A Scoping Review of Interventions to De-implement Potentially Harmful Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in Healthcare Settings

Abstract

ABSTRACTObjectivesPotentially harmful nonsteroidal anti-inflammatory drugs (NSAIDs) utilization persists at undesirable rates throughout the world. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research.DesignScoping reviewData SourcesPubMed, CINAHL, Embase, Cochrane Central, and Google Scholar (2000-2022)Study SelectionStudies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilization in healthcare settings.Data ExtractionUsing Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilization.ResultsFrom 7,818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the U.S. (35.3%), with randomized controlled trial as the most common design (55.9%). The majority of studies (76.2%) reported a reduction in the utilization of potentially harmful NSAIDs. Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%). Academic detailing, clinical decision support or electronic medical record interventions, performance reports, and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients’ age (55.8%) or history of gastrointestinal disorders (47.1%) or kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter NSAIDs in addition to prescription. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation.ConclusionMany varied interventions are effective in de-implementing potentially harmful NSAIDs in healthcare settings. Efforts to adapt, scale, and disseminate these interventions are needed. In addition, future interventions should address over-the-counter NSAIDs, which are broadly available and widely used. Evaluating unintended consequences of interventions, including patient-focused outcomes, is another important priority.What is already known on this topic–NSAIDs are overutilized by high-risk patients at persistent rates. Interventions to reduce potentially harmful NSAIDs prescribing and over-the-counter (OTC) NSAIDs use are needed.What this study adds–More than 50 studies published internationally from 2000 to 2022 (three quarters of those reviewed) reported on interventions effective in de-implementing potentially harmful NSAIDs. We extracted and summarized characteristics of studies and of interventions to identify research gaps and priorities for future research.How this study might affect research, practice or policy–In light of the large number of effective interventions on record, implementation and dissemination efforts should be the priority of future work.