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Posted on 02.11.02
Improving Quality of Life in Steroid-Induced Osteoporosis
By Jason Oliveri, MPH
Glucocorticoids (such as prednisone) are potent anti-inflammatory drugs often used to treat disorders such as rheumatoid arthritis, asthma, and inflammatory bowel disease. An estimated one million Americans are using these drugs at any given time to manage such long-term disorders. Despite their therapeutic benefits, however, long-term users of these drugs also have a higher risk of several side effects.
Bone loss leading to osteoporosis is the most frequent serious toxicity with long-term glucocorticoid therapy. Fractures because of osteoporosis, which can occur in up to 50% of long-term users of these drugs, can severely impair quality of life. Overall, glucocorticoid use is second only to menopause as the most common cause of osteoporosis.
Recognizing such risks, organizations such as the American College of Rheumatology have recommended that physicians use appropriate preventive measures and monitoring techniques in patients who likely will require prolonged glucocorticoid therapy. Despite strong evidence and guidelines, however, few physicians intervene to prevent or treat glucocorticoid-induced osteoporosis, or GIOP.
Investigators at the University of Alabama at Birmingham CERTs, in collaboration with Aetna U.S. Quality Algorithms, are developing an intervention to improve the quality of GIOP management. Using claims data from Aetna, the researchers will identify long-term users of glucocorticoids and link them to their primary-care and specialty physicians.
Physicians randomized to an intervention group will receive confidential and personal feedback about baseline performance regarding quality measures for GIOP management. Anonymous, peer-based comparisons and benchmarks also will be provided through an Internet site containing a case-based educational program, materials promoting system changes (such as printable chart reminders), and printable materials for patient education.
Physicians randomized to the control group will receive an equivalent educational program for an unassociated disease. After 6 months, performance with regard to quality measures for GIOP management will be compared between the intervention and control groups to measure the intervention's effectiveness.
We anticipate that this project will produce an evidence-based and replicable intervention that can be sustained in the "real world," readily adapted to other healthcare settings, and easily modified for other diseases.