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- Page navigation anchor for General practitioners’ NSAID prescribing behaviour – a national quality improvement toolkitGeneral practitioners’ NSAID prescribing behaviour – a national quality improvement toolkit
The editorial by Davis and Robson1 highlights the continuing need for vigilance when managing patients prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Reducing harm associated with the use of these medicines has been a priority for the All Wales Medicines Strategy Group (AWMSG), leading to the development of a quality improvement toolkit to support prescribers. The toolkit entitled “Towards appropriate non-steroidal anti-inflammatory drug (NSAID) prescribing 2010–2012” included educational material and an audit template and was made available on the AWMSG website in April 2010. The educational material provided prescribing advice and highlighted the increased cardiovascular risk associated with diclofenac and high dose ibuprofen compared with naproxen. The audit was designed to help practices review patients receiving repeat NSAID prescriptions and identify those with risk factors associated with adverse effects including age >65 years, medical co-morbidities (e.g cardiovascular disease) and drug interactions.
By October 2010, the audit had been completed by 85 (93%) practices in one of the health boards in Wales, including 9,397 patients prescribed repeat NSAIDs. Subsequent interrupted time series analysis of primary care prescribing data (measured as DDDs per 1,000 Patient Units) for that health board, using an autoregressive integrated moving average (ARIMA) model examined the trend in NSAID use. There was a signi...
Competing Interests: None declared. - Page navigation anchor for NSAIDs and chickenpoxNSAIDs and chickenpox
I read with interest the editorial by Davis and Robson on the dangers of NSAIDs1 and wanted to reinforce the need for better professional and public education surrounding their risks, especially those less frequently encountered. Having recently passed my medical school finals and the national Prescribing Safety Assessment I was initially dismissive of an article in the Daily Mail warning against the use of ibuprofen in children with chickenpox.2
In six years at medical school, numerous encounters with chickenpox and my studies for both these exams this was not something I had ever heard of. A little research though confirmed that NHS Choices,3 both the patient4 and professional5 Patient UK articles and the NICE Clinical Knowledge Summary6 all advise against the use of NSAIDs in children with varicella due to an association with an increased risk of severe skin and soft tissue complications.7 It seems surprising, therefore, that in neither my time as a medical student nor as a patient have I been made aware of this risk.
The guidance is clearly available when sought but with a drug such as ibuprofen that is so freely used and prescribed, perhaps this guidance should be better publicised.
References
1. Davis, A. and Robson, J. The dangers of NSAIDs: look both ways. Br J Gen Pract 2016; 66(645): 72-3.
2....Competing Interests: None declared.