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Am J Manag Care. 2004 Nov;10(11 Pt 1):742-50.

Appropriateness of NSAID and Coxib prescribing for patients with osteoarthritis by primary care physicians in Ontario: results from the CANOAR study.

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Centre for Evaluation of Medicines, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.



To assess the appropriateness of nonsteroidal anti-inflammatory drug (NSAID) use relative to recent osteoarthritis treatment guidelines from the Second Canadian Consensus Conference.


Observational study of self-reported practice in a cohort of physicians from the Canadian Osteoarthritis Rx (CANOAR) study.


Ontario primary care physicians were recruited from the top 10% of NSAID prescribers based on the number of NSAID prescriptions filled per year. Physicians were asked to record office visits on a 1-page data collection form from November 2000 to December 2001.


Of 1400 physicians invited, 185 were enrolled and 119 registered office visits. Data were analyzed for the first visits of 5459 patients for whom a prescribed NSAID was identified, of whom 60% were female and 46% were older than 65 years. Coxibs were prescribed for 56% of study patients and were more commonly used by those with recent gastrointestinal (GI) events (85%), those receiving warfarin sodium therapy (79%), and those with congestive heart failure (68%). Coxib use increased with increasing global assessment of OA severity, but not patient age. Overall, 58% of prescriptions were considered appropriate given patient GI risk factors.


Most coxib and NSAID prescriptions were consistent with the guidelines, but there was considerable underuse of coxibs in at-risk patients and some overuse of coxibs and of gastroprotective agents with NSAIDs in patients with no identified GI risk factors. Increased recognition of relationships between patient age and NSAID-related GI risk would likely promote more appropriate use of traditional NSAIDs, coxibs, and gastroprotective agents in osteoarthritis patients.

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