RT Journal Article SR Electronic T1 A Scoping Review of Interventions to De-implement Potentially Harmful NSAIDs in Healthcare Settings JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 5280 DO 10.1370/afm.22.s1.5280 VO 21 IS Supplement 3 A1 Rockwell, Michelle A1 Turner, Jamie K. A1 Singh, Eshika A1 Epling, John A1 Vinson, Matthew A1 Oyese, Emma A1 Yim, Isaiah YR 2023 UL http://www.annfammed.org/content/21/Supplement_3/5280.abstract AB CONTEXT: Although numerous professional organizations recommend against the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) by high-risk patients, potentially harmful use persists. Approaches to de-implement potentially harmful NSAIDs are needed.OBJECTIVE: To provide an overview of published interventions to reduce potentially harmful NSAIDs in healthcare settings, identify literature gaps, and suggest priorities for future research.STUDY DESIGN: Scoping review of the scientific and gray literature from 2000-2021 guided by the PRISMA Scoping Review extension.DATASET: We searched PubMed, CINAHL, Embase, Cochrane Central, and Google for active interventions focused on de-implementing potentially harmful NSAIDs in adults in healthcare settings. “Potentially harmful” was defined as prescribed or taken in a manner inconsistent with professional recommendations.INTERVENTION: Two authors screened abstracts, two authors reviewed full text articles that passed abstract screening, and two authors extracted data from qualifying articles. Consensus was achieved between the two authors at each step if there was disagreement. We used Covidence for review management.OUTCOME MEASURES: Extracted data included country, study design, setting, intervention approach, participants, patient population, and NSAIDs type. We also recorded the change in NSAIDs use and patient-reported outcomes.RESULTS: Of the 7,720 abstracts initially identified, 60 met inclusion criteria. Almost all studies were conducted in the US, Canada, or Europe. Most (57%) employed a randomized controlled trial design. Interventions were most commonly clinician-facing (78%), focused on older adults (57%) or gastrointestinal risks (27%), administered in primary care (83%), and were single component (58%), with education, academic detailing, and audit & feedback being the most widely used approaches. Some (27%) interventions focused on specific NSAIDs (e.g., COX-2 inhibitors) and 15% included both OTC and prescription NSAIDs. The majority (88%) of interventions were associated with reduced NSAIDs use. Patient-reported outcomes were infrequently evaluated.CONCLUSIONS: Many interventions are effective for de-implementing potentially harmful NSAIDs in healthcare settings. Further research is needed to expand interventions to other high-risk populations, incorporate OTC NSAIDs, evaluate patient outcomes such as pain and quality of life, and more broadly disseminate interventions.