Changing perceptions and practices regarding aspirin, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs among US primary care providers. 
Our understanding of the benefits and risks of aspirin non steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) selective NSAIDs and gastro-protective agents (GPAs) continues to expand.  To assess the perceptions and practices of US primary care physicians (PCPs) regarding the use of aspirin, NSAIDs, COX-2 selective NSAIDs and GPA.  A 34-question survey was administered to 1000 US PCPs via the internet.  Questions addressed issues involving aspirin, NSAIDs, COX-2 selective NSAIDs, and GPAs.  Around 491 of 1000 PCPs had participated in a similar survey conducted in 2003.  Eighty-five per cent of PCPs reported that >25% of their patients were taking aspirin for preventive reasons.  Nineteen per cent performed a risk calculation when deciding whether to start aspirin for cardioprotection.  Fifty-four per cent recommended a proton pump inhibitor (PPI) for a patient with a recently healed ulcer who required ongoing aspirin.  Thirty-one per cent reported prescribing NSAIDs more often and 52% were more likely to recommend a GPA with an NSAID than in 2003.  Although PCPs were less likely to recommend a COX-2 selective NSAID compared to 2003, only 41% felt that rofecoxib increased cardiovascular risk.  One-third felt that celecoxib and traditional NSAIDs were associated with increased cardiac risk.  This survey identified several areas of ongoing confusion regarding aspirin, NSAIDs, COX-2 selective NSAIDs and GPAs, which should help direct future educational efforts regarding the benefits, risks and appropriate use of these agents.