Assessing Gastro-Protective Medication Co-Prescription with NSAIDs, Anticoagulants, and Antiplatelets in Primary Care: An audit

Introduction: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), antiplatelets and anticoagulants, are ulcerogenic drugs associated with gastrointestinal (GI) bleeding, increased hospitalisation risks and straining healthcare resources. Co-prescribing gastroprotective medications (GPMs) can mitigate these effects. Methodology: Searches were conducted on electronic health record system ‘SystmOne’ to identify patients in a Northampton primary care setting from 02/01/2023 to 07/07/2023. Eligible patients were identified according to Medicine Safety 01- Medicine Safety 03 under the NHS Investment and Impact Fund Guidance to PCNs 2020/21: Over 65 and on NSAIDs, over 18 on anticoagulants and antiplatelets, over 18 on aspirin and another antiplatelet. Patient medication lists were anonymised and recorded. This data was used to produce descriptive statistics and for analysis against prior audit data from 01/10/2019 to 12/11/2020. Results: 81 patients were identified, with 66 patients above 65 and on NSAIDs, 4 patients above 18 on anticoagulants and antiplatelets and 11 patients above 18 on aspirin and another antiplatelet. 92.6% (75 out of 81) of patients were prescribed GPMs, a 18.7% relative increase, or a 14.6 percentage point improvement, from the 01/10/2019 to 12/11/2020 period. Discussion: Rational prescribing requires regular evaluation. Proton pump inhibitors (PPIs) are preferred gastroprotective medications and warrant supervision when co-prescribed with ulcerogenic drugs. GI bleeding has multiple aetiologies, each mandating its own treatments. By involving a multi-disciplinary team, implementing clinical education and conducting systematic auditing, hospitalisation numbers can be reduced. Conclusion: GPM prescriptions with NSAIDs, anticoagulants and antiplatelets in line with aforementioned guidelines have improved in the primary healthcare setting between the two audited time periods. This serves as a good reflection for healthcare practices, offering actionable insights to enhance appropriate drug use while supporting the development and implementation of effective policies.