The prevalence and contributing factors of NSAIDs prescription among chronic kidney disease patients in primary care: a mixed methods study from Kingdom of Bahrain.

Background: The prevalence of Non-steroidal Anti-Inflammatory Drugs (NSAIDs) prescription and its contributory factors among chronic kidney disease (CKD) patients are unknown in the Kingdom of Bahrain - though NSAIDs are known to cause significant renal impairment. This study will determine the prevalence of NSAIDs prescription among CKD patients and the contributory factors to this behavior from the perspective of primary care physicians in Bahrain.

Methodology: A sequential mixed-method design study comprising of a retrospective cross-sectional survey drawn from patients' electronic medical records (EMR) and qualitative in-depth interviews with primary care physicians (PCPs) was conducted between December 2022 and January 2023 - with an EMR data lookback from 1 st June 2021 to 1 st June 2022 Quantitative descriptive analysis was conducted to estimate the prevalence of NSAIDs and their associations with sociodemographic and service delivery indicators. An Ishikawa diagram was used to describe contributory factors to NSAID prescription among CKD patients drawing from the literature and was used to guide a deductive thematic analysis of the qualitative data.

Result: Of the enrolled CKD patient population (4,380 patients), 17.4% had at least one inappropriate NSAID prescription. 80% of these patients had moderate renal impairment, while 19.3% had severe impairment. Most of the prescriptions were in 24-h health centers (48.5%). A Bivariate relationship between the prescription and the sociodemographic factors showed a significant P value regarding age (P-value 0.008*) and the severity of the renal impairment (P-value < 0.001*). The contributory factors were divided into five themes: patient factors, physician factors, health team factors, I SEHA factors and system factors. Of these themes, patients and PCPs were identified by the primary care physicians as some of the most important reasons for NSAIDs prescription among CKD patients.

Conclusion: The prevalence of NSAIDs prescription among CKD patients is relatively high in the kingdom of Bahrain - largely due to patient and physician factors as identified by primary care physicians. Possible solutions for addressing these factors include raising awareness among patients, PCPs, and other healthcare workers and activating the Swiss Cheese Model that involves patients, PCPs, and other health team members to ensure appropriate medication practice and patients' safety.