Effects of quality indicator monitoring for glucocorticoid‐induced osteoporosis and trends of drug treatment in a Japanese hospital

Suda, Michael; Suyama, Yasuhiro; Ohde, Sachiko; Tsuda, Tokutaro; Sawada, Haruki; Kishimoto, Mitsumasa; Okada, Masato

doi:10.1111/1756-185x.13310

Cited by 6 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 50 remaining articles yielded 16 sets of indications, including 12 sets of prescribing criteria, 8 , 9 , 23 – 33 and 4 sets of prescribing measures. 10 , 19 , 34 , 35 Four of these 16 sets were identified by searching the references of studies employing the indications. 10 , 28 , 29 , 33 …”

Section: Resultsmentioning

confidence: 99%

“…Two sets were based only on guidelines. 10 , 35 One study also used patient interviews. 29 Seven sets, encompassing 421 (53.0%) prescribing indications, were developed in Europe.…”

Section: Resultsmentioning

confidence: 99%

“…Of note, two prescribing sets focused on a single problem (pain/inflammation and glucocorticoid-induced osteoporosis). 30 , 35 Antihypertensives were the most frequently addressed medications (18.6% of indications), followed by analgesics/antirheumatics (18.1%), antiplatelets/anticoagulants (11.4%) and antidepressants (10.9%) ( Figure 2 , Supplementary Table S2, Supplementary Figure S1). All other medication groups were addressed in less than 10% of the indications.…”

Section: Resultsmentioning

confidence: 99%

“…The 50 remaining articles yielded 16 sets of indications, including 12 sets of prescribing criteria, 8,9,[23][24][25][26][27][28][29][30][31][32][33] and 4 sets of prescribing measures. 10,19,34,35 Four of these 16 sets were identified by searching the references of studies employing the indications. 10,28,29,33 General characteristics of prescribing sets Among the 16 sets of indications, 11 (68.8%) were specifically developed for older adults, 8,9,[23][24][25][27][28][29][30][31]33 and only 1 (6.3%) was developed for multimorbid patients.…”

Section: Selection Of Prescribing Setsmentioning

confidence: 99%

See 3 more Smart Citations

Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

Aubert

Kerr

Klamerus³

et al. 2021

Journal of Multimorbidity and Comorbidity

View full text Add to dashboard Cite

Background: Inappropriate prescribing is frequent in older adults and associated with adverse outcomes. Prescribing indications aim to optimize prescribing, but little is known about the focus and features of prescribing indications for the most common chronic conditions in older adults. Understanding the conditions, medications, and issues addressed (e.g., patient perspective, drug-disease interaction, adverse drug event) in current prescribing indications may help to identify missing indications and develop standardized measures to improve prescribing quality. Methods: We searched Ovid/MEDLINE and EMBASE for articles published between 2015 and 2020 reporting prescribing indications for older adults. Prescribing indication included 1) prescribing “criteria,” or statements that guide prescribing action, and 2) prescribing “measures,” or prescribing actions observed in a population. We categorized their focus by conditions, medications and issues addressed, as well as level of evidence provided. Results: Among 16 sets of prescribing indications, we identified 748 criteria and 47 measures. The most common addressed medications were antihypertensives, analgesics/antirheumatics, and antiplatelets/anticoagulants. The most frequently addressed issues were drug-disease interaction, adverse drug event, administration, better therapeutic alternative, and (co-)prescription omission (20.8–36.1%). Age/functioning, drug-drug interaction, monitoring, and efficacy/safety ratio were found in only 9.9–16.5% of indications. Indications rarely focused on the patient perspective or issues with multiple providers. Conclusion: Most prescribing indications for chronic conditions in older patients are criteria rather than measures. Indications accounting for patient perspective and multiple providers are limited. The gaps identified in this review may help improve the development of prescribing measures for older adults and ultimately improve quality of care.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Two sets were based only on guidelines. 10 , 35 One study also used patient interviews. 29 Seven sets, encompassing 421 (53.0%) prescribing indications, were developed in Europe.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Selection Of Prescribing Setsmentioning

confidence: 99%

See 2 more Smart Citations

Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

Aubert

Kerr

Klamerus³

et al. 2021

Journal of Multimorbidity and Comorbidity

View full text Add to dashboard Cite

show abstract

“…Despite this, a recent French study investigating whether the guidelines for prevention of GC-induced osteoporosis were applied in patients with RA found that less than 30% of those with an indication for treatment received AOD [ 46 ]. Guidelines may not be sufficient, and a Japanese group decided to increase education and attention to GC-induced osteoporosis at their hospital by introducing a quality indicator to monitor prevention and treatment of GC-induced osteoporosis [ 47 ]. They found that these interventions improved the proportion of patients treated with AOD during 2010–2013.…”

Section: Discussionmentioning

confidence: 99%

Initiation of anti-osteoporotic drugs in high-risk female patients starting glucocorticoid treatment: a population study in Norway

et al. 2020

View full text Add to dashboard Cite

Summary Glucocorticoid use is a risk factor for osteoporosis and fractures. We studied whether women initiating glucocorticoid treatment also started anti-osteoporotic treatment, according to clinical guidelines. Women with versus without previous fracture were twice as likely to start anti-osteoporotic treatment within 1 year after initiating glucocorticoid treatment, but the cumulative incidences were low 9.1% vs. 4.6%, respectively. Purpose Use of glucocorticoids (GC) is a risk factor for osteoporosis and fractures, and clinical guidelines suggest that preventive treatment with anti-osteoporotic drugs (AOD) should be considered when starting GC. Women with high risk of osteoporosis comprise those with previous fractures or a known inflammatory rheumatic disease, for whom the indication of AOD is even stronger. The purpose of these analyses was to investigate whether women initiating GC treatment also started AOD, especially those with high risk of osteoporosis. Methods We used data from the Norwegian Prescription Database to identify all women 55 years and older initiating GC treatment in Norway during 2010–2016 and to obtain information on use of AOD. Data from the Norwegian Patient Registry were used to obtain information on previous fractures and diagnoses. Results Among 105,477 women initiating GC treatment during 2010–2016, 3256 had started AOD and 79,638 had discontinued GC treatment after 1-year follow-up. Cumulative incidence of starting AOD after 1 year was 9.1% (95% CI: 7.9, 10.4) for women with vs. 4.6% (95% CI: 4.4%, 4.8%) for women without a previous fracture. Women with rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start AOD than women with other indications. For the whole cohort, the probability of starting AOD treatment within 1 year after initiating GC increased on average 3% per year (HR = 1.03, CI: 1.01, 1.05) from 2010 to 2016. Conclusions Having had a previous fracture or an inflammatory rheumatic disease increased the probability of treatment with AOD. However, the proportions starting AOD were much lower than clinically indicated. Electronic supplementary material The online version of this article (10.1007/s11657-020-00783-8) contains supplementary material, which is available to authorized users.

show abstract

Bad to the bones: prescribing of drugs for the prevention and treatment of osteoporosis in patients on chronic glucocorticoids

et al. 2023

View full text Add to dashboard Cite

Summary Of patients prescribed systemic glucocorticoids, this study identifies the proportion prescribed osteoporosis pharmacologic treatment and associated characteristics. Overall, 13.2% of patients were prescribed osteoporosis pharmacologic treatment. Predictors included documented osteoporosis, past DXA or fracture, and provision of care within a department using embedded protocols, suggesting electronic medical record-based tools may be beneficial. Purpose This study aimed to identify a cohort of patients at risk for glucocorticoid-induced osteoporosis based on their prescribed glucocorticoid regimens and to quantify the proportion who were also prescribed osteoporosis pharmacologic treatment. The secondary objective was to recognize patient characteristics associated with receiving such treatment. Methods A retrospective single-site cohort study used prescription order data to identify 7774 adults prescribed chronic glucocorticoids and measure the proportion also prescribed osteoporosis pharmacologic treatment. Results Of the total cohort, 1026/7774 (13.2%) had osteoporosis pharmacologic treatment prescribed. Of the subgroups prescribed a prednisone-equivalent of 5, 10, or 20 mg per day or more for at least 180 days, 584/4262 (13.7%), 153/1048 (14.6%), and 47/344 (13.7%) had treatment prescribed. Factors independently associated with osteoporosis pharmacologic treatment initiation included having osteoporosis or osteopenia on the problem list (OR = 4.45, 95% CI 3.70–5.34), history of dual-energy X-ray absorptiometry (DXA) screening (OR = 2.18, 95% CI 1.82–2.62), history of fracture (OR = 1.83, 95% CI 1.54–2.167), and longer duration of glucocorticoid use (OR = 1.33, 95% CI 1.10–1.59). The prescribing department was also a significant predictor of medication initiation, with cardiac transplant (OR = 6.04, 95% CI 3.97–9.17), oncology (OR = 4.11, OR 3.28–5.14), and lung transplant (OR = 1.51, 95% CI 1.08, 2.12) being positively correlated with this outcome, and nephrology (OR = 0.51, 95% CI 0.36–0.72) and kidney transplant (OR = 0.53, 95% CI 0.37, 0.75) being negatively correlated. Conclusion Prescribing rate of osteoporosis pharmacologic treatment in patients using chronic glucocorticoids is low. Examining practices with higher prescribing rates may offer insight into improving protection against osteoporosis-induced fractures.

show abstract

Effects of quality indicator monitoring for glucocorticoid‐induced osteoporosis and trends of drug treatment in a Japanese hospital

Abstract: Quality indicator monitoring for GIOP significantly improved appropriate anti-osteoporotic drug prescriptions, especially in men and postmenopausal women.

Cited by 6 publications

References 29 publications

Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

Initiation of anti-osteoporotic drugs in high-risk female patients starting glucocorticoid treatment: a population study in Norway

Bad to the bones: prescribing of drugs for the prevention and treatment of osteoporosis in patients on chronic glucocorticoids

Contact Info

Product

Resources

About