Use of a computerized order set to increase prescription of calcium and vitamin D supplementation in patients receiving glucocorticoids.

Kohler MJ, Amezaga M, Drozd J, Crowley ST, Gulanski B, Anderson DR, Fraenkel L. Use of a computerized order set to increase prescription of calcium and vitamin D supplementation in patients receiving glucocorticoids. Journal of general internal medicine. 2013 Jun 1; 28(6):825-9.

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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.