Increase in prophylaxis of glucocorticoid-induced osteoporosis by pharmacist feedback: a randomised controlled trial

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• 作者：C. Klop (1)
  F. de Vries (1) (2) (3) (4)
  T. Vinks (5)
  M. J. Kooij (1)
  T. P. van Staa (1) (2)
  J. W. J. Bijlsma (6)
  A. C. G. Egberts (1) (7)
  M. L. Bouvy (1) (8)
  
• 关键词：Glucocorticoid ; induced osteoporosis ; Intervention ; Pharmacist ; Physician
• 刊名：Osteoporosis International
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：25
• 期：1
• 页码：385-392
• 全文大小：212 KB
• 作者单位：C. Klop (1)
  F. de Vries (1) (2) (3) (4)
  T. Vinks (5)
  M. J. Kooij (1)
  T. P. van Staa (1) (2)
  J. W. J. Bijlsma (6)
  A. C. G. Egberts (1) (7)
  M. L. Bouvy (1) (8)
  
  1. Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584, CG, Utrecht, The Netherlands
  2. MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
  3. Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
  4. Maastricht University/CAPHRI, Maastricht, The Netherlands
  5. Pharmacy DeLeij, Tilburg, The Netherlands
  6. Department of Rheumatology & Clinical Immunology, University Medical Centre, Utrecht, The Netherlands
  7. Hospital Pharmacy, University Medical Centre, Utrecht, The Netherlands
  8. SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
  
• ISSN：1433-2965

文摘

Summary The aim of this study was to determine whether feedback by pharmacists to prescribers of patients eligible for glucocorticoid-induced osteoporosis prophylaxis would stimulate the prescribing of osteoporosis prophylaxis. The intervention did not significantly increase the prescribing of bisphosphonates in the total study population, but a significant increase was seen in men and in the elderly. However, the proportion of bisphosphonate-treated patients remained low. Introduction The aim of this study was to determine whether feedback by pharmacists to prescribers of patients eligible for glucocorticoid-induced osteoporosis prophylaxis (GIOP) would stimulate the implementation of the Dutch GIOP guideline. Methods This randomised controlled trial included 695 patients who were dispensed ?75?mg prednisone equivalents without a concomitant bisphosphonate prescription within 6?months before baseline. Pharmacists were asked to contact the physicians of GIOP-eligible patients in the intervention group to suggest osteoporosis prophylaxis. The primary endpoint was a bisphosphonate prescription. Secondary endpoints were a prescription of calcium supplements, vitamin D or any prophylactic osteoporosis drug (bisphosphonate, calcium supplements, vitamin D). Results The group assigned to the intervention was slightly younger than the control group (68.7?±-5.4 vs. 65.9?±-6.9?years, p--.02) and used hydrocortisone more often (7.0?% vs. 3.1?%, p--.02). Within 6?months, the intervention did not significantly increase the prescribing of bisphosphonates (11.4?% after intervention vs. 8.0?% for controls; hazard ratio [HR] 1.47, 95?% confidence interval [CI] 0.91-.39). However, subgroup analyses showed a significant increase for the primary endpoint in men (12.8?% vs. 5.1?%, HR 2.53, 95?% CI 1.11-.74) and patients ?0?years (13.4?% vs. 4.9?%, HR 2.88, 95?% CI 1.33-.23). The prescribing of calcium and vitamin D was not significantly altered. Conclusion This study showed that active identification of patients eligible for GIOP by pharmacists did not significantly increase the prescribing of bisphosphonates in the total study population, but there was an increase in men and the elderly. However, the proportion of GIOP-treated patients remained low.