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

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Abstract

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 < 0.0001) after the new automated order set was implemented.

CONCLUSIONS

Implementation of an automatic prescription for calcium and vitamin D supplementation modestly increases the number of patients on glucocorticoids who are prescribed calcium and vitamin D supplementation.

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Funding

Dr. Kohler’s work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) 5 T32 AR007107 Training Program for Investigative Rheumatology. Dr. Fraenkel is supported by the NIAMS K24 AR060231-01.

Prior Presentations

American College of Rheumatology Annual Scientific Meeting, Chicago, IL, November 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Division of Rheumatology, Allergy, Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 2C, Boston, MA, 02114, USA

    Minna J. Kohler MD

  2. Section of Rheumatology, Allergy, and Immunology, Baylor College of Medicine, Houston, TX, USA

    Matxalen Amezaga MD

  3. Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, USA

    James Drozd RPH, Susan T. Crowley MD, Barbara Gulanski MD & Liana Fraenkel MD, MPH

  4. Yale University School of Medicine, New Haven, CT, USA

    Susan T. Crowley MD, Barbara Gulanski MD & Liana Fraenkel MD, MPH

  5. Community Health Center, Inc., Middletown, CT, USA

    Daren R. Anderson MD

Authors
  1. Minna J. Kohler MD
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  2. Matxalen Amezaga MD
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  3. James Drozd RPH
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  4. Susan T. Crowley MD
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  5. Barbara Gulanski MD
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  6. Daren R. Anderson MD
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  7. Liana Fraenkel MD, MPH
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Corresponding author

Correspondence to Minna J. Kohler MD.

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Kohler, M.J., Amezaga, M., Drozd, J. et al. Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids. J GEN INTERN MED 28, 825–829 (2013). https://doi.org/10.1007/s11606-013-2360-1

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  • DOI: https://doi.org/10.1007/s11606-013-2360-1

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