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)

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
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.

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