Research published in the Journal of General Internal Medicine suggests that automating calcium and vitamin D prescription orders might be a good way to increase supplementation in patients.
The research, authored by an assemblage of researchers in the northeast and led by Dr. Minna J. Kohler of Harvard Medical School, sought to increase supplement use in patients using glucocorticoids.
Glucocorticoid use is associated with bone loss and osteoporotic fractures, even within the first year of therapy. Glucocorticoids are a class of steroids used for an assortment of medical conditions. Because they cause bone loss, the American College of Rheumatology recommends all patients taking glucocorticoids take both calcium and vitamin D supplements, to try to minimize bone loss and risk of fractures.
Despite these recommendations, studies show that about only 50% of physicians recommend vitamin D and calcium supplements to their glucocorticoid-receiving patients. Several trials have attempted to implement educational programs for doctors to increase this percentage, but to date, these educational programs have proven ineffective.
In the present study, researchers used an automated prescription ordering system to try and increase vitamin D and calcium prescriptions for patients.
At the start of the study, the researchers looked at 535 glucocorticoid-receiving patients at a single medical center in Virginia. They found that physicians prescribed calcium and vitamin D 37% and 38% of the time, respectively.
They then implemented a program. At this medical center, physicians order prescriptions for their patients over a computer program. In the newly implemented program, when doctors ordered glucocorticoids, 1,500 mg of calcium and 1,000 IU of vitamin D supplements were automatically added to the order. If the doctor wanted to remove these supplements from the order, he/she would have to do it manually.
When the researchers followed up a year after this program was implemented and examined 506 patients, they found that calcium and vitamin D prescriptions increased to 49% and 53%, respectively.
The researchers concluded,
“Implementation of an automatic prescription order set significantly improves co-prescription of calcium and vitamin D in patients who are prescribed glucocorticoids.”
Perhaps surprisingly, this increase in calcium and vitamin D prescriptions only increased to around 50%, meaning that half of the doctors manually removed the calcium and vitamin D prescriptions from the orders each time. At the end of the study, the researchers asked the doctors why they were doing this. The doctors cited that they were unaware of evidence that showed patients only receiving glucocorticoids for less than 3 months needed calcium and vitamin D supplements.
This new research and idea to automate calcium and vitamin D prescriptions is interesting, novel and somewhat effective. This idea may be used as a basis for similar automated prescriptions for vitamin D in the future, for specific conditions or for populations at-risk.
If public health officials in time feel that a majority of the population should supplement with vitamin D, unique and innovative programs will be necessary. Readers, what ideas do you have to automate or get more people to take vitamin D?