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

Publication ,  Journal Article
Patino, FG; Allison, J; Olivieri, J; Mudano, A; Juarez, L; Person, S; Mikuls, TR; Moreland, L; Kovac, SH; Saag, KG
Published in: Arthritis Rheum
June 15, 2003

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.

Duke Scholars

Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

June 15, 2003

Volume

49

Issue

3

Start / End Page

293 / 299

Location

United States

Related Subject Headings

  • Rheumatology
  • Prostaglandin-Endoperoxide Synthases
  • Practice Patterns, Physicians'
  • Middle Aged
  • Membrane Proteins
  • Isoenzymes
  • Internal Medicine
  • Humans
  • Gastrointestinal Diseases
  • Family Practice
 

Citation

APA
Chicago
ICMJE
MLA
NLM
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 Rheum, 49(3), 293–299. https://doi.org/10.1002/art.11117
Patino, Fausto G., Jeroan Allison, Jason Olivieri, Amy Mudano, Lucia Juarez, Sharina Person, Ted R. Mikuls, Larry Moreland, Stacey H. Kovac, and Kenneth G. Saag. “The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs.Arthritis Rheum 49, no. 3 (June 15, 2003): 293–99. https://doi.org/10.1002/art.11117.
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 Rheum. 2003 Jun 15;49(3):293–9.
Patino, Fausto G., et al. “The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs.Arthritis Rheum, vol. 49, no. 3, June 2003, pp. 293–99. Pubmed, doi:10.1002/art.11117.
Patino FG, Allison J, Olivieri J, Mudano A, Juarez L, Person S, Mikuls TR, Moreland L, Kovac SH, Saag KG. The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs. Arthritis Rheum. 2003 Jun 15;49(3):293–299.
Journal cover image

Published In

Arthritis Rheum

DOI

ISSN

0004-3591

Publication Date

June 15, 2003

Volume

49

Issue

3

Start / End Page

293 / 299

Location

United States

Related Subject Headings

  • Rheumatology
  • Prostaglandin-Endoperoxide Synthases
  • Practice Patterns, Physicians'
  • Middle Aged
  • Membrane Proteins
  • Isoenzymes
  • Internal Medicine
  • Humans
  • Gastrointestinal Diseases
  • Family Practice