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Decisional support to prevent adverse drug reactions of long latency: pilot randomized controlled intervention for glucocorticoid‐induced diabetes
Author(s) -
Dischinger Hannah R.,
Cheng Elizabeth,
Mann Alyse D.,
Grueber Tiffany M.,
Hawk Sherri,
Davis Lisa A.,
Prochazka Allan V.,
Hutt Evelyn,
Caplan Liron
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12351
Subject(s) - medicine , confidence interval , randomized controlled trial , hazard ratio , odds ratio , diabetes mellitus , pharmacist , intervention (counseling) , adverse effect , medical record , glucocorticoid , emergency medicine , physical therapy , pharmacy , family medicine , psychiatry , endocrinology
Rationale, aims, and objectives Long‐term exposure to glucocorticoids can cause adverse drug reactions of long latency ( ADRLLs ), including glucocorticoid‐induced diabetes mellitus ( GID ). Providers can monitor for GID using the glycosylated haemoglobin blood ( HbA1C ) test. This study examined the utility of decisional support to improve HbA1C ‐based screening for GID . US veterans were identified as chronic users of oral glucocorticoids (>120 days of oral glucocorticoids in the last 2 years). The primary care providers caring for these patients were the target of the intervention. Providers were randomized to receive automatic HbA1C orders for their patients receiving chronic glucocorticoid or usual care. Methods This study was a pilot two‐arm, group‐randomized, controlled trial ( n = 12 providers, n = 38 patients). Data collection occurred from 5 M ay 2013 until 10 J anuary 2014. A pharmacist generated the order for an HbA1C through the electronic medical record. The time between the intervention start date and the date on which an HbA1C order was signed were compared using C ox proportional and hierarchical linear regression. Results The time to sign HbA1C orders (mean 12.0 days for the intervention arm; 104.0 days for control arm) was associated with significant differences favouring the intervention [ HR (Hazard Ratio) 50.2, P < 0.001, confidence interval ( CI ) 6.3 to 398.7]. For the intervention group, 95% of orders were signed, whereas only 12% of control providers signed orders (odds ratio 150, P < 0.001, CI 12.4 to 1812.9). Conclusions The results of this study strongly suggest that the clinical pharmacist‐triggered order intervention is effective. This method of computerized decisional support may be useful in improving screening for GID and ADRLLs .