GP Prescribing Behaviour GP Prescribing Behaviour ChangeChange

Calcium Supplement Prescribing Calcium Supplement Prescribing CessationCessation

Kenneth ChinKenneth Chin

BackgroundBackground

Audit.Audit. Calcium supplement discontinuation in Calcium supplement discontinuation in

light of recent research findings.light of recent research findings. Bolland et al August 2010, in BMJ.Bolland et al August 2010, in BMJ. Effect of calcium supplements on risk Effect of calcium supplements on risk

of myocardial infarctions and of myocardial infarctions and cardiovascular events: meta-analysis.cardiovascular events: meta-analysis.

BackgroundBackground

Ca supplements >500mg/d had Hazard Ca supplements >500mg/d had Hazard Ratio 1.27 times (30% increased risk) of MI Ratio 1.27 times (30% increased risk) of MI compared to those not on calcium.compared to those not on calcium.

More so in the elderly female population.More so in the elderly female population. ““Treatment of 1000 people with calcium Treatment of 1000 people with calcium

for 5 years would cause an additional 14 for 5 years would cause an additional 14 MIs, 10 Strokes and 13 deaths, while MIs, 10 Strokes and 13 deaths, while preventing 26 fractures”.preventing 26 fractures”.

MethodMethod

Audit of GP practice database using Audit of GP practice database using Medtech Query Builder.Medtech Query Builder.

Female patients ≥65y.Female patients ≥65y. Prescribed Calcium Carbonate Prescribed Calcium Carbonate

Supplements for osteoporosis Supplements for osteoporosis management / prevention.management / prevention.

Prescribing dates for inclusion were 1 June Prescribing dates for inclusion were 1 June 2010 to 31 December 2010.2010 to 31 December 2010.

MethodMethod

All subjects’ notes were reviewed All subjects’ notes were reviewed until June 2011 to determine if until June 2011 to determine if calcium supplements were calcium supplements were discontinued.discontinued.

ResultsResults

118 audit subjects118 audit subjects 84 (71%) - Calcium supplements 84 (71%) - Calcium supplements

discontinued between August 2010 discontinued between August 2010 and June 2011.and June 2011.

ResultsResults

Of 34 (29%) still on calcium Of 34 (29%) still on calcium supplements:supplements:

13/34 T score <-2.5 ie osteoporotic.13/34 T score <-2.5 ie osteoporotic. 10/34 T score > -2.5 ie osteopenic.10/34 T score > -2.5 ie osteopenic. 11/34 had no bone densitometry 11/34 had no bone densitometry

recorded.recorded. Most were down to 1 tab Ca od.Most were down to 1 tab Ca od.

DiscussionDiscussion

71% reduction in patients prescribed 71% reduction in patients prescribed calcium supplements.calcium supplements.

The published research findings (Bolland The published research findings (Bolland et al) has impacted on calcium et al) has impacted on calcium supplement prescribing behaviour in the supplement prescribing behaviour in the practice.practice.

New research findings can and do impact New research findings can and do impact quickly on the management of patients in quickly on the management of patients in the GP setting.the GP setting.

DiscussionDiscussion

Some reasons patients remained on Some reasons patients remained on calcium supplements:calcium supplements:

Patient preference.Patient preference. Poor dietary calcium intake.Poor dietary calcium intake.

Important to identify patients at Important to identify patients at high risk of CVD, who remain on high risk of CVD, who remain on calcium supplements.calcium supplements.

ConclusionConclusion

Practice doctors have responded Practice doctors have responded quickly to new significant research quickly to new significant research findings, by appropriately modifying findings, by appropriately modifying prescribing behaviour.prescribing behaviour.

Key learning point: ongoing new Key learning point: ongoing new research findings can and do impact research findings can and do impact rapidly on the management of rapidly on the management of patients in the GP setting.patients in the GP setting.

ConclusionConclusion

Relevant new management plans Relevant new management plans would need to be thoroughly would need to be thoroughly discussed with patients to ensure discussed with patients to ensure successful implementation.successful implementation.

Ref: Bolland MJ et al. BMJ 2010;341: c3691.Ref: Bolland MJ et al. BMJ 2010;341: c3691.