A toward prevention of ADR-related hospital admissions. Study


A lot of older patients take NSAIDS chronically. There
are a lot of adverse effects associated with chronic NSAID use including the risk of acute renal failure, stroke/myocardial
infarction, peptic ulcer disease, as well as worsening of other chronic
diseases including heart failure, hypertension. NSAIDs can also interact with a
number of drugs (warfarin, corticosteroids) ultimately increasing
hospitalizations amongst the elderly population. (4). Adverse drug events are
more likely to affect geriatric patients due to physiological changes occurring
with aging, from changes in renal function and metabolic changes. (3).


Non-steroidal anti-inflammatory drugs are a common
class of analgesic typically used chronically for pain such as musculoskeletal
pain including osteoarthritis. It is commonly used in the elderly population.

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Approximately 40% of people
over 65 years of age fill one or more prescriptions of NSAIDS each year not
including the over the counter NSAIDs. (5)


The main risk factors for ADR admissions are advanced age,
polypharmacy, comorbidity, and potentially inappropriate medications. (7). One
study emphasized on the need for an ADR events prediction tool to identify
high-risk patients (elderly population) thus target appropriate interventions
toward prevention of ADR-related hospital admissions. Study further emphasized
on the role of primary care doctors and pharmacists in the communities in
identifying patent at risk for ADR. (7). There are currently no validated tools
to assess the risk of ADRs in primary care.



According to a systematic review and meta-analysis that was performed
through a computerized search of main databases, between 1988 to 2015,
addressing adverse drug reaction-induced hospital admissions in
patients over 60 years of age, NSAIDS was the most common medication
induced adverse effects leading to hospitalizations ranging for 2.3 to 33.3%. (6)           


According to a prospective cohort study done, participating
pharmacies were called the intervention group (IG) and received feedback on
drug dispensing in non selective -NSAID users of ?60?years of age at risk for
UGI damage and were instructed to select patients to improve ns-NSAID
prescribing, in collaboration with primary care physicians. Ns-NSAID users from
other pharmacies without concomitant Gastro-protective agents (GPA) use were
followed in parallel as a control group (CG). Changes in the UGI risk of ns-NSAID
users between baseline and follow-up measurement, assessed either by the
addition of GPAs or the cessation of ns-NSAIDs, were compared between the two
study arms. Results showed that persistent ns-NSAID users from the selected IG
patients had an additional 7% likelihood of reduced UGI risk at follow-up (odds
ratio 0.93, 95% confidence interval 0.89–0.97) compared with CG patients. In
the IG, 91% of selected IG patients at UGI risk from ns-NSAIDs at baseline were
no longer at increased risk at follow-up because of cessation of ns-NSAIDS or
to concomitant GPA use. (10)


There is approximately one per 1000 persons per year in the
general population with an incidence of hospitalization for complicated peptic
ulcer disease among non-users of anti-inflammatory drugs compared to four and
five events of hospitalization amongst na-NSAIDs users with higher incidence
with higher dose of any NSAIDs (1)


It is important to understand the negative
complications of NSAIDS which includes increased mortality, morbidity and
increased health care cost. Providers should discuss potential adverse effects
of NSAIDS to patients and also review medication list as some patients may be taking
multiple NSAIDS without understanding the adverse effects of NSAIDS and
recognize patients at risk for developing adverse events. It is one of the most
preventable causes for hospital admissions in the elderly.  Patients taking NSAIDS are more likely to be
hospitalized versus those not taking NSAIDS. Patients with a history of peptic ulcer disease could benefit the most
from a reduction in NSAID induced gastro toxicity (2). Primary Care Physicians
should lower doses of NSAIDs to reduce adverse effects risk especially in the
group of patients with the greatest risk.