Drug Safety: Informing patients about risks.
IF a patient is newly prescribed any of the following drugs: NSAIDs (selective or non-selective), DMARDs, glucocorticoids or narcotics, THEN a discussion with the patient about the risks of the chosen therapy should be documented.
Drug Safety: Prophylaxis for patients at risk for gastrointestinal bleeding.
IF a patient is treated with 1) a non-selective NSAID or 2) a COX-2 selective NSAID plus aspirin, AND the patient has risk factors for upper gastrointestinal bleeding‡, THEN the patient should be treated concomitantly with either misoprostol or a proton pump inhibitor unless patient refuses.
Drug Safety: Lab monitoring.
IF a patient is treated with daily NSAIDs (selective or non-selective) and the patient has risk factors for gastrointestinal bleeding‡ THEN a hemoglobin or hematocrit should be performed at baseline and during the first year after initiating therapy.
Drug Safety: Lab monitoring.
IF a patient is treated with daily NSAIDs (selective or non-selective) AND the patient has risk factors for developing renal insufficiency** THEN a serum creatinine should be assessed at baseline, within the first 3 months, and then at least annually thereafter.
Drug Safety: Lab monitoring.
IF a patient with rheumatoid arthritis is newly prescribed a DMARD, THEN appropriate baseline studies should be documented within an appropriate period of time from the original prescription. (SEE Table 1).
Drug Safety: Lab monitoring.
IF a patient has established treatment with a DMARD or glucocorticoids, THEN monitoring for drug toxicity should be performed. (SEE Table 2).
*NSAID = non-steroidal anti-inflammatory drug
‡ Risk factors for gastrointestinal bleeding are defined as any of the following: age ≥ 75, peptic ulcer disease, gastrointestinal bleeding, or glucocorticoid use.
** Risk factors for renal insufficiency defined as any of the following: age ≥ 75, diabetes mellitus, hypertension, angiotensin converting enzyme (ACE) inhibitor use or diuretic use.
References
Arthritis Foundation Quality Indicator Project
Saag KG, Olivieri JJ, Patino F, Mikuls TR, Allison JJ, MacLean CH. The Arthritis Foundation’s quality indicators for nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic therapies. Arthritis Rheum. 2004;51:337-349.
Assessing Care for Vulnerable Elders
http://www.rand.org/health/projects/acove/quality_indicators.html
Grossman JM, MacLean CH. Quality indicators for the management of osteoporosis in vulnerable elders. Ann Intern Med2001; 135:722-730.
Shekelle PG, MacLean CH, Morton SC, Wenger NS. ACOVE quality indicators. Ann Intern Med 2001; 135:653-667.
