title: Monitoring of patients on long-term glucocorticoid therapy: a population-based cohort study.
abstract: About 1% of the general population receives long-term systemic glucocorticoids. The monitoring provided to these patients is unknown. We conducted a population-based cohort study using The Health Improvement Network database. A total of 100,944 adult patients prescribed systemic glucocorticoids for >3 months between January 2000 and December 2012 were studied. The monitoring done before prescribing glucocorticoid therapy and during exposure to the drug was examined. This included measurement of body weight, blood pressure, lipids, glucose and potassium levels, referrals for dual-energy X-ray absorptiometry (DEXA-scan) or to an ophthalmologist/optician, and vaccinations. We assessed factors associated with the odds of being monitored before and during exposure. Before glucocorticoid initiation, weight and blood pressure were monitored in < 20% and < 50% of patients, respectively. Glucose and lipid levels were monitored in less than one-third of the patients, while DEXA-scan and eye monitoring were offered to <15% of them. Vaccination against flu and pneumococcus was given to 57% and 46% of the patients, respectively. During exposure to the drug, <60% of patients who were prescribed the drug for more than a year had their weight, glucose, or lipid levels recorded at least once and <25% of patients were referred at least once for DEXA-scan or screening for eye diseases. Overall, the odds of being monitored were higher in older patients and in those with comorbidities. There were variations in the level of monitoring provided across the UK, but the monitoring has improved over the last 12 years. Although the extent of monitoring of people on long-term glucocorticoids has improved over time, the overall monitoring provided is not satisfactory, particularly in young patients and those without comorbidities.
authors.affiliation: From the University College London, Department of Primary Care and Population Health, London, UK (LF, IP, IN); Department of Dermatology, Henri Mondor Hospital, Paris, France (LF); and Université Paris Est Créteil, UPEC Paris 12, Créteil, France (LF).
authors.forename: Laurence
authors.initials: L
authors.lastname: Fardet
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D001837:Body Weights and Measures; D015331:Cohort Studies; D003941:Diagnostic Techniques, Ophthalmological; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D013997:Time Factors; D014612:Vaccines / Q000008:administration & dosage
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D008055:Lipids; D014612:Vaccines; D011188:Potassium