A Cohort Study of NSAID Use: METHODS
Patientswere selected from participating practices of the Tri-State Primary Care Research Network. This network includes more than 25 practices and 200 physicians in the greater metropolitan Philadelphia area. Ten practices with a total of 76 physicians participated. Two of the practices were family practice residency programs with attending and resident physicians. In these practices, second-year and third-year resident physicians as well as attending physicians participated in the study. The other eight practices consisted of solo practitioners or small groups with two to four physicians each. All of the practices provide comprehensive primary care to diverse patient populations.
Eligible patients were 50 years of age or older and had received a prescription (new or renewal) for an NSAID for any indication with an expected duration of treatment of 14 or more days. Potential subjects were identified by their primary care physicians and were referred to one of two research assistants to determine their eligibility. Patients who could not understand or complete the baseline interview or who did not anticipate being available for the two scheduled follow-up visits were excluded from enrollment.
After reviewing and signing a consent form, participants completed an interviewer-administered baseline survey that lasted 20 to 30 minutes. Two and six weeks after the baseline survey, a research assistant contacted the participants by telephone. Each telephone interview took five to 10 minutes. Patients were paid for their participation.
The investigators developed and pilot-tested the survey instruments in conjunction with an independent organization specializing in test construction. The baseline survey asked patients about demographics and their general health in addition to their knowledge, attitudes, and practices regarding previous NSAID therapy. The follow-up surveys assessed patterns of NSAID use and any reasons for discontinuing therapy.
Patients were also asked about any GI symptoms they experienced while taking prescription NSAIDs, and how they managed these symptoms, and about their use of prescription or OTC gastroprotective medications. To facilitate the patients’ recognition of prescription and nonprescription products, the research assistant gave them professionally produced cards with pictures of available gastroprotective medicines. The institutional review boards that were responsible for the practice sites approved all of the procedures.
Because we anticipated that the patients’ perceived effectiveness and drug tolerability would be related to their previous exposure to NSAIDs, we categorized patients according to their self-reported earlier experience with these agents as follows:
• New NSAID users received a prescription for an NSAID at the baseline visit and reported that they had not taken NSAIDs for more than one day during the previous two weeks.
• Changed NSAID users reported using an OTC or prescription NSAID in the previous two weeks but then receiving a different NSAID prescription from their physician.
• Renewal NSAID users received a continuing prescription for NSAIDs. cialis canadian pharmacy
The study was designed to follow patients’ experiences with NSAIDs under normal practice conditions, with no attempt made to influence the physicians’ patterns of NSAID-prescribing behaviors or their instructions to their patients. Patients received no instructions about their medication use. Drug adherence was not protocol-driven, and all survey data were collected separately from the physician-patient interactions. The SAS® PC program, version 8.0 (Windows™ statistical package, SAS Institute, Cary, North Carolina) was used to analyze the data.