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Abstract Number: 1978

A Web-Based Intervention Aimed to Improve Bone Health Among Individuals On Chronic Glucocorticoids

Amy H. Warriner1, Ryan C. Outman2, Nathan Markward3, Ronald Aubert3, Jeffrey R. Curtis4, Robert Epstein3, Felix Freuh3, Julia McEachern3, David T. Redden5, Monika M. Safford2, Eric Stanek3, Amy Steinkellner3 and Kenneth G. Saag6, 1Endocrinology, Diabetes, and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, 2Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 3Medco, Bethesda, MD, 4Rheumatology & Immunology, Univ of Alabama-Birmingham, Birmingham, AL, 5Biostatistics, University of Alabama at Birmingham, Birmingham, AL, 6Div Clinical Immun & Rheum, Univ of Alabama-Birmingham, Birmingham, AL

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: glucocorticoids, osteoporosis, patient participation and prevention

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Session Information

Title: Osteoporosis and Metabolic Bone Disease

Session Type: Abstract Submissions (ACR)

Background/Purpose: Despite a significant associated fracture risk, previous population-based studies document low osteoporosis treatment rates for individuals treated with chronic glucocorticoids (GCs) at risk for glucocorticoid-induced osteoporosis (GIOP). We evaluated the influence of a direct-to-patient web-based educational video on the rates of anti-osteoporosis prescription medication use among chronic GC users who filled GCs online.

Methods: Using integrated medical and pharmacy data, we identified members of a pharmacy benefits management company who were prescribed ≥5 milligrams of prednisone (or an equivalent) for ≥90 days, but not prescribed GIOP therapies in the prior year. We developed an online video of osteoporosis risk-factors, treatment options, and real-life patient stories. Through an interrupted time series design, the video was automatically shown for 45 days to GC users following completion of an online GC refill. During the subsequent 45-day period, the video was inactivated. Those refilling GCs during the initial 45-days were the exposure group (“Video On”) and those refilling GCs during the second 45-day period were the comparison group (“Video Off”). For 3 months following the completion of two Video On/Video Off cycles, the incidence of GIOP prescription use was assessed. Multivariable logistic regression was used to examine the influence of the video on GIOP prescription rates.

Results: Of the 4,659 patients that refilled their GC during the study, 3017 had the potential to view the intervention video. Among these, 59% had measurable video viewing time and 3% self-initiated the video. Most patients were between the ages of 50-70 (53.6%) and were male (56.8%). Commonly associated medical conditions in these patients included gastrointestinal illness (37.6%), history of organ transplant (29.9%), rheumatoid arthritis (17.5%), anxiety or depression (10.7%), and gout (9.2%).

During the 3-month follow-up, the overall GIOP prescription rate in the exposure group was 2.9% compared to 2.7% for the control group.  GIOP prescription rates were slightly higher in those patients that self-initiated the video rather than in the automated manner (5.7%, p = 0.1).  GIOP prescription rates were higher among older patients (50-70 years old: OR 2.1, 95% CI 1.3 – 3.5 and >70 years old: OR 1.8, 95% CI 1.0 – 3.2) when compared to those <50 years old and were lower among men (OR 0.2, 95% CI 0.2 – 0.4) when compared to women.

Conclusion: Among high-risk individuals, GIOP treatment rates were not affected greatly by an online educational video presented at the time of glucocorticoid refill.  Women and persons aged 50-70 years old were more likely to be initiated on GIOP medications during the study period. This novel method of approaching patients may be more accepted by certain populations and further tailoring of the intervention could improve effectiveness.


Disclosure:

A. H. Warriner,

Amylin,

2,

NIH,

2,

AHRQ,

2;

R. C. Outman,
None;

N. Markward,

Medco,

3,

Medco,

1;

R. Aubert,

Medco,

1,

Medco,

3;

J. R. Curtis,

Roche/Genetech, UCB, Centocor, CORRONA, Amgen Pfizer, BMS, Crescendo, Abbott,

5,

Roche/Genetech, UCB, Centocor, CORRONA, Amgen Pfizer, BMS, Crescendo, Abbott,

2;

R. Epstein,

Medco,

1,

Medco,

3;

F. Freuh,

Medco,

1,

Medco,

3;

J. McEachern,

Medco,

1,

Medco,

3;

D. T. Redden,
None;

M. M. Safford,
None;

E. Stanek,

Medco,

1,

Medco,

3;

A. Steinkellner,

Medco,

1,

Medco,

3;

K. G. Saag,

Amgen,

2,

Eli Lilly and Company,

2,

Merck Pharmaceuticals,

2,

Novartis Pharmaceutical Corporation,

2,

Amgen,

5,

Eli Lilly and Company,

5,

Merck Pharmaceuticals,

5,

Novartis Pharmaceutical Corporation,

5.

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