Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3051 — Gastrointestinal Symptoms and Pain among Dual NSAID Users

Kovac SH (Durham COE) , Houston TK (Birmingham REAP), Weinberger M (Durham COE)

Patients taking high dosages of non-steroidal anti-inflammatory drugs (NSAIDs) have a ten-fold risk of serious upper gastrointestinal (GI) problems compared to non-NSAID users. Patients using >= 2 NSAIDs (dual users) usually do so because of errors in prescribing or medication behavior. The current study will evaluate the prevalence and characteristics of veterans who are dual users.

We mailed surveys to a randomly selected sample of all patients at the Birmingham and Durham VAMCs who filled >= 3 NSAID prescriptions over 6 months. The survey asked about prescribed and over-the-counter (OTC) NSAID use over the past week, pain, and GI symptoms. Participants were categorized as dual users (>= 2 prescribed or OTC NSAIDs for >= 2 days during the past week) or non-dual users (1 prescribed or OTC NSAID >= 2 days during the past week). We compared dual to non-dual users using chi-square (categorical) and t-tests (continuous variables) on reported GI symptoms and pain. We then used multivariable linear stepwise regression to examine the independent effect of dual use on GI symptoms and pain; covariates included: age, race, income, education, comorbidities, and inpatient visits.

Of 6,861 eligible patients, 1,275 at each VAMC were randomly selected and mailed the survey; 1,572 participants (62%) returned the survey, 329 of whom were excluded for reporting no current NSAID use. Of the remaining 1,243 participants, 126 (10%) were dual users. Compared to non-dual users, dual users were older (72 vs. 67 years, p = .052) and more likely to have incomes <$20,000 (52% vs. 42%, p = .037). Dual users reported significantly (p < .001) more GI symptoms and pain than non-dual users. In multivariable analyses, dual use remained significantly associated with more GI symptoms (Beta = 0.87, p < .001) and pain (Beta = 0.89, p < .001).

Ten percent of veterans using NSAIDs are dual users, and they report more GI symptoms and pain than non-dual users, even after controlling for demographic and clinical characteristics.

We must design practical, cost-effective interventions to reduce NSAID dual use among veterans.