title: Barriers in the management of glucocorticoid-induced osteoporosis.
abstract: OBJECTIVE
  To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers and interventions in the management of GIOP.
  
  
  METHODS
  To characterize current management of GIOP in an academic veterans administration medical center, we conducted a retrospective chart review of 100 patients who were prescribed a 90-day supply of prednisone. To assess clinicians' knowledge of GIOP clinical guidelines and perceptions of GIOP management, primary care clinicians and subspecialists completed a questionnaire and participated in focus groups.
  
  
  RESULTS
  Chart review revealed that only 32 of 100 patients receiving long-term glucocorticoid treatment underwent bone mineral density testing, and only 32 patients were prescribed the recommended calcium supplements. Of the 23 providers who completed the questionnaire and participated in the focus groups, 4 correctly identified both the dose and duration of glucocorticoid use at which GIOP prevention measures should be instituted. Common GIOP management barriers cited by participants were lack of knowledge, having limited time during the clinic visit to address all problems, patient nonadherence, and system problems. The most commonly mentioned potential interventions were the use of computerized clinical reminders and patient education.
  
  
  CONCLUSIONS
  Clinicians frequently do not follow recommended guidelines for the management of GIOP. Improving the management of GIOP will likely require a fundamental redesigning of care processes for this disorder in order to overcome provider, patient-related, and system barriers.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. jenice.guzman@med.va.gov
authors.forename: Jenice Ria S
authors.initials: JR
authors.lastname: Guzman-Clark
authors.forename: Meika A
authors.initials: MA
authors.lastname: Fang
authors.forename: Mary E
authors.initials: ME
authors.lastname: Sehl
authors.forename: Laural
authors.initials: L
authors.lastname: Traylor
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Hahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002136:Calcium, Dietary / Q000627:therapeutic use; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D019983:Guideline Adherence; D006306:Health Surveys; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*; D010353:Patient Education as Topic; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002136:Calcium, Dietary; D005938:Glucocorticoids; D011241:Prednisone