
TI  - 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.
PG  - 761
LID - 10.1186/s12891-023-06904-x [doi]
LID - 761
AB  - 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.
CI  - (c) 2023. BioMed Central Ltd., part of Springer Nature.
FAU - Swan, Joshua T
AU  - Swan JT
AD  - Department of Pharmacy, Houston Methodist, Houston, TX, USA. 
      swan.joshua@gmail.com.
AD  - Department of Surgery, Houston Methodist, Houston, TX, USA. 
      swan.joshua@gmail.com.
AD  - Center for Outcomes Research, Houston Methodist, Houston, TX, USA. 
      swan.joshua@gmail.com.
FAU - Rizk, Elsie
AU  - Rizk E
AD  - Department of Pharmacy, Houston Methodist, Houston, TX, USA.
AD  - Department of Surgery, Houston Methodist, Houston, TX, USA.
FAU - Duong, Phuong Y
AU  - Duong PY
AD  - Department of Pharmacy, Houston Methodist, Houston, TX, USA.
AD  - Department of Surgery, Houston Methodist, Houston, TX, USA.
FAU - Alghamdi, Bader M
AU  - Alghamdi BM
AD  - Department of Pharmacy, Houston Methodist, Houston, TX, USA.
AD  - Department of Surgery, Houston Methodist, Houston, TX, USA.
FAU - Kaur, Navjot
AU  - Kaur N
AD  - Department of Pharmacy, Houston Methodist, Houston, TX, USA.
AD  - Department of Surgery, Houston Methodist, Houston, TX, USA.
FAU - Nagaraj, Sudha
AU  - Nagaraj S
AD  - Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA.
FAU - Brown, Anthony E
AU  - Brown AE
AD  - Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA.
FAU - Flores, Eleazar
AU  - Flores E
AD  - Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA.
FAU - Spence, Nathan
AU  - Spence N
AD  - Pfizer, Inc, New York, NY, USA.
FAU - Tajchman, Sharla
AU  - Tajchman S
AD  - Pfizer, Inc, New York, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20230927
PL  - England
TA  - BMC Musculoskelet Disord
JT  - BMC musculoskeletal disorders
JID - 100968565
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Humans
MH  - *Osteoarthritis, Knee/diagnosis/drug therapy/chemically induced
MH  - Retrospective Studies
MH  - Quality Indicators, Health Care
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Pain/drug therapy
MH  - *Renal Insufficiency, Chronic
MH  - Primary Health Care
PMC - PMC10523610
OTO - NOTNLM
OT  - NSAIDs
OT  - Osteoarthritis
OT  - Pain
OT  - Primary care
OT  - Quality indicators
COIS- Co-authors Sharla Tajchman and Nathan Spence, who are employees at Pfizer with 
      stock and/or stock options, participated in study design, interpretation of study 
      data, and writing of the manuscript. All remaining authors declare no conflict of 
      interest.
EDAT- 2023/09/28 00:42
MHDA- 2023/10/04 06:44
PMCR- 2023/09/27
CRDT- 2023/09/27 23:44
PHST- 2023/03/16 00:00 [received]
PHST- 2023/09/21 00:00 [accepted]
PHST- 2023/10/04 06:44 [medline]
PHST- 2023/09/28 00:42 [pubmed]
PHST- 2023/09/27 23:44 [entrez]
PHST- 2023/09/27 00:00 [pmc-release]
AID - 10.1186/s12891-023-06904-x [pii]
AID - 6904 [pii]
AID - 10.1186/s12891-023-06904-x [doi]
PST - epublish
SO  - BMC Musculoskelet Disord. 2023 Sep 27;24(1):761. doi: 10.1186/s12891-023-06904-x.