Assessment of steroid use as a key performance indicator in inflammatory bowel disease-analysis of data from 2385 UK patients.
Adrenal Cortex Hormones
/ therapeutic use
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents
/ classification
Cohort Studies
Female
Humans
Inflammatory Bowel Diseases
/ diagnosis
Male
Middle Aged
Practice Patterns, Physicians'
/ standards
Prognosis
Quality Assurance, Health Care
Quality Indicators, Health Care
Steroids
/ therapeutic use
Tumor Necrosis Factor-alpha
/ antagonists & inhibitors
United Kingdom
/ epidemiology
Young Adult
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
24
03
2019
revised:
21
04
2019
accepted:
21
08
2019
pubmed:
9
10
2019
medline:
26
5
2020
entrez:
10
10
2019
Statut:
ppublish
Résumé
Patients with IBD are at risk of excess corticosteroids. To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing. Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were assessed. Of 2385 patients, 28% received steroids in the preceding 12 months. 14.8% had steroid excess or dependency. Steroid use was significantly lower at 'intervention centres' which participated in a quality improvement programme (exposure: 23.8% vs 31.0%, P < .001; excess 11.5% vs 17.1%, P < .001). At intervention centres, steroid use fell from 2015 to 2017 (steroid exposure 30.0%-23.8%, P = .003; steroid excess 13.8%-11.5%, P = .17). Steroid excess was judged avoidable in 50.7%. Factors independently associated with reduced steroid excess in Crohn's disease included maintenance with anti-TNF agents (OR 0.61 [95% CI 0.24-0.95]), treatment in a centre with a multi-disciplinary team (OR 0.54 [95% CI 0.20-0.86]) and treatment at an intervention centre (OR 0.72 [95% CI 0.46-0.97]). Treatment with 5-ASA in CD was associated with higher rates of steroid excess (OR 1.72 [95% CI 1.24-2.09]). In ulcerative colitis (UC), thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI 1.19-3.01]) and treatment at an intervention centre with less steroid excess (OR 0.72 [95% CI 0.45-0.95]). This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort. A programme of quality improvement was associated with lower steroid use.
Sections du résumé
BACKGROUND
Patients with IBD are at risk of excess corticosteroids.
AIMS
To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing.
METHODS
Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were assessed.
RESULTS
Of 2385 patients, 28% received steroids in the preceding 12 months. 14.8% had steroid excess or dependency. Steroid use was significantly lower at 'intervention centres' which participated in a quality improvement programme (exposure: 23.8% vs 31.0%, P < .001; excess 11.5% vs 17.1%, P < .001). At intervention centres, steroid use fell from 2015 to 2017 (steroid exposure 30.0%-23.8%, P = .003; steroid excess 13.8%-11.5%, P = .17). Steroid excess was judged avoidable in 50.7%. Factors independently associated with reduced steroid excess in Crohn's disease included maintenance with anti-TNF agents (OR 0.61 [95% CI 0.24-0.95]), treatment in a centre with a multi-disciplinary team (OR 0.54 [95% CI 0.20-0.86]) and treatment at an intervention centre (OR 0.72 [95% CI 0.46-0.97]). Treatment with 5-ASA in CD was associated with higher rates of steroid excess (OR 1.72 [95% CI 1.24-2.09]). In ulcerative colitis (UC), thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI 1.19-3.01]) and treatment at an intervention centre with less steroid excess (OR 0.72 [95% CI 0.45-0.95]).
CONCLUSIONS
This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort. A programme of quality improvement was associated with lower steroid use.
Substances chimiques
Adrenal Cortex Hormones
0
Anti-Inflammatory Agents
0
Steroids
0
Tumor Necrosis Factor-alpha
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1009-1018Subventions
Organisme : AbbVie
Pays : International
Informations de copyright
© 2019 John Wiley & Sons Ltd.
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