Nurse intervention can cut NSAID use

By Pat Hagan

LONDON (Reuters Health) – The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis can be dramatically reduced through a nurse-led advisory service, according to a report in the January issue of Rheumatology.

Compared with controls, 28% of patients on regular doses of NSAIDs who used the service for 6 months either stopped taking or reduced NSAID use by more than 50%. None suffered any ill effects as a result.

UK researchers from Nottingham University and City Hospital Nottingham said the findings show the service has the capacity to cut NSAID usage and slash drug spending.

"Nurse-based intervention can reduce chronic NSAID usage and costs in primary care and would be cost-effective if maintained in the long term," lead investigator Dr. Adrian C. Jones and colleagues wrote. "This intervention package would be readily applicable in primary care."

A report by scientists at the John Radcliffe Hospital in Oxford 2 years ago claimed NSAIDs were responsible for about 2000 deaths a year in the UK.

But reducing patient dependence on the drugs has proved to be a big problem for busy GPs. The latest study looked at whether setting up services led by nurses trained in musculoskeletal assessment could help.

They focused on five GP surgeries in Nottinghamshire and identified 222 patients with nonmalignant, noninflammatory back or joint pain who were all on repeat prescriptions for oral NSAIDs.

The patients were split into two groups: a control group that received simple advice on NSAID use and a treatment group that was encouraged to quit taking NSAIDs altogether in favour of other drug or nondrug therapies. These included measures such as losing weight, getting fit, and trying new footwear.

The patients in the intervention group reported no detrimental effects to their health and well being as a result of switching to alternative therapies, and a separate analysis found their GPs' spending on NSAIDs had declined significantly.

However, Dr. Jones said that although NSAID spending had declined, average drug costs for all patients had increased.

"Total drugs costs increased from about £56 per person to £78 for patients in the intervention group, and from £90 to £112 in the control group," he told Reuters Health.

"We're not sure why. It may have been that they were taking more expensive drugs or treatments, or it may simply have been because they had more contact with their GP as a result of seeing the nurse."

He added the study was conducted before the emergence of COX-2 inhibitors, a new class of generally safer NSAIDs, which GPs are being encouraged to consider for patients with chronic musculoskeletal pain.

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