Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

• Published in: Journal of general internal medicine : JGIM 2013-06, Vol.28 (6), p.825-829
• Main Authors: Kohler, Minna J., Amezaga, Matxalen, Drozd, James, Crowley, Susan T., Gulanski, Barbara, Anderson, Daren R., Fraenkel, Liana
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - therapeutic use; Calcium; Calcium - administration & dosage; Calcium - therapeutic use; Computers; Dietary Supplements - utilization; Diseases of the osteoarticular system; Drug Prescriptions - statistics & numerical data; Drug therapy; Drug Utilization - statistics & numerical data; Electronic Prescribing; Female; General aspects; Glucocorticoids - adverse effects; Humans; Internal Medicine; Male; Medical Order Entry Systems - organization & administration; Medical sciences; Medication Systems - organization & administration; Medicine; Medicine & Public Health; Middle Aged; Original Research; Osteoporosis - chemically induced; Osteoporosis - prevention & control; Osteoporosis. Osteomalacia. Paget disease; Prescription drugs; United States; Vitamin D; Vitamin D - administration & dosage; Vitamin D - therapeutic use
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-013-2360-1

BACKGROUND American College of Rheumatology guidelines recommend that patients taking glucocorticoids also take calcium and vitamin D supplements, regardless of the dose or intended duration of glucocorticoid use, to decrease their risk of glucocorticoid-induced osteopenia or osteoporosis (GIOP). OBJECTIVE To increase the number of prescriptions made for calcium and vitamin D in patients who receive a prescription for glucocorticoids using an automated, computerized order set. DESIGN Pre-post test design. PATIENTS A total of 1,041 outpatients receiving care at a single VA medical center. INTERVENTION/MAIN MEASURES We developed an automated order set in which calcium and vitamin D were automatically co-ordered with glucocorticoid prescriptions of at least 2-week duration. We tested the impact of the order set by comparing the number of calcium and vitamin D prescriptions in patients taking glucocorticoids during a 12-month period before (T1) and after (T2) implementation. The automated order set could be modified by the treating physician, and it was not generated for patients with hypercalcemia. KEY RESULTS A total of 535 patients during T1 and 506 patients during T2 had a glucocorticoid prescription of at least 2-week duration. The percent of co-prescriptions for calcium increased from 37 to 49 % and vitamin D from 38 to 53 % (both p