Evidence map›Paper›PMID 38631836›Full record

ArticleBMJ open2024

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings.

Michelle S Rockwell, Emma G Oyese, Eshika Singh, Matthew Vinson, Isaiah Yim, Jamie K Turner, John W Epling

Abstract readScoping Review
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Michelle S RockwellFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA msrock@vt.edu.ORCID 0000-0001-7910-6083
Emma G OyeseFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Eshika SinghFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Matthew VinsonFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Isaiah YimFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Jamie K TurnerFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
John W EplingFamily and Community Medicine, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesPotentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. 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 review. DATA SOURCES: PubMed, CINAHL, Embase, Cochrane Central and Google Scholar (1 January 2000 to 31 May 2022). STUDY SELECTION: Studies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilisation in healthcare settings. DATA EXTRACTION: Using Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilisation.

resultsFrom 7818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the USA (35.3%), with randomised controlled trial as the most common design (55.9%). Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%) but were rarely (14.9%) guided by an implementation model, framework or theory. 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%), history of gastrointestinal disorders (47.1%), or history of kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter (OTC) NSAIDs in addition to prescription. The majority of studies (76.2%) reported a reduction in the utilisation of potentially harmful NSAIDs. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation.

conclusionMany varied interventions to de-implement potentially harmful NSAIDs have been applied in healthcare settings worldwide. Based on these findings and identified knowledge gaps, further efforts to comprehensively evaluate the effectiveness of interventions and the combination of intervention characteristics associated with effective de-implementation are needed. In addition, future work should be guided by de-implementation theory, focus on OTC NSAIDs and incorporate patient-focused strategies and outcomes, including the evaluation of unintended consequences of the intervention.

Indexed as

Anti-Inflammatory Agents, Non-SteroidalHumansAnti-Inflammatory Agents, Non-SteroidalCardiovascular DiseaseChronic PainGERIATRIC MEDICINEHealth & safetyPrimary CareQuality in health care

Identifiers

PMID38631836
PMCPMC11029194

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.