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An Internet-based Controlled Trial Aimed to Improve Osteoporosis Prevention among Chronic Glucocorticoid Users
Amy H Warriner1, Ryan C Outman1, Jeroan J Allison1
1From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
Objective:
To address the low prevention and treatment rates for those at risk of glucocorticoid-induced osteoporosis (GIOP), we evaluated the influence of a direct-to-patient, Internet-based educational video intervention using "storytelling" on rates of antiosteoporosis medication use among chronic glucocorticoid users who were members of an online pharmacy refill service.
Methods:
We identified members who refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 contiguous days and had no GIOP therapy for ≥ 12 months. Using patient stories, we developed an online video addressing risk factors and treatment options, and delivered it to members refilling a glucocorticoid prescription. The intervention consisted of two 45-day "Video ON" periods, during which the video automatically appeared at the time of refill, and two 45-day "Video OFF" periods, during which there was no video. Members could also "self-initiate" watching the video by going to the video link. We used an interrupted time series design to evaluate the effectiveness of this intervention on GIOP prescription therapies over 6 months.
Results:
Among 3017 members (64.8%) exposed to the intervention, 59% had measurable video viewing time, of which 3% "self-initiated" the video. The GIOP prescription rate in the "Video ON" group was 2.9% versus 2.7% for the "Video OFF" group. There was a nonsignificant trend toward greater GIOP prescription in members who self-initiated the video versus automated viewing (5.7% vs 2.9%, p = 0.1).
Conclusion:
Among adults at high risk of GIOP, prescription rates were not significantly affected by an online educational video presented at the time of glucocorticoid refill. ClinicalTrials.gov Identifier: NCT01378689.
Insights
An online educational video did not significantly increase antiosteoporosis medication use in patients at risk for glucocorticoid-induced osteoporosis (GIOP). This intervention showed no significant impact on GIOP prevention or treatment rates.
Area of Science:
- Endocrinology
- Pharmacology
- Digital Health
Background:
- Glucocorticoid-induced osteoporosis (GIOP) is a common side effect of long-term glucocorticoid use.
- Low rates of GIOP prevention and treatment necessitate innovative intervention strategies.
- Online educational interventions offer a scalable approach to patient education.
Purpose of the Study:
- To evaluate the effectiveness of an internet-based educational video intervention on antiosteoporosis medication use.
- To assess the impact of a "storytelling" video on patients at risk for GIOP.
- To determine if direct-to-patient online education improves GIOP treatment rates.
Main Methods:
- An interrupted time series design was used to analyze data from 3017 members of an online pharmacy refill service.
- Participants refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 days and had no prior GIOP therapy.
- An online video intervention was delivered during "Video ON" periods and compared to "Video OFF" periods.
Main Results:
- The GIOP prescription rate was similar between "Video ON" (2.9%) and "Video OFF" (2.7%) periods.
- Among those exposed, 59% viewed the video, with only 3% self-initiating viewing.
- A nonsignificant trend showed higher prescription rates for self-initiated viewing (5.7%) versus automated viewing (2.9%).
Conclusions:
- An online educational video intervention did not significantly increase antiosteoporosis medication prescription rates in high-risk patients.
- The intervention's impact on GIOP prevention and treatment rates was not statistically significant.
- Further research may be needed to optimize digital health strategies for GIOP management.
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