Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids.
J Gen Intern Med. 2013 Feb 13.
Kohler MJ, Amezaga M, Drozd J, Crowley ST, Gulanski B, Anderson DR, Fraenkel L.
Division of Rheumatology, Allergy, Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 2C, Boston, MA, 02114, USA, mkohler at partners.org.
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.