Kirigaya Daijun, Nakayama Takeo, Ishizaki Tatsuro, Ikeda Shunya, Satoh Toshihiko
Japan Association for Development of Community Medicine, Japan.
Intern Med. 2011;50(22):2793-800. doi: 10.2169/internalmedicine.50.5266. Epub 2011 Nov 15.
The aim of this study was to evaluate the adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis, and to investigate whether it is associated with factors such as age, gender, glucocorticoid dose, physician specialty, and size of facility.
This was a cross-sectional study utilizing administrative data from a database of health insurance claims (2004-2007); 2,368 patients who received glucocorticoid treatment for ≥90 days were extracted. The guideline adherence was determined by evaluations based on glucocorticoid prescription dose, prescription of anti-osteoporosis drugs, and whether or not bone mineral density was measured.
Overall proportion of guideline adherence was 23.3%. In cases in which the equivalent dose of prednisolone was <5 mg/d and ≥5 mg/d, the adherence was 8.3% and 30.5% respectively. Factors correlating with low adherence included young age, male gender, and lower glucocorticoid doses. Surgery and otolaryngology specialties had lower adherence than internal medicine. Smaller clinical facilities had lower adherence than larger facilities.
The adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis is still low, and improvements in treatment quality can be expected through education of patient groups and medical care providers with large deviations from the guidelines.
本研究旨在评估糖皮质激素性骨质疏松症管理和治疗指南的依从性，并调查其是否与年龄、性别、糖皮质激素剂量、医生专业以及医疗机构规模等因素相关。
这是一项利用医疗保险理赔数据库（2004 - 2007年）中的管理数据进行的横断面研究；提取了2368名接受糖皮质激素治疗≥90天的患者。通过基于糖皮质激素处方剂量、抗骨质疏松药物处方以及是否测量骨密度的评估来确定指南依从性。
指南总体依从率为23.3%。当泼尼松龙等效剂量<5mg/d和≥5mg/d时，依从率分别为8.3%和30.5%。与低依从性相关的因素包括年龄小、男性以及较低的糖皮质激素剂量。外科和耳鼻喉科专业的依从性低于内科。较小的临床机构依从性低于较大的机构。
糖皮质激素性骨质疏松症管理和治疗指南的依从性仍然较低，通过对与指南有较大偏差的患者群体和医疗服务提供者进行教育，有望提高治疗质量。
