Selinger, CP;
Parkes, GC;
Bassi, A;
Limdi, JK;
Ludlow, H;
Patel, P;
Smith, M;
Saluke, S;
Ndlovu, Z;
George, B;
et al.
Selinger, CP; Parkes, GC; Bassi, A; Limdi, JK; Ludlow, H; Patel, P; Smith, M; Saluke, S; Ndlovu, Z; George, B; Saunders, J; Adamson, M; Fraser, A; Robinson, J; Donovan, F; Parisi, I; Tidbury, J; Gray, L; Pollok, R; Scott, G; Raine, T
(2019)
Assessment of steroid use as a key performance indicator in inflammatory bowel disease-analysis of data from 2385 UK patients.
Aliment Pharmacol Ther, 50 (9).
pp. 1009-1018.
ISSN 1365-2036
https://doi.org/10.1111/apt.15497
SGUL Authors: Pollok, Richard Charles G
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Abstract
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.
Item Type: | Article | ||||||||
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Additional Information: | This is the peer reviewed version of the following article: Selinger, CP, Parkes, GC, Bassi, A, et al. Assessment of steroid use as a key performance indicator in inflammatory bowel disease—analysis of data from 3561 UK patients. Aliment Pharmacol Ther. 2019; 50: 1009– 1018, which has been published in final form at https://doi.org/10.1111/apt.15497. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | ||||||||
Keywords: | 1103 Clinical Sciences, 1115 Pharmacology And Pharmaceutical Sciences, Gastroenterology & Hepatology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Infection and Immunity Research Institute (INII) | ||||||||
Journal or Publication Title: | Aliment Pharmacol Ther | ||||||||
ISSN: | 1365-2036 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
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PubMed ID: | 31595533 | ||||||||
Web of Science ID: | WOS:000489433500001 | ||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/111342 | ||||||||
Publisher's version: | https://doi.org/10.1111/apt.15497 |
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