Pharmacist-Led Provider Education on Inappropriate NSAID Prescribing Rates

Abstract

Background and Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used pain medications among US adults with about 70 million people regularly taking NSAIDs annually. Despite clear recommendations from current clinical practice guidelines and recent supporting literature, NSAIDs are continually prescribed inappropriately in patients with chronic kidney disease (CKD), hypertension (HTN), and heart failure (HF). The purpose of this project was to determine the impact of direct pharmacist-led education to providers on rates of inappropriate prescribing of NSAIDs in high-risk populations in a family medicine setting. Methods: This study included all adult (aged 18 years or older) patient charts with NSAIDs prescribed, refilled, or recorded within the specified time periods. We defined inappropriate orders as oral and of chronic duration (at least 90 days) with at least one high-risk International Classification of Diseases-10 chart diagnosis (HTN, HF, CKD). This was a single-center, retrospective chart review of prescribing rates during a 3-month period before and after provider education delivered by a pharmacist. Results: We identified a total of 325 charts from preintervention and 489 charts postintervention that met inclusion criteria. Of those, the charts with orders categorized as inappropriate were 90 versus 44, respectively. The rate of inappropriate prescribing of NSAIDs significantly decreased from 27.7% to 9.0% (P<.0001) postintervention. Among chronic NSAID users, both serum creatinine and systolic blood pressure significantly increased following NSAID initiation. Conclusions: A single pharmacist-led education intervention to primary care providers on inappropriate NSAID use in high-risk patient populations had a significant impact on minimizing inappropriate NSAID prescribing patterns within a family medicine outpatient office.