Session Type: Abstract Submissions (ACR)
Background/Purpose: Glucocorticoid-induced osteoporosis (GIOP) is one of the most devastating side effects of glucocorticoid use, leading to a substantially increased risk of fracture and disability . Prevention is considered to be more critical than treatment, especially in patients with known risk factors. In rheumatology, the use of quality indicators (QI) has been receiving increasing attention; the American College of Rheumatology published recommendations in 2010 for the prevention and treatment of GIOP, recommending that patients on as low as 7.5 mg daily of prednisolone or equivalent for more than 3 months be treated with anti-osteoporosis medications. However, few studies have reported on QI implementation and interventions to improve its adherence in the clinical setting. Herein, we assess the efficacy of implementation of a QI initiative to prevent GIOP.
Methods: We reviewed records of all patients prescribed prednisolone as low as 7.5 mg daily or equivalent for more than 3 months in our institution. To evaluate adherence to population-specific preventive care for GIOP, we divided patients into 3 groups based on gender and age: ,men recommended to take a vitamin D analogue (Group A); women <50 years old recommended to take a vitamin D analogue (Group B); and women ≥50 years old recommended to take a bisphosphonate with vitamin D analogue (Group C). Clinical data from 2010 to 2012 were collected to compare the proportion of patients receiving appropriate therapy in each group before and after initiation of QI monitoring, implemented in 2011. Furthermore, prescription rates of preventive therapy were assessed by department in subanalysis.
Results: We identified 1800 eligible patients (586 in Group A, 540 in Group B, and 674 in Group C) in 2010; 2125 patients (760 in Group A, 643 in Group B and 722 in Group C) in 2011; and 2446 patients (851 in Group A, 851 in Group B and 744 in Group C) in 2012. Analysis revealed significant increases of targeted anti-osteoporosis treatment per QI standards after implementation of QI monitoring. Pooled rates of compliance with recommendations improved from 46.8% in 2010 to 52.7% in 2011 and 55.21% in 2012 (p<0.001). Appropriate preventive therapy increased for Group A from 43.34% in 2010 to 57.50% in 2011 and 58.87% in 2012; Group B increased from 63.9% in 2010 to 66.7% in 2011 and 68.2% in 2012; and Group C increased from 36.2% in 2010 to 35.0% in 2011 and 39.5% in 2012. Subanalysis by department demonstrated QI adherance to GIOP guidelines in 2012 as follows: nephrology (81.7%), rheumatology (69.9%), gastroenterology (66.3%), dermatology (60.8%), pulmonology (54.5%), otorhinolaryngology (52.6%), endocrinology (51.5%), orthopedic surgery (41.8%), ophthalmology (31.1%), hematology (29.5%), and neurology (10.4%).
Conclusion: Implementation of a QI for GIOP significantly improves adherence to 2010 ACR GIOP guidelines for appropriate population-specific, preventive therapy. Our results also indicate that, despite institution-wide announcements of QI goals, a substantial information gap may exist between the various clinical subspecialties involved in GIOP patient care.
K. I. Yamaguchi,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-before-and-after-comparison-of-the-effects-of-monitoring-on-a-quality-indicator-for-glucocorticoid-induced-osteoporosis-in-a-japanese-hospital/