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Managing and Monitoring Long-term Oral Corticosteroids – How Good Are We and Do We Follow Best Practice Guidelines?
ELSEVIER; 2020.
Non-conventional in English | ELSEVIER | ID: covidwho-710790
ABSTRACT

Background:

Long-term (defined as >1 month) oral corticosteroids are widely used for chronic inflammatory and autoimmune conditions. In cardiology, the primary indications are transplantation, cardiac sarcoidosis and large vessel vasculitis. Minimising organ-based complications including infection (Pneumocystis jiroveci pneumonia (PJP)), gastro-intestinal (GI) bleeding and osteoporosis warrant consideration but guidelines vary between specialties and co-existing treatments. The aim of this study was to assess prescribing patterns between specialties at Auckland, Waitemata and Counties Manukau District Health Boards.

Method:

An anonymised survey of cardiologists, respiratory, oncology, haematology, endocrinology, infectious diseases and rheumatologists with questions regarding prescribing and monitoring practices for i) PJP prophylaxis, ii) proton pump inhibitor (PPI) for GI protection, iii) baseline bone mineral density (BMD) and iv) bisphosphonate use.

Results:

In total 44 responders;cardiology n=16 vs. other n=28. PJP prophylaxis was prescribed n= 5 (31%) of cardiologists compared to n=23 (96%) of other specialties. Cardiologists were less likely to prescribe bisphosphonates n=1 (6%) than other specialists n=10 (36%, p value = 0.01) but with similar prescription of PPI and baseline BMD (Figure 1).

Conclusion:

Prescription of PJP prophylaxis, bisphosphonates and PPIs are lower amongst cardiologists. PPI and bisphosphonates use were high particularly amongst non-cardiologists increasing the patient pill burden but may be unnecessary in the absence of previous GI complications or co-existing NSAID use and moderate-high risk of fracture on BMD. Consensus guidelines for cardiologists aimed at standardising pre-treatment assessment and prevention of prove patient care and prevent unnecessary therapy. [Formula presented]

Full text: Available Collection: Databases of international organizations Database: ELSEVIER Type of study: Observational study / Prognostic study Language: English Year: 2020 Document Type: Non-conventional

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Full text: Available Collection: Databases of international organizations Database: ELSEVIER Type of study: Observational study / Prognostic study Language: English Year: 2020 Document Type: Non-conventional