Endocrine Abstracts

Aim: To assess whether patients on glucocorticoids understand how to manage their medication in the event of intercurrent illness.

Background: Studies have shown that, after as little as two weeks of glucocorticoid treatment, 10% of patients have adrenal suppression and it can take one year or longer for adrenal function to recover. With 7 out of 1000 people in the general population prescribed glucocorticoids, there is a large group at risk of adrenal crises and there were 78 reported incidents associated with glucorticoid prescribing in the last 4 years in England. Consequently, there is a national drive to improve safety of glucocorticoid prescribing. Neurology is one speciality in which glucocorticoids are frequently prescribed and often for extended periods of time.

Methods: Patients who attended the Oxford Muscle clinic during the past year and prescribed glucocorticoids were identified (Duchenne muscular dystrophy n = 11 and idiopathic inflammatory myopathy n = 9). Standardised telephone interviews were conducted to assess patient and family understanding of how to manage glucocorticoids in the event of an intercurrent illness.

Results: Despite improvements over the last 12 months, <20% of patients had documentation in their medical record that “sick day” rules were specifically discussed. Seventy per cent were uncertain or unaware of what to do in the event of an intercurrent illness and 60% did not know to seek medical advice if they were unable to take their glucocorticoids. Only half reported carrying a steroid card.

Conclusions: Improvements are needed to increase patients’ and healthcare professionals’ understanding of the potential risks associated with glucocorticoids. To mitigate against this, a programme of increased education and training of patients, families, and clinical staff has been undertaken and written information is now provided to every patient and their GP.