title: Use of a computerized order set to increase prescription of calcium and vitamin D supplementation in patients receiving glucocorticoids.
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.
  
  
  METHODS
  Pre-post test design.
  
  
  METHODS
  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.
  
  
  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.
authors: Division of Rheumatology, Allergy, Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 2C, Boston, MA 02114, USA. mkohler@partners.org
authors: Minna J
authors: MJ
authors: Kohler
authors: Matxalen
authors: M
authors: Amezaga
authors: James
authors: J
authors: Drozd
authors: Susan T
authors: ST
authors: Crowley
authors: Barbara
authors: B
authors: Gulanski
authors: Daren R
authors: DR
authors: Anderson
authors: Liana
authors: L
authors: Fraenkel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage* / Q000627:therapeutic use; D019587:Dietary Supplements / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D055695:Electronic Prescribing; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008509:Medication Systems / Q000458:organization & administration; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control; D014481:United States; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium
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