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Automated vitamin D co-prescription effective in getting patients to supplement

Posted on: February 4, 2014   by  Brant Cebulla

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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?

Source

Kohler MJ 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, 2013.

3 Responses to Automated vitamin D co-prescription effective in getting patients to supplement

  1. josukuopio@btinternet.com

    This is quite interesting. First and for most, majority of chronic and auto-immune illness is a subject to vitamin D deficiency. Leave alone when therapy which again depletes Vitamin D level, then this doubles the problem. Global deficiency is skyrocketing to 90% of the world population. Hence it is not rocket science to grab the logic. This type of approach merit attention. Best still doing so, is not just protecting the bone matrix, but optimizing genome health and performance. Those doctors testifying that there is no evidence, they should capture the evidence. Medicine is evidence-based practice. But there can never be evidence based practice if there is no practice based evidence. Practice based evidence is a step stone to evidence based practice. This category of doctors who wait for evidence should be informed that they are to participate in collecting the evidence. That is the philosophy of medicine, you cannot practice it well if you don’t educate yourself further. What one learns from a medical school is just a founding base. Even the Hippocrates era did more than what we are doing now. Yet it should be the opposite.
    Regards to all
    John

  2. Rita and Misty

    Brant, this was an extremely well-written article. I enjoyed reading it. Thank you.

    From your article, I found this statement very interesting:

    “…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.”

    You ask what ideas to automate or get more people to take vitamin D…

    Educate the physician, imo…it is the only way… Clinician to clinician.

    If each knowledgeable vitamin D physician/clinician would make it his or her life’s mission to mentor a non-vitamin D physician/clinician, then we would see progress.

    I have said this before; I will say it again…this is a doctor-to-doctor thing.

  3. bacullen@gmail.com

    Calcium and D prescriptions? We can be sure that big PhRMA will ensure that D2 will be supplied along w/ some patented Ca salt if this becomes SOP. The Medical Industry will do anything to keep D3 supplimentation from affecting its bottom line. Studies have shown the D2 has low activity all animals and 1000 iu even as D3 is too low so I view this report GREAT suspicion.

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