The Clinical Effectiveness and Evaulation Unit (CEEU) of the RCP (London) has developed an audit tool - Glucocorticoid-induced Osteporosis screening for older people (GIO SCOPE).

The tool assesses whether older people prescribed steroids are receiving appropriate bisphosphonate treatment to prevent osteoporosis. It has been piloted via the BGS and is now available through the Publications Department of the Royal College.

The tool has been developed in close conjunction with Prof Juliet Compston, Chairman of the Working Group that produced the Royal College Guidelines “Glucocorticoid - induced Osteoporosis”1. The standards used for the audit have been derived from the Guidelines and the audit tool has been approved by the guideline working group. It has been developed with a grant from the Alliance for Better Bone Health.

GIO SCOPE has been designed to be used on its own, or to be incorporated into the audit tool used in the National Sentinel Audit of Evidence Based Prescribing in Older People (EBPOP)2,3,4. The EBPOP audit assessed the appropriateness of prescribing in a range of clinical conditions including ischaemic heart disease, atrial fibrillation and diabetes as well as the appropriate use of benzodiazepines. Patients can be audited in primary care or secondary care (inpatients or outpatients). Subjects are identified by reviewing prescribing data or charts and by selecting those who are on treatment with glucocorticoids. Appropriateness of prescribing is determined by reviewing the patient records to identify such factors as the duration of steroid exposure, presence of contraindications or co-morbidity that would render bisphosphonates inappropriate (see algorithm below).

Pilot
The BGS Clinical Practice Effectiveness Committee (CPEC), using its network of departments committed to multi-centre audit, has piloted the audit tool. The results of the pilot (reported in Newsletter January 2004) have demonstrated that the tool is simple and practical, and can be used within busy district hospitals. There was variation in appropriateness of bisphosphonate prescribing ranging from 36 – 96%.

CPEC plans to repeat the audit in the light of the publication of the GIO Guidelines and utilising a broader range of departments within hospitals i.e. rheumatology, care of the elderly, chest. Anyone interested in contributing to the proposed audit should contact CPEC via: annette-guerda-fischer@bgs.org.uk

Jonathan Potter
Chairman
Clinical Practice Effectiveness Committee (CPEC)

References:

1. Glucocorticoid-induced Osteoporosis. Royal College of Physicans, London 2003.
2. Grant RL, Batty GM, Aggarwal R, Lowe D, Potter JM, Pearson MG, Oborne CA, and Jackson SHD. The National Sentinel Clinical Audit of Evidence-Based Prescribing for Older People: methodology and development. J Evaluation Clin Practice. 2002;8:189-98
3. Batty GM, Grant RL, Aggarwal R, Lowe D, Potter JM, Pearson MG et al. Using prescribing indicators to measure the quality of prescribing to elderly medical in-patients. Age and Ageing 2003;32:292-8.
4. Batty G, Potter J, Jackson S, Pearson M, Lowe D, and Grant R. National Clinical Sentinel Audit of Evidence-Based Prescribing for Older People. Journal of Evaluation in Clinical Practice. 2004. In press.