Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial

Abstract Background Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA’s revision of its safety warning. Method We used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians’ characteristics. Results Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician’s gender, and age were not consistent across insurance populations and types of ESA. Conclusions Physician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.

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Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after TREAT trial showed they are ineffective and unsafe

10.21203/rs.3.rs-329817/v1 ◽

2021 ◽

Author(s):

Khoa Vu ◽

Jiani Zhou ◽

Alexander Everhart ◽

Nihar Desai ◽

Jeph Herrin ◽

...

Keyword(s):

Primary Care Physicians ◽

Kidney Diseases ◽

Interrupted Time Series ◽

Study Cohort ◽

Fee For Service ◽

Erythropoiesis Stimulating Agents ◽

Safety Warning ◽

Gender And Age ◽

Levels Of Use ◽

Time Series Approach

Abstract Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney diseases (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. We used an interrupted time series approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial and Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians’ characteristics. Study cohort included patients with CKD stages 3 to 5 during 2007-2015. Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician's gender, and age were not consistent across insurance populations and types of ESA.

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WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

British Journal of General Practice ◽

10.3399/bjgp18x697085 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697085

Author(s):

Trudy Bekkering ◽

Bert Aertgeerts ◽

Ton Kuijpers ◽

Mieke Vermandere ◽

Jako Burgers ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Clinical Practice ◽

Primary Care Physicians ◽

Urinary Stones ◽

Care Practice ◽

Supporting Evidence ◽

Supervised Exercise ◽

Review Team ◽

New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

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Fortuna

10.1093/oso/9780198786566.001.0001 ◽

2018 ◽

Author(s):

Daniele Miano

Keyword(s):

Middle Ages ◽

Historical Development ◽

Conceptual Analysis ◽

Dominant Role ◽

Age Groups ◽

New Approach ◽

Good Fortune ◽

Gender And Age ◽

New Meanings ◽

And Gender

This book focuses on the Latin goddess Fortuna, one of the better known deities in ancient Italy. The earliest forms of her worship can be traced back to archaic Latium, and she was still a widely recognized allegorical figure during the Middle Ages and the Renaissance. The main reason for her longevity is that she was a conceptual deity, and had strong associations with chance and good fortune. When they were interacting with the goddess, communities, individuals, and gender and age groups were inevitably also interacting with the concept. These relations were not neutral: they allowed people to renegotiate the concept, enriching it with new meanings and challenging established ones. The geographical and chronological scope of this book is Italy from the archaic age to the late Republic. In this period Italy was a fragmented, multicultural and multilinguistic environment, characterized by a wide circulation of people, customs, and ideas, in which Rome played an increasingly dominant role. All available sources on Fortuna have been used: literary, epigraphic, and archaeological. The study of the goddess based on conceptual analysis will serve to construct a radically new picture of the historical development of this deity in the context of the cultural interactions taking place in ancient Italy. The book also aims at experimenting with a new approach to polytheism, based on the connection between gods and goddesses and concepts.

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Abstract 03: Outpatient Care Preceding Incident Heart Failure (HF) and Implications for Long-Term Outcomes. The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.131.suppl_1.03 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Anna Kucharska-Newton ◽

Lloyd Chambless ◽

Ricky Camplain ◽

Carmen Cuthbertson ◽

Patricia Chang ◽

...

Keyword(s):

Outpatient Care ◽

Primary Care Physicians ◽

Fee For Service ◽

Physician Visits ◽

Comorbidity Score ◽

Risk Of Death ◽

Outpatient Visits ◽

Outpatient Physician ◽

One Year ◽

Aric Study

Hypothesis: We hypothesized that outpatient management of patients at risk for a HF hospitalization is associated with lower mortality following an incident HF hospitalization. Methods: Patterns of outpatient visits prior to incident HF hospitalization were assessed among CMS Medicare beneficiaries with continuous fee-for-service eligibility residing during 2003-2006 in four geographic areas of CVD surveillance conducted by the ARIC Study. Incident HF hospitalization was defined as hospitalization with ICD9 code 428.x with no HF hospitalizations in preceding 2 years. Outpatient visits to primary care physicians, general internists, or cardiologists were identified from Carrier files. A comorbidity score was calculated from ICD9 codes at the time of incident HF hospitalization. Cox proportional hazard models adjusted for age, comorbidity score, gender, and race were used to estimate mortality. Results: Mean age among beneficiaries with observed incident HF hospitalization (n=2006; 90.4% white, 45.1% male) was 79.8 years (SD 7.4). Mean comorbidity score was 3.6 (SD 1.9). Mean number of outpatient physician visits occurring in two years preceding the incident HF hospitalization, was 9.6 (SD 9.0); 19.6% beneficiaries had no observed prior outpatient physician visits. Risk of death within one year of incident HF hospitalization was greater among those with no preceding outpatient physician visits as compared to those with at least one physician visit (adjusted HR=1.81 (95% CI 1.50, 2.18); Figure). Adjustment for the presence of an outpatient visit within 2 weeks following the HF hospitalization attenuated the risk of death (HR=1.56 (1.29, 1.89)). Conclusion: Lack of outpatient care in two years prior to a HF-related hospitalization is associated with increased mortality within one year following hospitalization. Further inquiry is warranted to assess whether the association reflects diversity in causes/manifestations of HF, ambulatory care received in ED settings, or benefits associated with outpatient care.

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Tourism and environmental performance: New evidence using a threshold regression analysis

Tourism Economics ◽

10.1177/13548166211042450 ◽

2021 ◽

pp. 135481662110424

Author(s):

Zhike Lv ◽

Ting Xu

Keyword(s):

Environmental Performance ◽

Negative Impact ◽

Tourism Development ◽

Threshold Level ◽

Optimal Level ◽

Negative Influence ◽

Threshold Regression ◽

Regression Approach ◽

New Evidence ◽

Panel Threshold Regression

To verify whether the effect of tourism on environmental performance differs by the level of tourism development, a panel threshold regression approach is applied to observe the effects of tourism on environmental performance in 97 countries over the 2002–2012 periods. Our results suggest that tourism always has a significant negative influence on the environmental performance, implying that tourism will unavoidably result in environmental degradation, irrespective of how high the level of tourism development. However, when tourism development exceeds a certain value, tourism will relatively have less influence on environmental performance. In terms of policy prescriptions, considering that tourism wills inevitably worse environmental qualities, this finding implies that policymakers should consider the optimal level of tourism development at around the estimated threshold level to minimize the negative impact of tourism on environmental quality.

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Sedimentary facies on the rises and slopes of passive continental margins

Philosophical Transactions of the Royal Society of London. Series A, Mathematical and Physical Sciences ◽

10.1098/rsta.1980.0023 ◽

1980 ◽

Vol 294 (1409) ◽

pp. 169-176 ◽

Cited By ~ 1

Keyword(s):

Sediment Transport ◽

Debris Flows ◽

Thermohaline Circulation ◽

Dominant Role ◽

Sedimentary Facies ◽

Turbidity Currents ◽

Continental Margins ◽

Passive Margins ◽

New Evidence

JOIDES drilling results provide new evidence concerning facies patterns on evolving passive margins that strengthens and extends hypotheses constructed from studies of morphology, seismic reflexion data and shallow samples on modern margins, and from field geologic studies of uplifted ancient margins. On the slopes and rise, gravity-controlled mechanisms - turbidity currents, debris flows, slides and the like - play the dominant role in sediment transport over the long term, but when clastic supplies are reduced, as for example during rapid transgressions, then oceanic sedimentation and the effects of thermohaline circulation become important. Sedimentary facies models used as the basis of unravelling tectonic complexities of some deformed margins, for example in the Mesozoic Tethys, may be too simplistic in the light of available data from modern continental margins.

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Does active management add value? New evidence from a quantile regression approach

Journal of the Operational Research Society ◽

10.1080/01605682.2019.1612549 ◽

2019 ◽

Vol 70 (10) ◽

pp. 1734-1751 ◽

Cited By ~ 2

Author(s):

Juan Carlos Matallín-Sáez ◽

Amparo Soler-Domínguez ◽

Emili Tortosa-Ausina

Keyword(s):

Quantile Regression ◽

Active Management ◽

Regression Approach ◽

New Evidence

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What Do Clinicians Who Deliver Maternity Services Think Patient-Centered Care Is and How Is That Different for Vulnerable Women? A Qualitative Study

Journal of Pregnancy ◽

10.1155/2018/5853235 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ted Adams ◽

Dana Sarnak ◽

Joy Lewis ◽

Jeff Convissar ◽

Scott S. Young

Keyword(s):

Qualitative Study ◽

Primary Care Physicians ◽

Health Management ◽

Physician Assistants ◽

Patient Centered Care ◽

Fee For Service ◽

Institute Of Medicine ◽

Patient Centered ◽

Maternity Services ◽

Centered Care

Background. Patient-centered care is said to have a myriad of benefits; however, there is a lack of agreement on what exactly it consists of and how clinicians should deliver it for the benefit of their patients. In the context of maternity services and in particular for vulnerable women, we explored how clinicians describe patient-centered care and how the concept is understood in their practice. Methods. We undertook a qualitative study using interviews and a focus group, based on an interview guide developed from various patient surveys focused around the following questions: (i) How do clinicians describe patient-centered care? (ii) How does being patient-centered affect how care is delivered? (iii) Is this different for vulnerable populations? And if so, how? We sampled obstetricians and gynecologists, midwives, primary care physicians, and physician assistants from a health management organization and fee for service clinician providers from two states in the US covering insured and Medicaid populations. Results. Building a relationship between clinician and patient is central to what clinicians believe patient-centered care is. Providing individually appropriate care, engaging family members, transferring information from clinician to patient and from patient to clinician, and actively engaging with patients are also key concepts. However, vulnerable women did not benefit from patient-centered care without first having some of their nonmedical needs met by their clinician. Discussion. Most providers did not cite the core concepts of patient-centered care as defined by the Institute of Medicine and others.

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