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Assessment of steroid use as a key performance indicator in inflammatory bowel disease—analysis of data from 2385 UK patients
Author(s) -
Selinger Christian P.,
Parkes Gareth C.,
Bassi Ash,
Limdi Jimmy K.,
Ludlow Helen,
Patel Pritash,
Smith Melissa,
Saluke Santosh,
Ndlovu Zandile,
George Becky,
Saunders John,
Adamson Mark,
Fraser Aileen,
Robinson Jenna,
Donovan Fiona,
Parisi Ioanna,
Tidbury Jude,
Gray Lynn,
Pollok Richard,
Scott Glyn,
Raine Tim
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15497
Subject(s) - medicine , steroid , inflammatory bowel disease , thiopurine methyltransferase , ulcerative colitis , cohort , steroid use , gastroenterology , disease , hormone
Summary 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.