Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting

Joshua T. Swan, Elsie Rizk, Phuong Y. Duong, Bader M. Alghamdi, Navjot Kaur, Sudha Nagaraj, Anthony E. Brown, Eleazar Flores, Nathan Spence, Sharla Tajchman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). Methods: This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). Results: Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74–83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. Conclusion: A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits.

Original languageEnglish (US)
Article number761
Pages (from-to)761
JournalBMC Musculoskeletal Disorders
Volume24
Issue number1
DOIs
StatePublished - Sep 27 2023

Keywords

  • NSAIDs
  • Osteoarthritis
  • Pain
  • Primary care
  • Quality indicators
  • Renal Insufficiency, Chronic
  • Humans
  • Anti-Inflammatory Agents, Non-Steroidal/adverse effects
  • Quality Indicators, Health Care
  • Osteoarthritis, Knee/diagnosis
  • Proton Pump Inhibitors/therapeutic use
  • Retrospective Studies
  • Primary Health Care
  • Pain/drug therapy

ASJC Scopus subject areas

  • Rheumatology
  • Orthopedics and Sports Medicine

Fingerprint

Dive into the research topics of 'Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting'. Together they form a unique fingerprint.

Cite this