Quality Improvement Program Lowers Prolonged Steroid Use With IBD
Excess steroid use seen in 14 percent of patients
THURSDAY, Oct. 17, 2019 (HealthDay News) -- A quality improvement program can lower steroid use among patients with inflammatory bowel disease (IBD), according to a study published online Oct. 8 in Alimentary Pharmacology and Therapeutics.
Christian P. Selinger, M.D., from St. James University Hospital in Leeds, U.K., and colleagues examined steroid exposure among 2,385 outpatients with IBD attending 19 centers. As part of a national quality improvement effort, intervention centers undertook a series of measures in 2015, including patient and physician education and opening telephone helplines and rapid access clinics.
The researchers found that 28 percent of patients received steroids in the preceding 12 months, and 14.8 percent had steroid excess or dependency. At intervention centers, steroid use and excess steroid use were significantly lower (steroid exposure: 23.8 versus 31 percent; steroid excess: 11.5 versus 17.1 percent). There was a drop in steroid use from 2015 to 2017 at intervention centers (steroid exposure: 30 to 23.8 percent; steroid excess: 13.8 to 11.5 percent). Among Crohn disease patients, factors independently associated with lower steroid excess included maintenance with anti‐tumor necrosis factor agents (odds ratio [OR], 0.61), treatment in a center with a multidisciplinary team (OR, 0.54), and treatment at an intervention center (OR, 0.72). Higher rates of steroid excess were associated with treatment with 5-aminosalicylic acid (OR, 1.72). Among patients with ulcerative colitis, steroid excess was associated with thiopurine monotherapy (OR, 1.97), while treatment at an intervention center was associated with less steroid excess (OR, 0.72).
"This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort," the authors write.
Several authors disclosed financial ties to pharmaceutical companies.