1
|
Corrao G, Rea F, Iommi M, Lallo A, Fantaci G, Di Martino M, Davoli M, Leoni O, Pompili M, Scondotto S, De Luca G, Carle F, Lorusso S, Giordani C, Di Lenarda A, Maggioni AP. Cost-effectiveness of outpatient adherence to recommendations for monitoring of patients hospitalized for heart failure. ESC Heart Fail 2024; 11:2719-2729. [PMID: 38725148 PMCID: PMC11424316 DOI: 10.1002/ehf2.14779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS A set of indicators to assess the quality of care for patients hospitalized for heart failure was developed by an expert working group of the Italian Health Ministry. Because a better performance profile measured using these indicators does not necessarily translate to better outcomes, a study to validate these indicators through their relationship with measurable clinical outcomes and healthcare costs supported by the Italian National Health System was carried out. METHODS AND RESULTS Residents of four Italian regions (Lombardy, Marche, Lazio, and Sicily) who were newly hospitalized for heart failure (irrespective of stage and New York Heart Association class) during 2014-2015 entered in the cohort and followed up until 2019. Adherence to evidence-based recommendations [i.e. renin-angiotensin-aldosterone system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and echocardiograms (ECCs)] experienced during the first year after index discharge was assessed. Composite clinical outcomes (cardiovascular hospital admissions and all-cause mortality) and healthcare costs (hospitalizations, drugs, and outpatient services) were assessed during the follow-up. The restricted mean survival time at 5 years (denoted as the number of months free from clinical outcomes), the hazard of clinical outcomes (according to the Cox model), and average annual healthcare cost (expressed in euros per person-year) were compared between adherent and non-adherent patients. A non-parametric bootstrap method based on 1000 resamples was used to account for uncertainty in cost-effectiveness estimates. A total of 41 406 patients were included in this study (46.3% males, mean age 76.9 ± 9.4 years). Adherence to RAS inhibitors, beta-blockers, MRAs, and ECCs were 64%, 57%, 62%, and 20% among the cohort members, respectively. Compared with non-adherent patients, those who adhered to ECCs, RAS inhibitors, beta-blockers, and MRAs experienced (i) a delay in the composite outcome of 1.6, 1.9, 1.6, and 0.6 months and reduced risks of 9% (95% confidence interval, 2-14%), 11% (7-14%), 8% (5-11%), and 4% (-1-8%), respectively; and (ii) lower (€262, €92, and €571 per year for RAS inhibitors, beta-blockers, and MRAs, respectively) and higher costs (€511 per year for ECC). Adherence to RAS inhibitors, beta-blockers, and MRAs showed a delay in the composite outcome and a saving of costs in 98%, 84%, and 93% of the 1000 bootstrap replications, respectively. CONCLUSIONS Strict monitoring of patients with heart failure through regular clinical examinations and drug therapies should be considered the cornerstone of national guidelines and audits.
Collapse
Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and PharmacoepidemiologyUniversity of Milano–BicoccaMilanItaly
- Department of Statistics and Quantitative MethodsUniversity of Milano–BicoccaMilanItaly
| | - Federico Rea
- National Centre for Healthcare Research and PharmacoepidemiologyUniversity of Milano–BicoccaMilanItaly
- Department of Statistics and Quantitative MethodsUniversity of Milano–BicoccaMilanItaly
| | - Marica Iommi
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public HealthMarche Polytechnic UniversityAnconaItaly
| | - Adele Lallo
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Giovanna Fantaci
- Department of Epidemiologic ObservatoryHealth Department of SicilyPalermoItaly
| | - Mirko Di Martino
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Marina Davoli
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | | | | | - Salvatore Scondotto
- National Centre for Healthcare Research and PharmacoepidemiologyUniversity of Milano–BicoccaMilanItaly
- Department of Epidemiologic ObservatoryHealth Department of SicilyPalermoItaly
| | - Giovanni De Luca
- Department of Epidemiologic ObservatoryHealth Department of SicilyPalermoItaly
| | - Flavia Carle
- National Centre for Healthcare Research and PharmacoepidemiologyUniversity of Milano–BicoccaMilanItaly
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public HealthMarche Polytechnic UniversityAnconaItaly
| | - Stefano Lorusso
- Department of Health PlanningItalian Health MinistryRomeItaly
| | | | - Andrea Di Lenarda
- Cardiovascular CenterUniversity Hospital and Health Services of TriesteTriesteItaly
| | | | | |
Collapse
|
2
|
Kurita T, Kuramitsu S, Ishii M, Takasaki A, Domei T, Matsuo H, Horie K, Ando H, Terai H, Kikuta Y, Ishihara T, Saigusa T, Sakamoto T, Suematsu N, Shiono Y, Asano T, Tsujita K, Masamura K, Doijiri T, Toyota F, Ogita M, Shiraishi J, Harada K, Isogai H, Anai R, Sonoda S, Yokoi H, Tanaka N, Dohi K. Impact of Antiplatelet Therapy on 5-Year Outcomes After Fractional Flow Reserve-Guided Deferral of Revascularization in Nonsignificant Obstructive Coronary Artery Disease. Circ Rep 2024; 6:313-321. [PMID: 39132333 PMCID: PMC11309776 DOI: 10.1253/circrep.cr-24-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Background Because the clinical benefit of antiplatelet therapy (APT) for patients with nonsignificant coronary artery disease (CAD) remains poorly understood, we evaluated it in patients after fractional flow reserve (FFR)-guided deferral of revascularization. Methods and Results From the J-CONFIRM (Long-Term Outcomes of Japanese Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), we investigated 265 patients with deferred lesions who did not require APT for secondary prevention of cardiovascular disease. A 2-year landmark analysis assessed the relationship between APT at 2 years and 5-year major cardiac adverse events (MACE: composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization). Of the 265 patients, 163 (61.5%) received APT. The 5-year MACE did not significantly differ between the APT and non-APT groups after adjustment for baseline clinical characteristics (9.2% vs. 6.9%, inverse probability weighted hazard ratio, 1.40 [95% confidence interval, 0.53-3.69]; P=0.49). There was a marginal interaction between the effect of APT on MACE and FFR values (< or ≥0.84) (P for interaction=0.066). Conclusions The 5-year outcomes after FFR-guided deferral of revascularization did not significantly differ between the APT and non-APT groups, suggesting that APT might not be a critical requirement for nonsignificant obstructive CAD patients not requiring APT for secondary prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| | - Shoichi Kuramitsu
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | - Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital Fukuoka Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital Sendai Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University Aichi Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital Ishikawa Japan
| | - Yuetsu Kikuta
- Department of Cardiology, Fukuyama Cardiovascular Hospital Hiroshima Japan
| | | | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Nagano Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Taku Asano
- Department of Cardiology, St. Luke's International Hospital Tokyo Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | | | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital Kanagawa Japan
| | | | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Jun Shiraishi
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital Kyoto Japan
| | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital Nagoya Japan
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital Chiba Japan
| | - Reo Anai
- The Second Department of Internal Medicine, University of Occupational and Environmental Health Japan School of Medicine Kitakyushu Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University Saga Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital Fukuoka Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center Tokyo Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| |
Collapse
|
3
|
Moreira FT, Accorsi TAD, Amicis KD, Köhler KF, Morbeck RA, Cordioli E, Pedrotti CHS. Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters. EINSTEIN-SAO PAULO 2024; 22:eAO0707. [PMID: 38985017 PMCID: PMC11213559 DOI: 10.31744/einstein_journal/2024ao0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/04/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols. METHODS A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections. RESULTS Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%. CONCLUSION Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
Collapse
Affiliation(s)
- Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Tarso Augusto Duenhas Accorsi
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Renata Albaladejo Morbeck
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Carlos Henrique Sartorato Pedrotti
- Hospital Israelita Albert EinsteinTelemedicine DepartmentSão PauloSPBrazilTelemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Kagerbauer SM, Wißler J, Blobner M, Biegert F, Andonov DI, Schneider G, Podtschaske AH, Ulm B, Jungwirth B. Anaesthesiologists' guideline adherence in pre-operative evaluation: a retrospective observational study. Perioper Med (Lond) 2024; 13:64. [PMID: 38943163 DOI: 10.1186/s13741-024-00424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Surveys suggest a low level of implementation of clinical guidelines, although they are intended to improve the quality of treatment and patient safety. Which guideline recommendations are not followed and why has yet to be analysed. In this study, we investigate the proportion of European and national guidelines followed in the area of pre-operative anaesthetic evaluation prior to non-cardiac surgery. METHODS We conducted this monocentric retrospective observational study at a German university hospital with the help of software that logically links guidelines in such a way that individualised recommendations can be derived from a patient's data. We included routine logs of 2003 patients who visited our pre-anaesthesia outpatient clinic between June 2018 and June 2020 and compared the actual conducted pre-operative examinations with the recommendations issued by the software. We descriptively analysed the data for examinations not performed that would have been recommended by the guidelines and examinations that were performed even though they were not covered by a guideline recommendation. The guidelines examined in this study are the 2018 ESAIC guidelines for pre-operative evaluation of adults undergoing elective non-cardiac surgery, the 2014 ESC/ESA guidelines on non-cardiac surgery and the German recommendations on pre-operative evaluation on non-cardiothoracic surgery from the year 2017. RESULTS Performed ECG (78.1%) and cardiac stress imaging tests (86.1%) indicated the highest guideline adherence. Greater adherence rates were associated with a higher ASA score (ASA I: 23.7%, ASA II: 41.1%, ASA III: 51.8%, ASA IV: 65.8%, P < 0.001), lower BMI and age > 65 years. Adherence rates in high-risk surgery (60.5%) were greater than in intermediate (46.5%) or low-risk (44.6%) surgery (P < 0.001). 67.2% of technical and laboratory tests performed preoperatively were not covered by a guideline recommendation. CONCLUSIONS Guideline adherence in pre-operative evaluation leaves room for improvement. Many performed pre-operative examinations, especially laboratory tests, are not recommended by the guidelines and may cause unnecessary costs. The reasons for guidelines not being followed may be the complexity of guidelines and organisational issues. A software-based decision support tool may be helpful. TRIAL REGISTRATION ClinicalTrials.gov ID NCT04843202.
Collapse
Affiliation(s)
- Simone Maria Kagerbauer
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Jennifer Wißler
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Manfred Blobner
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Ferdinand Biegert
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimislav Ivanov Andonov
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gerhard Schneider
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Armin Horst Podtschaske
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Ulm
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| |
Collapse
|
5
|
Kühn L, Rosen D, Reiter NL, Prill R, Choi KEA. Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany. BMC Musculoskelet Disord 2024; 25:422. [PMID: 38811932 PMCID: PMC11137918 DOI: 10.1186/s12891-024-07505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery. METHODS We used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. "Appropriate exercise delivery" was determined by a relative total score achievement of > 80%. "Partly appropriate exercise delivery" was determined by a relative total score achievement of 50-79%, and "inappropriate exercise delivery" by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses. RESULTS 11.9% (N = 35) of 298 physiotherapists' exercise delivery was considered "appropriate", 83.3% (N = 245) was "partly appropriate", and 4.8% (N = 14) was "inappropriate". In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = - 0.520; 95% CI [-0.959; - 0.081]). CONCLUSION Appropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management. REGISTRATION Open science framework: https://doi.org/10.17605/OSF.IO/S76MF .
Collapse
Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Diane Rosen
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
| | - Nils Lennart Reiter
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
- PhysioBib GbR, Johanniterstraße 26, 10961, Berlin, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Neuruppin, Germany
| | - Kyung-Eun Anna Choi
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany
- Health Services Research, Medical Imaging and Artificial Intelligence, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, Krems-Stein, 3500, Austria
| |
Collapse
|
6
|
Clavel MA, Van Spall HG, Mantella LE, Foulds H, Randhawa V, Parry M, Liblik K, Kirkham AA, Cotie L, Jaffer S, Bruneau J, Colella TJ, Ahmed S, Dhukai A, Gomes Z, Adreak N, Keeping-Burke L, Limbachia J, Liu S, Jacques KE, Mullen KA, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 8: Knowledge Gaps and Status of Existing Research Programs in Canada. CJC Open 2024; 6:220-257. [PMID: 38487042 PMCID: PMC10935691 DOI: 10.1016/j.cjco.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 03/17/2024] Open
Abstract
Despite significant progress in medical research and public health efforts, gaps in knowledge of women's heart health remain across epidemiology, presentation, management, outcomes, education, research, and publications. Historically, heart disease was viewed primarily as a condition in men and male individuals, leading to limited understanding of the unique risks and symptoms that women experience. These knowledge gaps are particularly problematic because globally heart disease is the leading cause of death for women. Until recently, sex and gender have not been addressed in cardiovascular research, including in preclinical and clinical research. Recruitment was often limited to male participants and individuals identifying as men, and data analysis according to sex or gender was not conducted, leading to a lack of data on how treatments and interventions might affect female patients and individuals who identify as women differently. This lack of data has led to suboptimal treatment and limitations in our understanding of the underlying mechanisms of heart disease in women, and is directly related to limited awareness and knowledge gaps in professional training and public education. Women are often unaware of their risk factors for heart disease or symptoms they might experience, leading to delays in diagnosis and treatments. Additionally, health care providers might not receive adequate training to diagnose and treat heart disease in women, leading to misdiagnosis or undertreatment. Addressing these knowledge gaps requires a multipronged approach, including education and policy change, built on evidence-based research. In this chapter we review the current state of existing cardiovascular research in Canada with a specific focus on women.
Collapse
Affiliation(s)
- Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Harriette G.C. Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Toronto, Ontario, Canada
| | - Laura E. Mantella
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Varinder Randhawa
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston Health Science Center, Kingston, Ontario, Canada
| | - Amy A. Kirkham
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Lisa Cotie
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Shahin Jaffer
- General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Bruneau
- Faculty of Nursing, Memorial University of Newfoundland and Labrador, St John, Newfoundland and Labrador, Canada
| | - Tracey J.F. Colella
- Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Ontario, Canada
| | - Sofia Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abida Dhukai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Faculty of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Najah Adreak
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Keeping-Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Jayneel Limbachia
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Shuangbo Liu
- Section of Cardiology, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen E. Jacques
- Person with lived experience, Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Kerri A. Mullen
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon L. Mulvagh
- Faculty of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Seleznova Y, Bruder O, Loeser S, Artmann J, Shukri A, Naumann M, Stock S, Wein B, Müller D. Health economic consequences of optimal vs. observed guideline adherence of coronary angiography in patients with suspected obstructive stable coronary artery in Germany: a microsimulation model. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:45-54. [PMID: 36893809 PMCID: PMC10785585 DOI: 10.1093/ehjqcco/qcad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/10/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
AIMS While the number of patients with stable coronary artery disease (SCAD) is similar across European countries, Germany has the highest per capita volume of coronary angiographies (CA). This study evaluated the health economic consequences of guideline-non-adherent use of CA in patients with SCAD. METHODS AND RESULTS As part of the ENLIGHT-KHK trial, a prospective observational study, this microsimulation model compared the number of major adverse cardiac events (MACE) and the costs of real-world use of CA with those of (assumed) complete guideline-adherent use (according to the German National Disease Management Guideline 2019). The model considered non-invasive testing, CA, revascularization, MACE (30 days after CA), and medical costs. Model inputs were obtained from the ENLIGHT-KHK trial (i.e. patients' records, a patient questionnaire, and claims data). Incremental cost-effectiveness ratios were calculated by comparing the differences in costs and MACE avoided from the perspective of the Statutory Health Insurance (SHI). Independent on pre-test probability (PTP) of SCAD, complete guideline adherence for usage of CA would result in a slightly lower rate of MACE (-0.0017) and less cost (€-807) per person compared with real-world guideline adherence. While cost savings were shown for moderate and low PTP (€901 and €502, respectively), for a high PTP, a guideline-adherent process results in slightly higher costs (€78) compared with real-world guideline adherence. Sensitivity analyses confirmed the results. CONCLUSION Our analysis indicates that improving guideline adherence in clinical practice by reducing the amount of CAs in patients with SCAD would lead to cost savings for the German SHI.
Collapse
Affiliation(s)
- Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
- Faculty of Medicine, Ruhr University Bochum, 44801, Bochum, Germany
| | - Simon Loeser
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany
| | - Jörg Artmann
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany
| | - Arim Shukri
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Marie Naumann
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Bastian Wein
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany
- Department of Cardiology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
| |
Collapse
|
8
|
Tamblyn R, Moraga T, Girard N, Chan FKI, Habib B, Boulet J. Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults. BMC Geriatr 2023; 23:761. [PMID: 37986045 PMCID: PMC10662284 DOI: 10.1186/s12877-023-04429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Although lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical competence are associated with prescribing lipid-lowering drugs for primary and secondary prevention. METHODS We used a cohort of 4,501 international medical graduates, 161,214 U.S. Medicare patients with hyperlipidemia (primary prevention) and 49,780 patients with a history of cardiovascular disease (secondary prevention) not treated with lipid-lowering therapy who were seen by study physicians in ambulatory care. Clinical competence and communication ability were measured by the ECFMG clinical assessment examination. Physician citizenship, age, gender, specialty and patient characteristics were also measured. The outcome was an incident prescription of lipid-lowering drug, evaluated using multivariable GEE logistic regression models for primary and secondary prevention for patients 75+ and 65-74. RESULTS Patients 75+ were less likely than those 65-74 to receive lipid-lowering drugs for primary (OR 0.62, 95% CI 0.59-0.66) and secondary (OR 0.70, 95% CI 0.63-0.78) prevention. For every 20% increase in clinical competence score, the odds of prescribing therapy for primary prevention to patients 75+ increased by 24% (95% CI 1.02-1.5). Communication ability had the opposite effect, reducing the odds of prescribing for primary prevention by 11% per 20% score increase (95% CI 0.8-0.99) for both age groups. Physicians who were citizens of countries with higher proportions of Hispanic (South/Central America) or Asian (Asia/Oceania) people were more likely to prescribe treatment for primary prevention, and internal medicine specialists were more likely to treat for secondary prevention than primary care physicians. CONCLUSION Clinical competence, communication ability and physician citizenship are associated with lipid-lowering drug prescribing for primary prevention in patients aged 75+.
Collapse
Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue., Montreal, QC, H3A 1G1, Canada.
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
| | - Teresa Moraga
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - Fiona K I Chan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue., Montreal, QC, H3A 1G1, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - John Boulet
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, PA, USA
| |
Collapse
|
9
|
Gopwani S, Bahrun E, Singh T, Popovsky D, Cramer J, Geng X. Efficacy of Electronic Reminders in Increasing the Enhanced Recovery After Surgery Protocol Use During Major Breast Surgery: Prospective Cohort Study. JMIR Perioper Med 2023; 6:e44139. [PMID: 37921854 PMCID: PMC10656665 DOI: 10.2196/44139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room. OBJECTIVE Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers' adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols. METHODS This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient's record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements. RESULTS Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance. CONCLUSIONS This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols.
Collapse
Affiliation(s)
- Sumeet Gopwani
- Department of Anesthesiology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ehab Bahrun
- Georgetown University School of Medicine, Washington, DC, United States
| | - Tanvee Singh
- Georgetown University School of Medicine, Washington, DC, United States
| | - Daniel Popovsky
- Georgetown University School of Medicine, Washington, DC, United States
| | - Joseph Cramer
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xue Geng
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, United States
| |
Collapse
|
10
|
Zheng J, Heidenreich PA, Kohsaka S, Fearon WF, Sandhu AT. Long-Term Outcomes of Early Coronary Artery Disease Testing After New-Onset Heart Failure. Circ Heart Fail 2023; 16:e010426. [PMID: 37212148 PMCID: PMC10523905 DOI: 10.1161/circheartfailure.122.010426] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) testing remains underutilized in patients with newly diagnosed heart failure (HF). The longitudinal clinical impact of early CAD testing has not been well-characterized. We investigated changes in clinical management and long-term outcomes after early CAD evaluation in patients with incident HF. METHODS We identified Medicare patients with incident HF from 2006 to 2018. The exposure variable was early CAD testing within 1 month of initial HF diagnosis. Covariate-adjusted rates of cardiovascular interventions after testing, including CAD-related management, were modeled using mixed-effects regression with clinician as a random intercept. We assessed mortality and hospitalization outcomes using landmark analyses with inverse probability-weighted Cox proportional hazards models. Falsification end points and mediation analysis were employed for bias assessment. RESULTS Among 309 559 patients with new-onset HF without prior CAD, 15.7% underwent early CAD testing. Patients who underwent prompt CAD evaluation had higher adjusted rates of subsequent antiplatelet/statin prescriptions and revascularization, guideline-directed therapy for HF, and stroke prophylaxis for atrial fibrillation/flutter than controls. In weighted Cox models, 1-month CAD testing was associated with significantly reduced all-cause mortality (hazard ratio, 0.93 [95% CI, 0.91-0.96]). Mediation analyses indicated that ≈70% of this association was explained by CAD management, largely from new statin prescriptions. Falsification end points (outpatient diagnoses of urinary tract infection and hospitalizations for hip/vertebral fracture) were nonsignificant. CONCLUSIONS Early CAD testing after incident HF was associated with a modest mortality benefit, driven mostly by subsequent statin therapy. Further investigation on clinician barriers to testing and treating high-risk patients may improve adherence to guideline-recommended cardiovascular interventions.
Collapse
Affiliation(s)
- Jimmy Zheng
- Stanford University School of Medicine, Stanford, CA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
- Department of Medicine, Palo Alto VA Veteran’s Affairs Hospitals, Palo Alto, CA
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
- Department of Medicine, Palo Alto VA Veteran’s Affairs Hospitals, Palo Alto, CA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA
| |
Collapse
|
11
|
Use of fixed-dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia. Clin Res Cardiol 2023; 112:197-202. [PMID: 35220445 PMCID: PMC9898344 DOI: 10.1007/s00392-022-01993-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines for the management of hypertension highlight the importance of fixed-dose combinations (FDC) for the treatment of hypertension and recommend initial single-pill combination therapy in almost all patients. However, data on the implementation of these recommendations in clinical practice are scarce. METHODS Data from the German Institute for Drug Use Evaluation (DAPI) were analyzed and extrapolated accounting for approximately 88% of Germany's population (approximately 73.3 million subjects). All antihypertensive (AHT) FDC products available on the German market were included in the analyses. We examined the time course of dispensed packages between January 2016 and December 2020. RESULTS FDCs accounted for 15.4% of all AHT in 2016 and for 10.9% in 2020. While dispensing of all AHT increased slightly from year to year (2016: 143.8 million, 2020: 153.2 million packs), dispensing of FDCs decreased from 22.2 million (2016) to 16.6 million (2020) packs. Dispensing of FDCs containing hydrochlorothiazide (HCT) declined considerably from 2016 to 2020 (Q1 2016: 4.65 million, Q4 2020: 3.13 million packs). Accordingly, the proportion of HCT-containing combinations in all FDCs decreased from 85.3 to 74.2% from Q1 2016 to Q4 2020. Patients younger than 80 years were prescribed FDCs more frequently (14.6% of all AHT, based on the entire evaluation period) than patients 80 years and older (10.0%). In both age groups, this proportion decreased continuously over time. CONCLUSIONS Almost 2 years following the release of the 2018 ESC/ESH guidelines, only 10.9% of the prescribed packs of antihypertensive drugs in 2020 were FDC products, documenting underutilization of current guideline recommendations on pharmacotherapy in hypertension. Structured programs to evidence-based decision support are required to improve guideline inertia and patient outcomes, eventually.
Collapse
|
12
|
Suttels V, Van Singer M, Clack LC, Plüss-Suard C, Niquille A, Mueller Y, Boillat Blanco N. Factors Influencing the Implementation of Antimicrobial Stewardship in Primary Care: A Narrative Review. Antibiotics (Basel) 2022; 12:30. [PMID: 36671230 PMCID: PMC9854946 DOI: 10.3390/antibiotics12010030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is directly driven by inappropriate use of antibiotics. Although the majority of antibiotics (an estimated 80%) are consumed in primary care settings, antimicrobial stewardship (AMS) activities in primary care remain underdeveloped and factors influencing their implementation are poorly understood. This can result in promising stewardship activities having little-to-no real-world impact. With this narrative review, we aim to identify and summarize peer-reviewed literature reporting on (1) the nature and impact of AMS interventions in primary care and (2) the individual and contextual factors influencing their implementation. Reported activities included AMS at different contextual levels (individual, collective and policy). AMS activities being often combined, it is difficult to evaluate them as stand-alone interventions. While some important individual and contextual factors were reported (difficulty to reach physicians leading to a low uptake of interventions, tight workflow of physicians requiring implementation of flexible and brief interventions and AMS as a unique opportunity to strengthen physician-patients relationship), this review identified a paucity of information in the literature about the factors that support or hinder implementation of AMS in primary care settings. In conclusion, identifying multilevel barriers and facilitators for AMS uptake is an essential step to explore before implementing primary care AMS interventions.
Collapse
Affiliation(s)
- Véronique Suttels
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Mathias Van Singer
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Lauren Catherine Clack
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, 8006 Zürich, Switzerland
| | - Catherine Plüss-Suard
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), Pharmacy University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, 1011 Lausanne, Switzerland
| | - Yolanda Mueller
- Center for Primary Care and Public Health (Unisanté), Department of Family Medicine, 1011 Lausanne, Switzerland
| | - Noémie Boillat Blanco
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| |
Collapse
|
13
|
Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
Collapse
Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| |
Collapse
|
14
|
Lehmann DM, Cohen N, Lin IH, Alexander S, Kathuria R, Kerpelev M, Taur Y, Seo SK. Analyzing Adherence to the 2016 Infectious Diseases Society of America Guidelines for Candidemia in Cancer Patients. Open Forum Infect Dis 2022; 9:ofac555. [PMID: 36540383 PMCID: PMC9757685 DOI: 10.1093/ofid/ofac555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Candidemia is associated with morbidity and mortality in cancer patients. We analyzed adherence to the 2016 Infectious Diseases Society of America (IDSA) candidiasis guidelines and the reasons for guideline nonadherence. We also investigated whether matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) improved time to effective antifungal therapy compared with historical data (median, 43.2 hours). Methods Cancer patients with candidemia between 1/1/17 and 12/31/19 were included. Adherence to 7 individual IDSA guideline components was assessed. Composite IDSA guideline adherence (defined as meeting ≥6 guideline components) was also assessed. Charts were reviewed to examine reasons for noncompliance. Results Of 157 patients with candidemia, 150 (95.5%) had infectious disease (ID) consultation. The median total time from blood culture collection to antifungal initiation was 42.1 hours. Excluding 39 patients with short treatment due to death, there was 100% adherence with surveillance blood cultures, followed by antifungal susceptibility testing (117/118, 99.2%), initial appropriate therapy (117/118, 99.2%), antifungal duration (110/118, 93.2%), line removal (82/91, 90.1%), eye exams (93/118, 78.8%), and step-down therapy (69/94, 73.4%). A quarter (30/118) did not meet composite IDSA guideline adherence. Univariate logistic regression suggested a relationship between poor cancer prognosis and incomplete adherence to the 2016 IDSA candidiasis guidelines (odds ratio, 8.6; 95% CI, 1.6-47). Conclusions The addition of MALDI-TOF did not shorten time to effective antifungal therapy. Nearly all patients were seen by ID for candidemia. Poor cancer prognosis was a common factor for incomplete composite adherence to the 2016 IDSA candidiasis guidelines.
Collapse
Affiliation(s)
| | | | - I-Hsin Lin
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Marina Kerpelev
- Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Cornell Medical College, New York, New York, USA
| | - Susan K Seo
- Correspondence: S. K. Seo, MD, Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 ()
| |
Collapse
|
15
|
Seibert AM, Hersh AL, Patel PK, Matheu M, Stanfield V, Fino N, Hicks LA, Tsay SV, Kabbani S, Stenehjem E. Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e184. [PMID: 36406162 PMCID: PMC9672912 DOI: 10.1017/ash.2022.329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Healthcare disparities and inequities exist in a variety of environments and manifest in diagnostic and therapeutic measures. In this commentary, we highlight our experience examining our organization's urgent care respiratory encounter antibiotic prescribing practices. We identified differences in prescribing based on several individual characteristics including patient age, race, ethnicity, preferred language, and patient and/or clinician gender. Our approach can serve as an electronic health record (EHR)-based methodology for disparity and inequity audits in other systems and for other conditions.
Collapse
Affiliation(s)
- Allan M. Seibert
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Murray, Utah
| | - Adam L. Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Payal K. Patel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Murray, Utah
| | - Michelle Matheu
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Murray, Utah
| | | | - Nora Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Lauri A. Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon V. Tsay
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Murray, Utah
| |
Collapse
|
16
|
Ishii M, Kuramitsu S, Yamanaga K, Matsuo H, Horie K, Takashima H, Terai H, Kikuta Y, Ishihara T, Saigusa T, Sakamoto T, Suematsu N, Shiono Y, Asano T, Masamura K, Doijiri T, Toyota F, Ogita M, Kurita T, Matsuo A, Harada K, Yaginuma K, Kanemura N, Sonoda S, Yokoi H, Tanaka N, Tsujita K. Association of guideline-directed medical therapy adherence with outcomes after fractional flow reserve-based deferral of revascularization. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:600-608. [PMID: 35108383 DOI: 10.1093/ehjcvp/pvac008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 01/29/2022] [Indexed: 11/14/2022]
Abstract
AIMS Guideline-directed medical therapy (GDMT) is essential to prevent future cardiovascular events in chronic coronary syndrome (CCS) patients. However, whether achieving optimal GDMT could improve clinical outcomes in CCS patients with deferred lesions based on fraction flow reserve (FFR) remains thoroughly investigated. We sought to evaluate the association of GDMT adherence with long-term outcomes after FFR-based deferral of revascularization in a real-world registry. METHODS AND RESULTS This is a post-hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicentre registry). Optimal GDMT was defined as combining four types of medications: antiplatelet drug, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, beta-blocker, and statin. After stratifying patients by the number of individual GDMT agents at 2 years, landmark analysis was conducted to assess the relationship between GDMT adherence at 2 years and 5-year major adverse cardiac events (MACEs), defined as a composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization. Compared with the suboptimal GDMT group (continuing ≤3 types of medications, n = 974), the optimal GDMT group (n = 139) showed a lower 5-year incidence of MACE (5.2% vs. 12.4%, P = 0.02). The optimal GDMT was associated with a lower risk of MACE (hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.92; P = 0.03). CONCLUSION Patients with optimal GDMT were associated with better outcomes, suggesting the importance of achieving optimal GDMT on long-term prognosis in CCS patients after FFR-guided deferral of revascularization.
Collapse
Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, 3 Chome-2-1 Asano, Kokurakita Ward, Kitakyushu 802-8555, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, 4 Chome-14-4, Yabuta-minami, Gifu City, Gifu 500-8384, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba Ward, Sendai 980-0873, Japan
| | - Hiroaki Takashima
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Ha-16 Tanakamachi, Kanazawa 920-0007, Japan
| | - Yuetsu Kikuta
- Department of Cardiology, Fukuyama Cardiovascular Hospital, 2-39 Midorimachi, Fukuyama 720-0804, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-chōme-1-69 Inabasō, Amagasaki 660-8511, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3 Chome-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5 Chome-3 No. 1 Chikami, Minami Ward, Kumamoto 861-4193, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital, 1 Chome-3-46 Tenjin, Fukuoka 810-0001, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Taku Asano
- Department of Cardiology, St Luke's International Hospital, 9-1 Akashicho, Chuo City Tokyo 104-8560, Japan
| | - Katsuhiko Masamura
- Department of Cardiology, Nakamura Hospital, 4-28 Tennocho, Echizen 915-0068, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, 9 Chome-8-2 Minamirinkan, Yamato 242-0006, Japan
| | - Fumitoshi Toyota
- Department of Cardiology, Chidoribashi Hospital, 5-18-1 Chiyo, Fukuoka 812-8633, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Shizuoka 410-2295, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2 Chome-174, Mie 514-8507, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Higashiuratsujicho, Kamigyo Ward, Kyoto 602-8031, Japan
| | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital, 1-10-6 Komei, Minato Ward, Nagoya 455-8530, Japan
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, 2 Chome-1-1 Tomioka, Chiba 279-0021, Japan
| | - Noriyoshi Kanemura
- Department of Cardiology, Kainan hospital, Minamihonden-396 Maegasucho, Aichi 498-8502, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Failure Therapy, Saga University, 5-1-1, Nabeshima 849-8501, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| |
Collapse
|
17
|
Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
18
|
Sammani A, Jansen M, de Vries NM, de Jonge N, Baas AF, te Riele ASJM, Asselbergs FW, Oerlemans MIFJ. Automatic Identification of Patients With Unexplained Left Ventricular Hypertrophy in Electronic Health Record Data to Improve Targeted Treatment and Family Screening. Front Cardiovasc Med 2022; 9:768847. [PMID: 35498038 PMCID: PMC9051030 DOI: 10.3389/fcvm.2022.768847] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Unexplained Left Ventricular Hypertrophy (ULVH) may be caused by genetic and non-genetic etiologies (e.g., sarcomere variants, cardiac amyloid, or Anderson-Fabry's disease). Identification of ULVH patients allows for early targeted treatment and family screening. Aim To automatically identify patients with ULVH in electronic health record (EHR) data using two computer methods: text-mining and machine learning (ML). Methods Adults with echocardiographic measurement of interventricular septum thickness (IVSt) were included. A text-mining algorithm was developed to identify patients with ULVH. An ML algorithm including a variety of clinical, ECG and echocardiographic data was trained and tested in an 80/20% split. Clinical diagnosis of ULVH was considered the gold standard. Misclassifications were reviewed by an experienced cardiologist. Sensitivity, specificity, positive, and negative likelihood ratios (LHR+ and LHR–) of both text-mining and ML were reported. Results In total, 26,954 subjects (median age 61 years, 55% male) were included. ULVH was diagnosed in 204/26,954 (0.8%) patients, of which 56 had amyloidosis and two Anderson-Fabry Disease. Text-mining flagged 8,192 patients with possible ULVH, of whom 159 were true positives (sensitivity, specificity, LHR+, and LHR– of 0.78, 0.67, 2.36, and 0.33). Machine learning resulted in a sensitivity, specificity, LHR+, and LHR– of 0.32, 0.99, 32, and 0.68, respectively. Pivotal variables included IVSt, systolic blood pressure, and age. Conclusions Automatic identification of patients with ULVH is possible with both Text-mining and ML. Text-mining may be a comprehensive scaffold but can be less specific than machine learning. Deployment of either method depends on existing infrastructures and clinical applications.
Collapse
Affiliation(s)
- Arjan Sammani
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mark Jansen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nynke M. de Vries
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Annette F. Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Marish I. F. J. Oerlemans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- *Correspondence: Marish I. F. J. Oerlemans
| |
Collapse
|
19
|
Zheng J, Heidenreich PA, Kohsaka S, Fearon WF, Sandhu AT. Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure. J Am Coll Cardiol 2022; 79:849-860. [PMID: 35241218 PMCID: PMC9031351 DOI: 10.1016/j.jacc.2021.11.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized. OBJECTIVES This study aimed to identify contemporary trends in CAD testing for patients with new-onset HF, particularly after publication of the STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study), and to characterize geographic and clinician-level variability in testing patterns. METHODS We determined the proportion of patients with incident HF who received CAD testing from 2004 to 2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90 days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians. RESULTS Among 558,322 patients with new-onset HF, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20% to 45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR: 5.12; 95% CI: 4.98-5.27) but varied substantially across cardiologists (IQR: 50.9%-62.4%). CONCLUSIONS Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians.
Collapse
Affiliation(s)
- Jimmy Zheng
- Stanford University School of Medicine, Stanford, California, USA.
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Department of Medicine, Palo Alto VA Veteran's Affairs Hospitals, Palo Alto, California, USA. https://twitter.com/paheidenreich
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Department of Medicine, Palo Alto VA Veteran's Affairs Hospitals, Palo Alto, California, USA. https://twitter.com/wfearonmd
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA. https://twitter.com/ATSandhu
| |
Collapse
|
20
|
Zyryanov SK, Fitilev SB, Vozzhaev AV, Shkrebniova II. Multivariable Analysis of Primary Care Physician Adherence to Guideline-recommended Pharmacotherapy of Stable Coronary Artery Disease. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2020-16-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study predictors of primary care physician adherence to guideline-recommended pharmacotherapy of stable coronary artery disease.Material and methods. This pharmacoepidemiologic cross-sectional study was conducted in primary care setting of Moscow. 805 patients (mean age 68.9±9.9 years, males 51.4%) with established stable coronary artery disease (SCAD) were included. Demography, medical history, prescribed pharmacological treatment data were obtained. Physician adherence to guideline-recommended pharmacotherapy (GRP) of SCAD was evaluated based on the Class I guideline recommendations. Pharmacotherapeutic guideline adherence index (PGAI) was introduced as composite quality indicator, calculated in line with “all-or-none” rule and in regard with documented contraindications. To search for predictors of adherence the patient population was divided in two groups by level of physician adherence measured by PGAI. Statistical analysis was performed by IBM SPSS Statistics 16.0, the level of statistical significance was set at p<0.05.Results. The prescription rates of essential drug therapies of SCAD (regarding contraindications) were quite adequate: beta-blockers/calcium channel blockers – 90,1%, acetylsalicylic acid/clopidogrel/oral anticoagulants – 95,7%, statins/ezetimibe – 86,3%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers – 87,6%. 82,9% (n=667) of patients were prescribed treatment for SCAD in compliance with the guidelines. Suboptimal pharmacotherapy was identified in 17,1% (n=138) of patients. These groups were similar in sex distribution (males 50,4 vs. 56,5%; p=0,188). Mean age tended to be lower in GRP adherent group (68,5±9,9 vs. 70,6±10,0 years; p=0,052). Bivariable analysis showed that good adherence to guideline-recommended pharmacotherapy was associated with higher prevalence of stable angina (66,4 vs. 53,6%; p=0,004), arterial hypertension (93,3 vs. 79,7%; p<0,001) and dyslipidemia (21,4 vs. 9,4%; p<0,001) and with lower prevalence of myocardial infarction (48,1 vs. 67,4%; p<0,001). Logistic multivariable regression model (gender, age, 6 medical history variables) identified 6 patient-related factors that were significantly associated with physician adherence to guideline-recommended pharmacotherapy: age (odds ratio [OR] 0,97; 95% confidence interval [CI] 0,95-0,99; p=0,009), arterial hypertension (OR 3,89; 95%CI 2,19-6,90; p<0,001), dyslipidemia (OR 2,31; 95%CI 1,23-4,34; p=0,009), chronic heart failure (OR 1,95; 95%CI 1,06-3,61; p=0,032), revascularization (OR 2,14; 95%CI 1,33-3,45; p=0,002), myocardial infarction (OR 0,28; 95%CI 0,16-0,48; p<0,001).Conclusion. Primary care cardiologist adherence to guideline-recommended pharmacotherapy of SCAD was satisfactory evaluated as 82,9% by composite indicator PGAI. Arterial hypertension, heart failure, dyslipidemia и revascularization were predictors of better physician adherence. History of myocardial infarction and older age were risk factors of non-adherence. Identification of patient-related factors associated with underperformance may facilitate tailoring quality improvement interventions in primary care of coronary patients.
Collapse
Affiliation(s)
- S. K. Zyryanov
- Peoples Friendship University of Russia (RUDN University)
| | - S. B. Fitilev
- Peoples Friendship University of Russia (RUDN University)
| | - A. V. Vozzhaev
- Peoples Friendship University of Russia (RUDN University)
| | | |
Collapse
|
21
|
Chen L, Ionescu-Ittu R, Romdhani H, Guerin A, Kessler P, Borentain M, Friend K, DeSouza M, Sato N. Disease Management and Outcomes in Patients Hospitalized for Acute Heart Failure in Japan. Cardiol Ther 2021; 10:211-228. [PMID: 33609268 PMCID: PMC8126582 DOI: 10.1007/s40119-021-00212-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/18/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction This study described patients hospitalized for acute heart failure (AHF) in Japan who received intravenous (IV) diuretics and/or vasodilators as the initial therapy. Methods The Japan Medical Data Vision database was used to identify adult patients hospitalized for AHF during 2013–2017, who were hemodynamically stable at presentation and treated with IV diuretics and/or IV vasodilators as initial therapy. Treatment patterns and use of cardiac rehabilitation, as well as outcomes (e.g., length of stay [LOS], in-hospital mortality, HF-readmission) were reported overall and by year of AHF hospitalization. Results Of 30,360 patients (mean age = 80.0 years; 52.2% male), 87.0% were treated during the hospitalization with IV diuretics, 63.9% with IV vasodilators, and 13.8% with intensified therapies. On average, the duration of IV therapy was 10.6 days. In-hospital cardiac rehabilitation was utilized by 51.7% of the patients for 11.7 days on average. Mean LOS was 23.3 days, while in-hospital mortality and 30-day HF readmission post-discharge were 13.2 and 9.5%, respectively. Hospitalization outcomes remained stable between 2013 and 2017 despite important changes in AHF management such as a decrease in carperitide use (55.9–40.0% in 2017), and increases in use of tolvaptan (from 14.2% in 2013 to 31.3% in 2017) and of cardiac rehabilitation (from 43.2% in 2013 to 56.1% in 2017). Patients with intensified therapies had the longest IV therapy duration (mean 23.8 days vs. 5.5–9.9 days), the highest cardiac rehabilitation services use (60.2 vs. 38.3–57.0%), the longest LOS (mean 36.7 vs. 16.3–22.2 days), and the highest in-hospital mortality (37.4 vs. 3.1–12.4%) compared to the other treatment groups. Conclusions Contemporary treatment for AHF hospitalization in Japan comprises a long duration of IV therapy followed by extended use of oral medications and in-hospital cardiac rehabilitation prior to discharge. Patients requiring intensified therapies had much longer LOS and higher in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-021-00212-y.
Collapse
Affiliation(s)
- Lei Chen
- Employee of Bristol Myers Squibb at the time when the research was conducted, Lawrenceville, NJ, USA
| | | | | | | | | | | | | | | | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan.
| |
Collapse
|
22
|
Asselbergs FW, Sammani A, Elliott P, Gimeno JR, Tavazzi L, Tendera M, Kaski JP, Maggioni AP, Rubis PP, Jurcut R, Heliö T, Calò L, Sinagra G, Zdravkovic M, Olivotto I, Kavoliūnienė A, Laroche C, Caforio AL, Charron P. Differences between familial and sporadic dilated cardiomyopathy: ESC EORP Cardiomyopathy & Myocarditis registry. ESC Heart Fail 2021; 8:95-105. [PMID: 33179448 PMCID: PMC7835585 DOI: 10.1002/ehf2.13100] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) is a complex disease where genetics interplay with extrinsic factors. This study aims to compare the phenotype, management, and outcome of familial DCM (FDCM) and non-familial (sporadic) DCM (SDCM) across Europe. METHODS AND RESULTS Patients with DCM that were enrolled in the prospective ESC EORP Cardiomyopathy & Myocarditis Registry were included. Baseline characteristics, genetic testing, genetic yield, and outcome were analysed comparing FDCM and SDCM; 1260 adult patients were studied (238 FDCM, 707 SDCM, and 315 not disclosed). Patients with FDCM were younger (P < 0.01), had less severe disease phenotype at presentation (P < 0.02), more favourable baseline cardiovascular risk profiles (P ≤ 0.007), and less medication use (P ≤ 0.042). Outcome at 1 year was similar and predicted by NYHA class (HR 0.45; 95% CI [0.25-0.81]) and LVEF per % decrease (HR 1.05; 95% CI [1.02-1.08]. Throughout Europe, patients with FDCM received more genetic testing (47% vs. 8%, P < 0.01) and had higher genetic yield (55% vs. 22%, P < 0.01). CONCLUSIONS We observed that FDCM and SDCM have significant differences at baseline but similar short-term prognosis. Whether modification of associated cardiovascular risk factors provide opportunities for treatment remains to be investigated. Our results also show a prevalent role of genetics in FDCM and a non-marginal yield in SDCM although genetic testing is largely neglected in SDCM. Limited genetic testing and heterogeneity in panels provides a scaffold for improvement of guideline adherence.
Collapse
Affiliation(s)
- Folkert W. Asselbergs
- Department of CardiologyUniversity Medical Centre Utrecht, University of UtrechtHeidelberglaan 100Utrecht3584CXThe Netherlands
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - Arjan Sammani
- Department of CardiologyUniversity Medical Centre Utrecht, University of UtrechtHeidelberglaan 100Utrecht3584CXThe Netherlands
| | - Perry Elliott
- Barts Heart Centre, St Bartholomew's HospitalUniversity College London and Inherited Cardiac Diseases UnitLondonUK
| | - Juan R. Gimeno
- Cardiac DepartmentHospital Universitario Virgen de la ArrixacaMurciaSpain
| | - Luigi Tavazzi
- GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
| | - Michael Tendera
- Department of Cardiology and Structural Heart Diseases, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street HospitalUK and University College London Institute of Cardiovascular ScienceLondonUK
| | - Aldo P. Maggioni
- GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
- EUR Observational Research Programme, European Society of CardiologySophia‐AntipolisFrance
| | - Pawel P. Rubis
- Department of Cardiac and Vascular DiseasesJagiellonian University Medical College, John Paul II HospitalKrakowPoland
| | - Ruxandra Jurcut
- Department of CardiologyEmergency Institute of Cardiovascular Diseases C.C. IliescuBucharestRomania
| | - Tiina Heliö
- Department of CardiologyHelsinki University Central Hospital MeilahtiHelsinkiFinland
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano IsontinaTriesteItaly
| | - Marija Zdravkovic
- Clinical Hospital Center Bezanijska kosa, Faculty of MedicineUniversity of BelgradeBeogradSerbia
| | | | - Aušra Kavoliūnienė
- Department of CardiologyLithuanian University of Health SciencesKaunasLithuania
| | - Cécile Laroche
- EUR Observational Research Programme, European Society of CardiologySophia‐AntipolisFrance
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Philippe Charron
- APHP, Centre de Référence des Maladies Cardiaques Héréditaires, ICAN, Hôpital Pitié‐SalpêtrièreSorbonne UniversitéParisFrance
| | | |
Collapse
|
23
|
Seleznova Y, Wein B, Müller D, Naumann M, Bruder O, Steffen M, Windhövel U, Loeser S, Artmann J, Fritz T, Eckardt M, Stock S, Naber CK. Evaluation of Guideline Adherence for Cardiac Catheterization in Patients With Presumed Obstructive Coronary Artery Disease in Germany (ENLIGHT-KHK) - A Multicentre, Prospective, Observational Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:19-25. [PMID: 33288463 DOI: 10.1016/j.carrev.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The diagnosis or exclusion of obstructive stable coronary artery disease (SCAD) in clinical practice is challenging and therefore clinical guidelines provide recommendations on the use of non-invasive and invasive testing. For Germany, data obtained from the OECD and health insurances indicate a potential non-adherence to guideline-recommended diagnostic pathways. However, there is a lack of prospective and reliable evidence for appropriate use of invasive coronary angiography (CA) in Germany. OBJECTIVE To provide evidence on the nature and extent of guideline non-adherence in patients undergoing CA with presumed obstructive SCAD in Germany and, to evaluate the clinical and economic consequences of potential deviations in guideline adherence. METHODS ENLIGHT-KHK is a multicentre, prospective observational study recruiting 1500 patients being admitted for CA with presumed obstructive SCAD and exclusion of acute myocardial infarction (DRKS00015638). The primary outcome measure is the adherence to clinical guidelines in the decision-making process for use of CA. Therefore, the patients' diagnostic pathways and adherence to German and European guidelines will be assessed using clinical data, health-claims data, and a patient questionnaire. The primary safety outcome is a composite of myocardial infarction, stroke and all-cause death. Secondary outcome measures are periprocedural complications and costs. Using a decision-analytic model, the clinical and economic impact of observed guideline adherence in clinical practice will be assessed. Potential barriers and facilitators of guideline-adherent decision-making will be evaluated via semi-structured interviews. CONCLUSIONS ENLIGHT-KHK will give insights into the appropriateness of invasive CA in Germany and enable the development of concepts to improve guideline-adherence in the German health-care setting.
Collapse
Affiliation(s)
- Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.
| | - Bastian Wein
- University Hospital Augsburg, Medical Department I, Stenglingstr. 2, 86156 Augsburg, Germany; Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany.
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.
| | - Marie Naumann
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.
| | - Oliver Bruder
- Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany.
| | - Melanie Steffen
- Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138 Essen, Germany.
| | - Ute Windhövel
- Cardiovascular European Research Center (CERC) Deutschland GmbH, Huttropstr. 60, 45138 Essen, Germany.
| | - Simon Loeser
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany.
| | - Jörg Artmann
- AOK Rheinland/Hamburg, Kasernenstraße 61, 40213 Düsseldorf, Germany.
| | - Thomas Fritz
- AOK NORDWEST, Kopenhagener Straße 1, 44269 Dortmund, Germany.
| | - Melanie Eckardt
- AOK NORDWEST, Kopenhagener Straße 1, 44269 Dortmund, Germany.
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.
| | - Christoph Kurt Naber
- Hospital Wilhelmshaven, Department of Cardiology und Intensive Care, Friedrich-Paffrath-Straße 100, 26389 Wilhelmshaven, Germany.
| |
Collapse
|
24
|
Plate A, Kronenberg A, Risch M, Mueller Y, Di Gangi S, Rosemann T, Senn O. Treatment of urinary tract infections in Swiss primary care: quality and determinants of antibiotic prescribing. BMC FAMILY PRACTICE 2020; 21:125. [PMID: 32611320 PMCID: PMC7329427 DOI: 10.1186/s12875-020-01201-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
Background Urinary tract infections are one of the most common reasons for prescribing antibiotics in primary care. Current guidelines recommend fosfomycin, nitrofurantoin, or trimethoprim - sulfamethoxazol as empiric first line antimicrobial agents in uncomplicated infections. However, there is evidence that the use of fluoroquinolones, which are no longer recommended, is still inappropriate high. We determined antibiotic prescription patterns, quality and factors affecting antibiotic prescriptions in urinary tract infections in primary care in Switzerland. Methods From June 2017 to August 2018, we conducted a cross-sectional study in patients suffering from a urinary tract infection (UTI). Patient and general practitioners characteristics as well as antibiotic prescribing patterns were analysed. Results Antibiotic prescribing patterns in 1.352 consecutively recruited patients, treated in 163 practices could be analysed. In 950 (84.7%) patients with an uncomplicated UTI the prescriptions were according to current guidelines and therefore rated as appropriate. Fluoroquinolones were prescribed in 13.8% and therefore rated as inappropriate. In multivariable analysis, the age of the general practitioner was associated with increasing odds of prescribing a not guideline recommended antibiotic therapy. Conclusions We found a high degree of guideline conform antibiotic prescriptions in patients with an uncomplicated urinary tract infection in primary care in Switzerland. However, there is still a substantial use of fluoroquinolones in empiric therapy.
Collapse
Affiliation(s)
- Andreas Plate
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, 8071, Zurich, Switzerland.
| | - Andreas Kronenberg
- Swiss Center for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern and Medix General Practice Network, Bern, Switzerland
| | - Martin Risch
- labormedizinisches zentrum Dr Risch Ostschweiz AG, Buchs, St. Gallen, Switzerland
| | - Yolanda Mueller
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stefania Di Gangi
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, 8071, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, 8071, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University and University Hospital of Zurich, Pestalozzistrasse 24, 8071, Zurich, Switzerland
| |
Collapse
|
25
|
Krittayaphong R, Winijkul A, Kunjara-Na-Ayudhya R, Apiyasawat S, Siriwattana K, Kanjanarutjawiwat W, Dutsadeevettakul S, Lip GYH. Adherence to Anticoagulant Guideline for Atrial Fibrillation Improves Outcomes in Asian Population: The COOL-AF Registry. Stroke 2020; 51:1772-1780. [PMID: 32390554 DOI: 10.1161/strokeaha.120.029295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and Purpose- Guideline adherent oral anticoagulant (OAC) management of patients with nonvalvular atrial fibrillation has been associated with improved outcomes, but limited data are available from Asia. We aimed to investigate outcomes in patients who received guideline compliant management compared with those who were OAC undertreated or overtreated, in a large nationwide multicenter cohort of patients with nonvalvular atrial fibrillation in Thailand. Methods- Patients with nonvalvular atrial fibrillation were prospectively enrolled from 27 hospitals-all of which are data contributors to the COOL-AF Registry (Cohort of Antithrombotic Use and Optimal INR Level in Patients With Non-Valvular Atrial Fibrillation in Thailand). Patients were categorized as follows: (1) guideline adherence group when OAC was given in high-risk or intermediate-risk, but not in low-risk patients; (2) undertreatment group when OAC was not given in the high-risk or intermediate-risk groups; and (3) overtreatment group when OAC was given in the low-risk group or when OAC was given in combination with antiplatelets without indication. Results- A total of 3327 patients who had follow-up clinical outcome data were included. The mean age of patients was 67.4 years and 58.1% were male. The numbers of patients in the guideline adherence group, undertreatment group, and overtreatment group were 2267 (68.1%), 624 (18.8%), and 436 (13.1%) patients, respectively. The overall rate of ischemic stroke, major bleeding, all bleeding, and death was 3.0%, 4.4%, 15.1%, and 7.8%, respectively. Undertreated patients had a higher risk of ischemic stroke and death compared with guideline adherent patients, and overtreated patients had a higher risk of bleeding and death compared with OAC guideline-managed patients. Conclusions- Adherence to OAC management guidelines is associated with improved clinical outcomes in Asian nonvalvular atrial fibrillation patients. Undertreatment or overtreatment was found to be associated with increased risk of adverse outcomes compared with guideline-adherent management.
Collapse
Affiliation(s)
- Rungroj Krittayaphong
- From the Division of Cardiology, Siriraj Hospital (R.K.,A.W.), Mahidol University, Bangkok, Thailand
| | - Arjbordin Winijkul
- From the Division of Cardiology, Siriraj Hospital (R.K.,A.W.), Mahidol University, Bangkok, Thailand
| | | | - Sirin Apiyasawat
- Division of Cardiology, Department of Medicine, Ramathibodi Hospital (S.A.), Mahidol University, Bangkok, Thailand
| | | | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.).,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | | |
Collapse
|
26
|
Denger B, Kinnett K, Martin A, Grant S, Armstrong C, Khodyakov D. Patient and caregiver perspectives on guideline adherence: the case of endocrine and bone health recommendations for Duchenne muscular dystrophy. Orphanet J Rare Dis 2019; 14:205. [PMID: 31429780 PMCID: PMC6702715 DOI: 10.1186/s13023-019-1173-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clinical care guidelines are typically developed by clinicians and researchers. Including patient and caregiver voices in guideline development may help create guidelines that are more useful for patients and consequently improve their guideline adherence. Although there is substantial research on the factors the affect providers' adherence to guidelines, there is less research on the factors that affect patients' compliance with guideline recommendations, especially among those with rare disorders. The purpose of this study is to explore factors that are likely to affect patient/caregiver adherence to endocrine and bone health recommendations for Duchenne Muscular Dystrophy (DMD). To do so, we used qualitative data collected as part of the study designed to develop, implement, and evaluate a new online, modified-Delphi approach to engaging patients with rare diseases and their caregivers in guideline development, using care guidelines for DMD as a case study. METHODS We thematically analyzed qualitative data collected from 95 adults with DMD and their caregivers who participated in at least one round of our online Modified-Delphi panel process. Participants rated and commented on the patient-centeredness of 19 recommendations about vertical growth, weight management, bone health, and delayed puberty included in the 2018 DMD care considerations. Patient-centeredness was operationalized as the importance and acceptability of care recommendations. RESULTS Thematic analyses revealed six factors that affect guideline adherence from the patient/caregiver perspective: content and format of recommendations, patient and provider characteristics, and social and financial factors. CONCLUSIONS This study used a novel approach to exploring patient and caregiver perspectives on factors that may affect guideline adherence. The six factors identified by DMD patients and caregivers are similar to the factors affecting provider adherence and are not limited to DMD. Understanding consistency between provider- and patient/caregiver-identified barriers to following guideline recommendations can lead to developing more successful interventions for increasing guideline adherence.
Collapse
Affiliation(s)
- Brian Denger
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Ann Martin
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, 07601, USA
| | - Sean Grant
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.,Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, 46202, IN, USA
| | - Courtney Armstrong
- RAND Corporation, 1885 Mission Street, Suite 300, San Francisco, CA, 94103, USA
| | - Dmitry Khodyakov
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| |
Collapse
|