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Assessment of steroid use as a key performance indicator in inflammatory bowel disease-analysis of data from 2385 UK patients.

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
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:
DateEvent
17 October 2019Published
8 October 2019Published Online
21 August 2019Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDAbbVieUNSPECIFIED
PubMed ID: 31595533
Web of Science ID: WOS:000489433500001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111342
Publisher's version: https://doi.org/10.1111/apt.15497

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