Managing osteoarthritis and joint pain at work: helping the primary care physician educate patients who rely on non-prescription NSAIDs.

AIMS: To inform physicians who utilise over-the-counter (OTC) analgesics to treat osteoarthritis (OA) pain on differences among agents and to guide decisions in therapy selection. METHODS: A search of medical literature was conducted to identify articles on the treatment of OA published between 1990 and 2009. MEDLINE, EMBASE and SCISEARCH databases were searched using the terms: OTC NSAIDs, NSAIDs, naproxen, low-dose aspirin, ibuprofen, acetaminophen and COX-2-selective NSAIDs. A total of 396 publications were identified. After a review of the literature, 63 publications were considered sufficiently relevant for inclusion in the manuscript. RESULTS: The majority of working patients with OA pain will require exercise, weight control but above all pharmacotherapy. OTC analgesics, including acetaminophen and NSAIDs, provide an effective option for pain management but vary in regard to their safety and efficacy profiles. Selection of an appropriate agent should be based on an evaluation of pain severity, comorbidities and concomitant medications, as well as efficacy and safety of the individual agents. CONCLUSION: The key to effective OTC therapy for OA pain at work is to suggest exercise and weight control but above all to select an agent that will optimally provide effective clinical benefits with a good safety and tolerability profile.

[Critical aspects of the direct distribution of medicines to patients upon discharge at the G. Rummo hospital in Benevento (Italy)]. / Criticità del percorso di distribuzione diretta dei farmaci e possibili interventi correttivi presso l'A.O.

Delivering prescription drugs directly to patients at the moment of discharge from the hospital is a useful tool for ensuring continuity in patient drug use, improving prescriptive appropriateness, limiting pharmaceutical expenditure and analyzing pharmacoepidemiological data. A project was therefore conducted from April 2005 to January 2007, at the G. Rumino hospital in Benevento (Italy), to encourage the direct delivery of drugs to patients upon discharge. The project consisted of various phases. Firstly, the medical records of all patients discharged from the hospital during April 2005 were analysed, mainly to collect information regarding discharge prescriptions, verify whether copies of the discharge form and prescription records were present in the chart, the type of drugs prescribed and whether these were available in the hospital pharmacy list of available drugs and had been dispensed to the patient. The percentage of drugs not available and of patients who did not pick up the prescribed drugs was calculated, critical aspects of the prescription process were analysed, and corrective measures implemented. A second evaluation of medical records was then performed for patients discharged in January 2007, to evaluate the effectiveness of the corrective measures applied. Results show that most discharged patients continue not to take advantage of the direct distribution of drugs in hospital and more information and communication to physicians and patients regarding this opportunity is required.