(P-410) The Effectiveness of a Module for Primary Health Care Professionals in Preventing Nonsteroidal Anti-inflammatory Drugs-associated Gastrointestinal Adverse Reactions Among Elderly

Background: Inappropriate prescribing of Nonsteroidal Anti-inflammatory Drug (NSAID) among the elderly may increase the risk of adverse drug reaction (ADR). Inappropriate prescribing often occurred in primary health centres (PHCs) due to health care professionals (HCPs) incapabilities.

Objectives: We aimed to evaluate the effectiveness of a module, in improving HPC’s knowledge and prescribing of NSAID for the elderly in PHC, which further will decrease the ADR.

Methods: This is a 3-months experimental study in 8 PHCs to examine the effectiveness of a module that was developed to improve NSAID prescribing for the elderly by HCPs. The module, first of its kind designed to be applied at PHCs in Indonesia, was developed through a scientific method based on the real problem found in the field, explained in another publication. The PHCs were divided into 2 groups, intervention and control. In the intervention group (4 PHCs), workshops using the module for the HCPs were run, while no intervention was done in the control PHCs (4 PHCs). We identified the inappropriate prescriptions based on the medical records and patient interviews. In addition, to examine the module effectiveness to prevent NSAID associated gastrointestinal (GI) ADR in PHCs, we compiled GI symptoms reported by patients, and rapid test result of faecal occult bleeding.

Results: We evaluated performance of 10 HCPs from the intervention group and 11 HPCs from control group. All participants agreed that the module is important for their practice (47.9% agreed, 52.1% strongly agreed), and applicable for the PHC (68.8% agreed, 31.2% strongly agreed). The HCP’s knowledge of NSAID improved significantly. The doctors’ mean score of pre-test (maximum score 100) was 71 ± 10.41, and the post-test was 95.00 ± 5.00 (p = 0.020). The nurse/midwives’ mean score of pre-test (maximum score 100) was 58.13 ± 13.61 and the post-test was 85.63 ± 5.630 (p = 0.002). By considering other risk factors of ADR, the multivariate analyses showed that the HCPs who did not participate in module workshop would contribute to inappropriate prescribing (adjusted OR 5.84; CI 1.91−17.88). The module did not directly affect the incidence of GI ADR of the patients 3 months post intervention.

Conclusions: The module worked effectively on HCP’s knowledge about NSAID and reduced inappropriate prescribing for the elderly even after 3 months of intervention. Evaluation up to 3 months after intervention could not give a clear effect of the module on the incidence of GI ADR in the elderly patients.