ABSTRACT
All members registered on the managed care database for the chronic condition
Rheumatoid Arthritis (RA), for the period 01 January 2003 to 30 June 2003, were
evaluated to determine the prescribing pattern of the cyclo-oxygenase (COX) II inhibitors
and non-selective non-steroidal anti-inflammatory (NSAIDs). A total of 2818 members
were registered on the managed care database of the chronic condition RA and 1372
members were identified as using COX II inhibitors and 827 members were using nonsteroidal
anti-inflammatory (NSAIDs). The prescribing frequency determined for the
COX II inhibitors were 48.60% and 29.35% for the NSAIDs. The members identified as
either using a COX II inhibitor or a NSAIDs were divided into two groups. The
prescribing patterns of each group such as age, gender, co-morbid conditions,
concomitant medication use and frequency were analysed and compared to the national
institute of clinical excellence (NICE) and the South African Rheumatism and Arthritis
Association (SARAA) guidelines for the appropriate prescribing of the COX II inhibitors.
Celecoxib was the most frequently prescribed COX II inhibitor accounting for 46% of all
the COX II inhibitors identified and diclofenac was the most frequently prescribed
NSAID accounting for 34% of all the NSAIDs prescriptions. COX II inhibitors were
prescribed more frequently to females with a mean age of 55 years than males. A similar
prescribing trend was found with the NSAIDs. The COX II inhibitors were frequently
prescribed to patients over the age of 56 with co morbid gastro-oesophageal disease and
concomitant warfarin and steroid use. The prescribing patterns found in the managed care
environment were similar to those recommended by the NICE and SARAA guidelines.
The managed care data showed that the COX II inhibitors, which are supposed to have
less gastric adverse side effects, were frequently used in combination with gastroprotective
agents (GPA’s).
This study indicates that even though COX II inhibitors were prescribed more frequently
than NSAIDs in the managed care environment the recommended clinical guidelines and
protocols employed by the managed care environment were adhered to. However, there
v
is a need to closely monitor patients on concomitant GPA’s treatment and COX II
inhibitors.
This study helped to evaluate the current prescribing patterns of COX II inhibitors in the
managed health care environment. This study confirmed that guidelines and protocols
were adhered to. These are excellent tools to be used in the managed health care
environment to ensure effective and appropriate prescribing.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/4504 |
| Date | 29 February 2008 |
| Creators | Beeka, Menicksha |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 24720 bytes, 12229 bytes, 593823 bytes, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf, application/pdf |
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