The frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) among elderly patients is increasingly controversial, because of the costs for expensive single-source drugs and the substantial clinical and economic consequences of NSAID-associated peptic ulcer disease. Acetaminophen, a safer and often less costly drug, is equally effective for many patients with osteoarthritis, the primary reason for NSAID use in the elderly. The objective of this study is to develop and test an educational program that encourages physicians to reassess elderly NSAID users with osteoarthritis and at high risk of peptic ulcer disease and, when appropriate, conduct a trial of acetaminophen. A randomized controlled trial of the program in Tennessee Medicaid will test three hypotheses: 1. NSAID use will decrease by 33%, leading to a reduction in expenditures for analgesics; 2. There will be a corresponding reduction in the rate of and costs for peptic ulcers; 3. There will be no detectable increase in undesirable effects, including deterioration of patient pain control or function, substitution effects, and serious adverse reactions to acetaminophen. To minimize contamination of the control group, the unit of randomization will be the small geographic region. The 80 health service regions in Tennessee will be matched by patient and physician characteristics and one member of each pair randomly assigned to the intervention group. Each of the estimated 270 physicians in the intervention regions with equal to or greater than 6 elderly Medicaid high-risk NSAID users will receive a brief educational visit from a specially trained physician educator. The evaluation will focus on the estimated 4,000/4,000 intervention/control elderly Medicaid high risk NSAID users in the practices of the visit-eligible physicians. Medicaid-Medicare data for a two year followup period will be used to evaluate changes in analgesic use, rates of and costs for peptic ulcer disease, and possible undesirable effects of the intervention. A special prospective study will be conducted in a random sample of 240/240 intervention/control patients to assess changes in pain control or function.
| Griffin, M R; Yared, A; Ray, W A (2000) Nonsteroidal antiinflammatory drugs and acute renal failure in elderly persons. Am J Epidemiol 151:488-96 |
| Smalley, W E; Griffin, M R; Fought, R L et al. (1996) Excess costs from gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs. J Gen Intern Med 11:461-9 |
| Griffin, M R; Brandt, K D; Liang, M H et al. (1995) Practical management of osteoarthritis. Integration of pharmacologic and nonpharmacologic measures. Arch Fam Med 4:1049-55 |
| Smalley, W E; Griffin, M R; Fought, R L et al. (1995) Effect of a prior-authorization requirement on the use of nonsteroidal antiinflammatory drugs by Medicaid patients. N Engl J Med 332:1612-7 |
