Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Glucocorticoid-induced osteoporosis (GIOP) is one of the most clinically significant side effects of glucocorticoid use, and the prevention of GIOP has become more important in these days. The American College of Rheumatology (ACR) published the recommendations for the prevention and treatment of GIOP in 2010, and it recommended patients on prednisolone as low as 7.5 mg daily or its equivalent for more than 3 months to take anti-osteoporosis drugs. Quality indicators (QI) has been received an increasing attention in rheumatology field. However, few studies have reported the clinical use of QI in the GIOP care. Herein, we repot the efficacy of monitoring for the QI for GIOP. Besides, It is well known that the adherence to bisphosphonate relate with the risk reduction of fracture, and monthly bisphosphonate greatly improves patient’s adherence. Therefore, we analyzed the prescription trend of monthly bisphosphonate as well.
Methods: We studied all patients who were prescribed prednisolone as low as 7.5 mg daily or its equivalent for more than 3 months in our institution. We divided patients into 3 groups based on gender and age; male as group A, female younger than 50 year-old as group B, and female older than 50 year-old as group C. Group A and B were recommended to take vitamin D analogue, and group C was recommended to take bisphosphonates with vitamin D analogue following the ACR 2010 guideline for GIOP. Since 2011, we started monitoring of QI for GIOP and shared the result with other department in the seasonal QI meeting. Moreover, we informed the need of GIOP treatment to each attending physician if his/her patient was a candidate for the GIOP prophylaxis, by writing the recommended regimen to patients’ chart. Clinical data from 2010 to 2013 were collected to compare the adherence rate in each group (A-C) before and after the investigation. We also measured an adherence rate of each department as a subanalysis. Furthermore, we searched for the trend of drug variation other than vitamin D, especially prescription rate of daily, weekly, monthly bisphosphonates.
Results: After implementation of monitoring, the adherence to the QI standards had elevated year by year until 2013 (69.0% in maximum). In the subanalysis, there were substantial gap in the adherence rate between each department.There was increasing trend in prescription rate of monthly bisphosphonates from 2011. The trend was most prominently seen in rheumatology department. In other departments, the mainstay of osteoporosis treatment was daily or weekly bisphosphonates.
Conclusion: Implementation of monitoring on a QI for GIOP significantly improved adherence to the QI standards, which followed the 2010 ACR GIOP guidelines.Despite institution-wide announcements of QI goals, a substantial information gap may exist between the various clinical subspecialties involved in GIOP patient care.
To cite this abstract in AMA style:Suda M, Okada M, Suyama Y, Kishimoto M, Tsuda T. The Effects of Monitoring on a Quality Indicator for Glucocorticoid–Induced Osteoporosis and Trends of the Drug Variation in a Japanese Hospital [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/the-effects-of-monitoring-on-a-quality-indicator-for-glucocorticoidaeinduced-osteoporosis-and-trends-of-the-drug-variation-in-a-japanese-hospital/. Accessed January 20, 2018.
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