The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs

Fausto G. Patino, Jeroan Allison, Jason Olivieri, Amy Mudano, Lucia Juarez, Sharina Person, Ted R Mikuls, Larry Moreland, Stacey H. Kovac, Kenneth G. Saag

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective. To examine the effects of physician specialty and comorbidities on cyclooxygenase 2-selective nonsteroidal antiinflammatory drugs (NSAIDs; coxibs) utilization. Methods. Medical records of 452 patients from a regional managed care organization with ≥3 consecutive NSAID prescriptions from June 1998 to April 2001 were abstracted. Multivariable adjusted associations between coxib initiation and discontinuation and patient and provider characteristics were examined. Results. A total of 1,142 NSAID prescriptions were written over 9,398 total patient-months of followup. Compared with patients seeing family or general practitioners, patients seeing rheumatologists (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.1-5.7) and internists (OR 2.3, 95% CI 1.5-3.6) were significantly more likely to receive a coxib, as well as patients with a history of osteoarthritis (OR 2.6, 95% CI 1.7-3.8), gastrointestinal disease (OR 2.3, 95% CI 1.2-4.5), and congestive heart failure (OR 4.1, 95% CI 1.0-16.4). Although specialists were more likely than generalists to prescribe coxibs, only family or general practitioners were significantly more likely to selectively use coxibs among their patients with a history of gastrointestinal disease. Fifty-four percent of NSAID prescriptions were discontinued, and coxibs were significantly less likely to be discontinued than were traditional NSAIDs (OR 0.6, 95% CI 0.5-0.8). Conclusion. Our findings suggest significantly greater, but perhaps less selective use of coxibs among specialists, even after accounting for important covariates. The initiation and discontinuation of coxibs was influenced by physician specialty and by patient risk factors.

Original languageEnglish (US)
Pages (from-to)293-299
Number of pages7
JournalArthritis Care and Research
Volume49
Issue number3
StatePublished - Jun 15 2003

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Cyclooxygenase 2 Inhibitors
Comorbidity
Non-Steroidal Anti-Inflammatory Agents
Physicians
Odds Ratio
Confidence Intervals
Prescriptions
Gastrointestinal Diseases
General Practitioners
Managed Care Programs
Cyclooxygenase 2
Osteoarthritis
Medical Records
Anti-Inflammatory Agents
Heart Failure
Organizations
Pharmaceutical Preparations

Keywords

  • Coxibs
  • Nonsteroidal antiinflammatory drugs
  • Practice pattern variation

ASJC Scopus subject areas

  • Rheumatology

Cite this

Patino, F. G., Allison, J., Olivieri, J., Mudano, A., Juarez, L., Person, S., ... Saag, K. G. (2003). The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs. Arthritis Care and Research, 49(3), 293-299.

The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs. / Patino, Fausto G.; Allison, Jeroan; Olivieri, Jason; Mudano, Amy; Juarez, Lucia; Person, Sharina; Mikuls, Ted R; Moreland, Larry; Kovac, Stacey H.; Saag, Kenneth G.

In: Arthritis Care and Research, Vol. 49, No. 3, 15.06.2003, p. 293-299.

Research output: Contribution to journalArticle

Patino, FG, Allison, J, Olivieri, J, Mudano, A, Juarez, L, Person, S, Mikuls, TR, Moreland, L, Kovac, SH & Saag, KG 2003, 'The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs', Arthritis Care and Research, vol. 49, no. 3, pp. 293-299.
Patino FG, Allison J, Olivieri J, Mudano A, Juarez L, Person S et al. The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs. Arthritis Care and Research. 2003 Jun 15;49(3):293-299.
Patino, Fausto G. ; Allison, Jeroan ; Olivieri, Jason ; Mudano, Amy ; Juarez, Lucia ; Person, Sharina ; Mikuls, Ted R ; Moreland, Larry ; Kovac, Stacey H. ; Saag, Kenneth G. / The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs. In: Arthritis Care and Research. 2003 ; Vol. 49, No. 3. pp. 293-299.
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abstract = "Objective. To examine the effects of physician specialty and comorbidities on cyclooxygenase 2-selective nonsteroidal antiinflammatory drugs (NSAIDs; coxibs) utilization. Methods. Medical records of 452 patients from a regional managed care organization with ≥3 consecutive NSAID prescriptions from June 1998 to April 2001 were abstracted. Multivariable adjusted associations between coxib initiation and discontinuation and patient and provider characteristics were examined. Results. A total of 1,142 NSAID prescriptions were written over 9,398 total patient-months of followup. Compared with patients seeing family or general practitioners, patients seeing rheumatologists (odds ratio [OR] 3.4, 95{\%} confidence interval [95{\%} CI] 2.1-5.7) and internists (OR 2.3, 95{\%} CI 1.5-3.6) were significantly more likely to receive a coxib, as well as patients with a history of osteoarthritis (OR 2.6, 95{\%} CI 1.7-3.8), gastrointestinal disease (OR 2.3, 95{\%} CI 1.2-4.5), and congestive heart failure (OR 4.1, 95{\%} CI 1.0-16.4). Although specialists were more likely than generalists to prescribe coxibs, only family or general practitioners were significantly more likely to selectively use coxibs among their patients with a history of gastrointestinal disease. Fifty-four percent of NSAID prescriptions were discontinued, and coxibs were significantly less likely to be discontinued than were traditional NSAIDs (OR 0.6, 95{\%} CI 0.5-0.8). Conclusion. Our findings suggest significantly greater, but perhaps less selective use of coxibs among specialists, even after accounting for important covariates. The initiation and discontinuation of coxibs was influenced by physician specialty and by patient risk factors.",
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AU - Person, Sharina

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