SAT293 Improving Prescribing For Emergency Glucocorticoid Kits In Primary Adrenal Insufficiency
Authors: Porter Michael W , Anderson Karolina E , Myers Kyle M , Friedman Sally , Perez-Martinez Sebastian U , Adamczyk Jessica , Patel Vishal , Hendrickson Chase Dean 
Published: October 2023

Disclosure: M.W. Porter: None. K.E. Anderson: None. K.M. Myers: None. S. Friedman: None. S.U. Perez-Martinez: None. J. Adamczyk: None. V. Patel: None. C.D. Hendrickson: None.

Introduction: Primary adrenal insufficiency (PAI) is a condition defined by the inability of the adrenal cortex to produce sufficient amounts of glucocorticoids and mineralocorticoids. Adrenal crisis is a complication of PAI which studies suggest approximately 1 in 12 patients will experience in the coming year, with an associated mortality rate of 0.5/100 patient years.1

Endocrine Society guidelines recommend that every PAI patient should be equipped with a glucocorticoid injection kit for emergency use.2 Despite this recommendation, rates of prescription are variable with recently published survey data demonstrating ranges of 30% 3 to 86.5%.4

Aim: The aim of this quality improvement project was to increase emergency glucocorticoid injection prescribing to greater than 80% of patients with Addison’s disease.

Methods: Our project first identified baseline data on active emergency glucocorticoid prescription for patients with diagnosis of Addison’s disease and a clinical encounter within the prior year.We then engaged clinical pharmacist stakeholders who were presented these patients and proactively contacted each directly, facilitating prescriptions being sent in the most affordable method to the pharmacy of choice and then notifying the clinician.

Results: Retrospective analysis into prescribing patterns at our clinic demonstrated a mean of 54.7% PAI patients with an active prescription for emergency glucocorticoid during 2021.

Following a transition period after initiating the intervention in March 2022 there was a statistically significant increase in mean active prescriptions to 88% maintained from May to Nov. 2022 as demonstrated on a statistical process control chart.

Discussion/Conclusion: While emergency glucocorticoid is recommended for all patients with PAI, we identified a deficit in prescription patterns that appears consistent with previous data.

Numerous challenges exist for consistent prescription practices; however, our intervention demonstrated a reproducible model for increasing access to potentially lifesaving medication in patients with PAI.

References: 1.Hahner S, Spinnler C, Fassnacht M, et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab. 2015;100:407– 416. 2.Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. 3.

Kienitz T, Hahner S, Burger-Stritt S, Quinkler M. Therapeutic Patient Education for Adrenal Insufficiency under COVID-19 Pandemic Conditions. Exp Clin Endocrinol Diabetes. 2021;129(3):241-249. 4.Li D, Suresh M, Abbondanza T, et al. The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency. J Clin Endocrinol Metab. 2021;106(7):e2469-e2479.

Presentation: Saturday, June 17, 2023