The debate on the safety of NSAIDs in the medical literature has caused confusion and uncertainty for GPs and patients, and there is a need for clear, unbiased information to help guide decision-making, according to a study in the MJA.
The study authors conducted GP and osteoarthritis patient focus groups to explore the impact of the NSAID debate on prescribing habits, decision-making and safety concerns. The results were analysed to identify key themes arising from the discussions.
For GPs, there was a feeling of uncertainty about the safe use of NSAIDs in general, and COX-2 inhibitors in particular, and all GPs were very concerned about ensuring the patients' wellbeing and protecting against medicolegal liability. GPs had adopted a more cautious approach to NSAID prescribing, using the lowest effective dose for the shortest possible time and increasing the use of paracetamol and non-pharmacological alternatives where possible.
The NSAIDs debate had resulted in more dialogue between GPs and patients, often driven by patients who had heard reports in the media. Patients also actively sought information from other sources, including pharmacists, medical books, consumer medicine information, the internet, and the media. However, the authors note, "Although pharmacists were perceived as reliable sources of information, sometimes in preference to doctors, patients were displeased at the variability of the provision of CMI leaflets from pharmacies." Some patients also complained that their GPs did not provide them with enough information.
Most GPs were sceptical about medical information provided by the pharmaceutical industry or from expert opinion leaders sponsored by drug companies. The authors say that, despite the ongoing efforts of the National Prescribing Service, their findings suggest that there is still a need for clear, unbiased information for GPs and the need for simple tools to help GPs deliver complex information in a meaningful way to patients.
Reference
Mikhail, S. Zwar, N. et al. 2007, 'Non-steroidal anti-inflammatory drugs in general practice: a decision-making dilemma', The Medical Journal of Australia, vol. 187, pp.160-163.
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