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Adherence to risk management guidelines for drugs which cause vitamin D deficiency – big data from the Swedish health system

Authors Nordqvist O, Lönnbom Svensson U, Brudin L, Wanby P, Carlsson M

Received 20 September 2018

Accepted for publication 8 January 2019

Published 22 March 2019 Volume 2019:11 Pages 19—28

DOI https://doi.org/10.2147/DHPS.S188187

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Siew-Siang Chua


Ola Nordqvist,1,2 Ulrika Lönnbom Svensson,3 Lars Brudin,4,5 Pär Wanby,2,6 Martin Carlsson2,7

1The Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden; 2eHealth Institute, Data Intensive Sciences and Applications (DISA), Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; 3Department of Chemistry and Biomedical Sciences, Linnaeus University, Kalmar, Sweden; 4Department of Clinical Physiology, County Hospital of Kalmar, Kalmar, Sweden; 5Department of Medical and Health Sciences, University of Linkoping, Linköping, Sweden; 6Section of Endocrinology, Department of Internal Medicine, County Hospital of Kalmar, Kalmar, Sweden; 7Department of Clinical Chemistry, County Hospital of Kalmar, Kalmar, Sweden

Purpose:
Several medications are known to cause vitamin D deficiency. The aim of this study is to describe vitamin D testing and supplementation in patients using these “risk medications”, thereby assessing adherence to medical guidelines.
Patients and methods: A database with electronic health records for the population in a Swedish County (≈240,000 inhabitants) was screened for patients prescribed the pre-defined “risk medications” during a 2-year period (2014–2015). In total, 12,194 patients were prescribed “risk medications” pertaining to one of the three included pharmaceutical groups. Vitamin D testing and concomitant vitamin D supplementation, including differences between the included pharmaceutical groups, was explored by matching personal identification numbers.
Results: Corticosteroids were prescribed to 10,003 of the patients, antiepileptic drugs to 1,101, and drugs mainly reducing vitamin D uptake to 864. Two hundred twenty-six patients were prescribed >1 “risk medication”. Seven hundred eighty-seven patients (6.5%) had been tested during the 2-year period. There were no differences regarding testing frequency between groups. Concomitant supplements were prescribed to 3,911 patients (32.1%). It was more common to be prescribed supplements when treated with corticosteroids. Vitamin D supplementation was more common among tested patients in all three groups. Women were tested and supplemented to a higher extent. The mean vitamin D level was 69 nmol/L. Vitamin D deficiency was found in 24.1% of tested patients, while 41.3% had optimal levels. It was less common to be deficient and more common to have optimal levels among patients prescribed corticosteroids.
Conclusion: Adherence to medical guidelines comprising testing and supplementation of patients prescribed drugs causing vitamin D deficiency needs improvement in Sweden.

Keywords: drug-induced vitamin D deficiency, medication risk management, big data, electronic health records, vitamin D, precision medicine

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