1. GP Prescribing Behaviour Change Calcium Supplement Prescribing Cessation Kenneth Chin

2. Background Audit. Audit. Calcium supplement discontinuation in light of recent research findings. Calcium supplement discontinuation in 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 of myocardial infarctions and cardiovascular events: meta-analysis. Effect of calcium supplements on risk of myocardial infarctions and cardiovascular events: meta-analysis.

3. Background Ca supplements >500mg/d had Hazard Ratio 1.27 times (30% increased risk) of MI compared to those not on calcium. Ca supplements >500mg/d had Hazard Ratio 1.27 times (30% increased risk) of MI 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 for 5 years would cause an additional 14 MIs, 10 Strokes and 13 deaths, while preventing 26 fractures”. “Treatment of 1000 people with calcium for 5 years would cause an additional 14 MIs, 10 Strokes and 13 deaths, while preventing 26 fractures”.

4. Method Audit of GP practice database using Medtech Query Builder. Audit of GP practice database using Medtech Query Builder. Female patients ≥65y. Female patients ≥65y. Prescribed Calcium Carbonate Supplements for osteoporosis management / prevention. Prescribed Calcium Carbonate Supplements for osteoporosis management / prevention. Prescribing dates for inclusion were 1 June 2010 to 31 December 2010. Prescribing dates for inclusion were 1 June 2010 to 31 December 2010.

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

6. Results 118 audit subjects 118 audit subjects 84 (71%) - Calcium supplements discontinued between August 2010 and June 2011. 84 (71%) - Calcium supplements discontinued between August 2010 and June 2011.

7. Results Of 34 (29%) still on calcium supplements: Of 34 (29%) still on calcium supplements:  13/34 T score <-2.5 ie osteoporotic.  10/34 T score > -2.5 ie osteopenic.  11/34 had no bone densitometry recorded.  Most were down to 1 tab Ca od.

8. Discussion 71% reduction in patients prescribed calcium supplements. 71% reduction in patients prescribed calcium supplements. The published research findings (Bolland et al) has impacted on calcium supplement prescribing behaviour in the practice. The published research findings (Bolland et al) has impacted on calcium supplement prescribing behaviour in the practice. New research findings can and do impact quickly on the management of patients in the GP setting. New research findings can and do impact quickly on the management of patients in the GP setting.

9. Discussion Some reasons patients remained on calcium supplements: Some reasons patients remained on calcium supplements:  Patient preference.  Poor dietary calcium intake. Important to identify patients at high risk of CVD, who remain on calcium supplements. Important to identify patients at high risk of CVD, who remain on calcium supplements.

10. Conclusion Practice doctors have responded quickly to new significant research findings, by appropriately modifying prescribing behaviour. Practice doctors have responded quickly to new significant research findings, by appropriately modifying prescribing behaviour. Key learning point: ongoing new research findings can and do impact rapidly on the management of patients in the GP setting. Key learning point: ongoing new research findings can and do impact rapidly on the management of patients in the GP setting.

11. Conclusion Relevant new management plans would need to be thoroughly discussed with patients to ensure successful implementation. Relevant new management plans would need to be thoroughly discussed with patients to ensure successful implementation. Ref: Bolland MJ et al. BMJ 2010;341: c3691.