Educational Program for Nursing Home Physicians and Staff to Reduce Use of Non-steroidal Anti-inflammatory Drugs Among Nursing Home Residents: a Randomized Controlled Trial

Content: The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients.

Objective: To determine the effects of an educational program on NSAID use and clinical outcomes in nursing homes.

Design And Setting: Randomized controlled study. Ten pairs of Tennessee nursing homes with > or = 8% of residents receiving NSAIDs were randomized to intervention or control.

Subjects: Nursing home residents (intervention n = 76 and control n = 71) aged 65 years and older taking NSAIDs regularly.

Interventions: An educational program for physicians and nursing home staff that included the risks and benefits of NSAIDs in the elderly and an algorithm that substituted acetaminophen, topical agents, and nonpharmacologic measures for the treatment of noninflammatory musculoskeletal pain. Intervention and control subjects were assessed at baseline and 3 months later.

Main Outcome Measures: Differences in NSAID and acetaminophen use, and pain, function, and disability scores in intervention and control nursing home subjects.

Results: The intervention was effective resulting in markedly decreased NSAID use and increased acetaminophen use. Mean number of days of NSAID use in the 7 day periods before the baseline and 3 month assessments decreased from 7.0 to 1.9 days in intervention home subjects compared with a decrease from 7.0 to 6.2 days in control homes (P = 0.0001). Acetaminophen use in the 7 days immediately before the 3 month assessment increased by 3.1 days in intervention home subjects compared with 0.31 days in control homes (P = 0.0001). A similar proportion of subjects in control (32.5%) and intervention (35.4%) groups had worsening of their arthritis pain score (P = 0.81).

Conclusions: An educational intervention effectively reduced NSAID use in nursing homes without worsening of arthritis pain.