Appropriateness of NSAID and Coxib prescribing for patients with osteoarthritis by primary care physicians in Ontario: results from the CANOAR study

Am J Manag Care. 2004 Nov;10(11 Pt 1):742-50.


Objective: To assess the appropriateness of nonsteroidal anti-inflammatory drug (NSAID) use relative to recent osteoarthritis treatment guidelines from the Second Canadian Consensus Conference.

Study design: Observational study of self-reported practice in a cohort of physicians from the Canadian Osteoarthritis Rx (CANOAR) study.

Subjects and methods: Ontario primary care physicians were recruited from the top 10% of NSAID prescribers based on the number of NSAID prescriptions filled per year. Physicians were asked to record office visits on a 1-page data collection form from November 2000 to December 2001.

Results: Of 1400 physicians invited, 185 were enrolled and 119 registered office visits. Data were analyzed for the first visits of 5459 patients for whom a prescribed NSAID was identified, of whom 60% were female and 46% were older than 65 years. Coxibs were prescribed for 56% of study patients and were more commonly used by those with recent gastrointestinal (GI) events (85%), those receiving warfarin sodium therapy (79%), and those with congestive heart failure (68%). Coxib use increased with increasing global assessment of OA severity, but not patient age. Overall, 58% of prescriptions were considered appropriate given patient GI risk factors.

Conclusions: Most coxib and NSAID prescriptions were consistent with the guidelines, but there was considerable underuse of coxibs in at-risk patients and some overuse of coxibs and of gastroprotective agents with NSAIDs in patients with no identified GI risk factors. Increased recognition of relationships between patient age and NSAID-related GI risk would likely promote more appropriate use of traditional NSAIDs, coxibs, and gastroprotective agents in osteoarthritis patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antacids / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Cohort Studies
  • Contraindications
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Drug Prescriptions / standards
  • Drug Utilization / standards
  • Drug Utilization / statistics & numerical data*
  • Family Practice / standards*
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Gastrointestinal Hemorrhage / chemically induced
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Observation
  • Ontario
  • Osteoarthritis / drug therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Risk Factors


  • Antacids
  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase Inhibitors