To analyze neurologists’ practice on prevention of possible complications of systemic corticosteroid therapy

Systemic steroids are used in the treatment of a variety of neurological conditions. Long-term use increases risk for possible complications, including pneumocystis pneumonia (PCP), osteoporosis, and gastrointestinal ulcers. National guidelines recommend certain monitoring parameters and preventative measures but it is unclear to what extent these are followed by neurologists. With this study, we aim to identify barriers to guideline adherence so that in a next step we can implement changes to improve guideline adherence.

Prior research on guideline adherence used structured surveys addressing resource/support barriers, system/process barriers, and attitudinal/rational-emotive barriers. We designed a survey based on these previously validated principles and distributed it to the neurological faculty at our institute using an online survey tool. Limited demographic data, including subspecialty and fellowship training of the providers, was also collected. Following this local pilot study we secured sponsorship from the ºÃÉ«ÏÈÉú (AAN) Member Research Subcommittee and have been working with a research analyst on distributing the survey to AAN members to obtain nationwide data.

Our local pilot project showed that 71% of physicians counsel patients on common steroid side effects. Most physicians monitor for blood pressure changes and gastrointestinal (GI) symptoms. Less than 50% monitor for diabetes, bone health with DEXA scan, or possible ophthalmologic side effects. Almost none use fracture risk assessment tools. About 50% of physicians prescribe vitamin D, calcium, and GI prophylaxis. Only 25% prescribe PCP prophylaxis. Most neurologists believe that treatment guidelines are evidence-based and useful but may be difficult to implement because of lack of medical resources or lack of time amongst other factors.  

Guidelines are not always followed in clinical practice with significant variation between different institutions, which may have important implications for patient outcome.