Improving on Our Goal to Reduce NSAID-Induced GI Complications: A Challenging Task?

A large number of at-risk patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) do not receive prophylaxis for gastrointestinal (GI) complications. The combination of a 10-min physician educational intervention and a computer alert has been proved to increase the rate of prescribing gastroprotective therapy for high-risk patients who receive ulcerogenic drugs at hospital discharge from 45% to 67%. This improvement is remarkable; still, more than 30% of these high-risk patients did not receive appropriate therapy. Considering that most patients who receive NSAIDs are outpatients treated by generalists, and considering that adherence may be poor and self-medication with NSAIDs is common among patients with GI risk factors, closing the gap between patients treated with NSAIDs who do and do not receive adequate GI prophylaxis is a challenging endeavor. In order to more effectively pursue this goal, we will need to develop new and more complex approaches.