title: Decisional support to prevent adverse drug reactions of long latency: pilot randomized controlled intervention for glucocorticoid-induced diabetes.
abstract: OBJECTIVE
  Long-term exposure to glucocorticoids can cause adverse drug reactions of long latency (ADRLLs), including glucocorticoid-induced diabetes mellitus (GID). Providers can monitor for GID using the glycosylated haemoglobin blood (HbA1C) test. This study examined the utility of decisional support to improve HbA1C-based screening for GID. US veterans were identified as chronic users of oral glucocorticoids (>120 days of oral glucocorticoids in the last 2 years). The primary care providers caring for these patients were the target of the intervention. Providers were randomized to receive automatic HbA1C orders for their patients receiving chronic glucocorticoid or usual care.
  
  
  METHODS
  This study was a pilot two-arm, group-randomized, controlled trial (n = 12 providers, n = 38 patients). Data collection occurred from 5 May 2013 until 10 January 2014. A pharmacist generated the order for an HbA1C through the electronic medical record. The time between the intervention start date and the date on which an HbA1C order was signed were compared using Cox proportional and hierarchical linear regression.
  
  
  RESULTS
  The time to sign HbA1C orders (mean 12.0 days for the intervention arm; 104.0 days for control arm) was associated with significant differences favouring the intervention [HR (Hazard Ratio) 50.2, P < 0.001, confidence interval (CI) 6.3 to 398.7]. For the intervention group, 95% of orders were signed, whereas only 12% of control providers signed orders (odds ratio 150, P < 0.001, CI 12.4 to 1812.9).
  
  
  CONCLUSIONS
  The results of this study strongly suggest that the clinical pharmacist-triggered order intervention is effective. This method of computerized decisional support may be useful in improving screening for GID and ADRLLs.
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Hannah R
authors: HR
authors: Dischinger
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Elizabeth
authors: E
authors: Cheng
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Alyse D
authors: AD
authors: Mann
authors: Pharmacy, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.
authors: Tiffany M
authors: TM
authors: Grueber
authors: Pharmacy, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.
authors: Sherri
authors: S
authors: Hawk
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.|Rheumatology, Denver Health Medical Center, Denver, CO, USA.
authors: Lisa A
authors: LA
authors: Davis
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Allan V
authors: AV
authors: Prochazka
authors: Internal Medicine, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Evelyn
authors: E
authors: Hutt
authors: Rheumatology Section, Research, Denver Veterans Affairs Medical Center (VAMC), Denver, CO, USA.|Research, University of Colorado School of Medicine, Denver, CO, USA.
authors: Liron
authors: L
authors: Caplan
mesh_terms: D003660:Decision Support Systems, Management; D003920:Diabetes Mellitus / Q000139:chemically induced*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D057286:Electronic Health Records; D005938:Glucocorticoids / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000032:analysis; D006302:Health Services Research; D006801:Humans; D010595:Pharmacists; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D006442:Glycated Hemoglobin
keywords: adverse drug reaction; clinical; clinical safety; decision support systems; drug toxicity; glucocorticoids; medication safety