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

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.

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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Khoa Vu ◽  
Jiani Zhou ◽  
Alexander Everhart ◽  
Nihar Desai ◽  
Jeph Herrin ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Dominant Role ◽  
Fee For Service ◽  
Erythropoiesis Stimulating Agents ◽  
Safety Warning ◽  
Gender And Age ◽  
Levels Of Use ◽  
Regression Approach ◽  
New Evidence ◽  
Anemia Treatment

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.

scholarly journals Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth A. Brown ◽  
Brandi M. White ◽  
Walter J. Jones ◽  
Mulugeta Gebregziabher ◽  
Kit N. Simpson
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Medicaid Expansion ◽  
Time Series Approach ◽  
Access To Primary Care ◽  
The Impact

An amendment to this paper has been published and can be accessed via the original article.

THE IMPACT OF THE HOTEL ROOM TAX: AN INTERRUPTED TIME SERIES APPROACH

1992 ◽  
Vol 45 (4) ◽  
pp. 433-441 ◽  
Author(s):  
CARL BONHAM ◽  
EDWIN FUJII ◽  
ERIC IM ◽  
JAMES MAK
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Hotel Room ◽  
Time Series Approach ◽  
The Impact

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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

Circulation ◽  
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.

ERYTHROFERRONE AS A NEW BIOMARKER ASSOCIATED WITH ANEMIA IN IRAQI PATIENTS WITH CKD

2021 ◽  
Vol 17 (37) ◽  
pp. 135-148
Author(s):  
Intisar Razzaq SHARBA ◽  
Hasanat Abdulrazzaq ALJABERY ◽  
Manal Farhan AL-KHAKANI
Keyword(s):  
Kidney Diseases ◽  
Transferrin Saturation ◽  
Elevated Serum ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Erythropoietic Activity ◽  
Glycoprotein Hormone ◽  
Hormone Synthesis ◽  
Gender And Age ◽  
Group 2

Background: Erythroferrone (ERFE) is a glycoprotein hormone synthesis and release by erythroblasts. Recently identified as an erythropoietic regulator and activated in response to stimulating erythropoietin (Epo). In chronic kidney diseases (CKD), anemia is a hallmark disorder due to a decrease in hyposensitive erythropoietic to the Epo; these patients recommended to use of Erythropoiesis-stimulating agents (ESAs). The aim: This study aimed to assess serum ERFE level in patients with CKD and investigate the continuing effects of long-term anemic ESA use associated with markers of erythropoiesis and iron metabolism. Methods: Sixty-five CKD patients divided in two groups, included 30 hemodialyses (HD) and 35 without hemodialysis (non-HD) CKD patients, were compared to 25 healthy voluntaries matched by gender and age enrolled in the current study. Serum ERFE level was measured by an enzyme-linked immunosorbent assay (ELISA). Results: Serum ERFE level was significantly elevated in HD patients median (IQR) about 17.25 (13.4) ng/mL, odds ratio (OR = 10.161), (AUC 0.996) greater than CKD 4(6.1) ng/ml, (OR = 6.295), (AUC = 0.984) p 0.001; also, these are positively correlated with the use of ESA in HD, and CKD (r = 1.00 and r = 0.95) respectively as compared to healthy group 2(2.1) ng/ml. Serum ERFE levels were significantly negative (p 0.05) in both CKD and HD patients related to GFR (r = -0.396, and r = -0.68), transferrin saturation (TS%) (r = -0.842, and r = -0.877), serum levels of Ferritin (r = -0.865 and r = -0.866), and Iron (r = -0.860, and r = -0.851), RBC (r = -0.841, and r = -0.843), hemoglobin (Hb) (r = -0.758, and r = -0.796). Conclusion: The present study demonstrated that elevated serum ERFE levels associated with erythropoietic activity and anemia are higher in CKD with HD and non -HD patients treated with ESA than in non-ESA patients. This study suggested using ERFE as a successful tool for erythropoietic activity inspection in CKD, especially those taking ESAs to treat anemia.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
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.

scholarly journals 74 Effects of Community Falls Prevention Service Closure on Ischaemic Heart Disease Attendances in Secondary Care: An Interrupted Time Series Approach

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i24-i24
Author(s):  
A McCarthy ◽  
P McMeekin ◽  
G Anderson ◽  
S McCarthy ◽  
S W Parry
Keyword(s):  
Time Series ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Service Provision ◽  
Secondary Care ◽  
Interrupted Time Series ◽  
Falls Prevention ◽  
Initial Increase ◽  
Time Series Approach ◽  
Service Closure

Abstract Background In 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service model utilising proactive, primary care-based screening (≥60 years). Participants underwent comprehensive geriatric assessment, while 25% of the 4032 service participants had exercise training. All had additional lifestyle advice on exercise, alcohol intake, weight loss and smoking cessation. The preliminary outcomes of this approach have been previously reported, with occult atrial fibrillation, murmurs, ECG-evident ischaemic heart disease (IHD) etc reported to GPs for further action.1 Funding was withdrawn and the service closed on 31/01/2014. We examined IHD secondary care attendances with and without service provision. Methods Patients: North Tyneside residents ≥60 years at time of closure of the service in January 2014, who were presented acutely to secondary care with IHD using an interrupted time series method. ICD-10 coded IHD numbers were determined (Hospital Episode Statistics from 01/02/2012[date of a change in coding compared to service commencement in 2009] until 31/05/2017) including 25-months with, and 40-months without, service provision. Results The Table summarises the change in IHD +/- service provision; there was a significant reduction in IHD non-elective admissions during both time series’, but the reduction was significantly lower without service provision. In addition, immediately following the service closure there was an initial increase in IHD complications of 18.4% (p=0.059) followed by an increase in the time trend of 2.7% (p=0.029), resulting in a 0.6% post-service monthly reduction in IHD complications. Conclusions Disinvestment in this service resulted in a slowdown in the underlying reduction of IHD diagnoses in secondary care. However, further research is needed to control for patient-level characteristics, the economic impact and to look at the effect of the service on other cardiovascular diseases. Reference 1. Parry SW. JAGS 2016; 64 (11):2368–2373.

scholarly journals The Association between the Australian Alcopops Tax and National Chlamydia Rates among Young People—an Interrupted Time Series Analysis

2020 ◽  
Vol 17 (4) ◽  
pp. 1343 ◽  
Author(s):  
William Gilmore ◽  
Tanya Chikritzhs ◽  
Hamish McManus ◽  
John Kaldor ◽  
Rebecca Guy
Keyword(s):  
Time Series ◽  
Alcohol Consumption ◽  
Young People ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Sexually Transmitted ◽  
Series Analysis ◽  
Alcohol Taxation ◽  
Gender And Age

A national tax increase, which became known as the “alcopops tax”, was introduced in Australia on the 27th April 2008 on ready-to-drink alcoholic beverages, which are consumed predominantly by young people. The affordability of alcohol has been identified as the strongest environmental driver of alcohol consumption, and alcohol consumption is a well-known risk factor in the spread of sexually transmitted infections via its association with sexual risk-taking. We conducted a study to investigate whether there was any association between the introduction of the tax and changes in national chlamydia rates: (i) notification rates (diagnoses per 100,000 population; primary outcome and standard approach in alcohol taxation studies), and (ii) test positivity rates (diagnoses per 100 tests; secondary outcome) among 15–24 and 25–34-year-olds, using interrupted time series analysis. Gender- and age-specific chlamydia trends among those 35 and older were applied as internal control series and gender- and age-specific consumer price index-adjusted per capita income trends were controlled for as independent variables. We hypothesised that the expected negative association between the tax and chlamydia notification rates might be masked due to increasing chlamydia test counts over the observation period (2000 to 2016). We hypothesised that the association between the tax and chlamydia test positivity rates would occur as an immediate level decrease, as a result of a decrease in alcohol consumption, which, in turn, would lead to a decrease in risky sexual behaviour and, hence, chlamydia transmission. None of the gender and age-specific population-based rates indicated a significant immediate or lagged association with the tax. However, we found an immediate decrease in test positivity rates for 25–34-year-old males (27% reduction—equivalent to 11,891 cases prevented post-tax) that remained detectable up to a lag of six months and a decrease at a lag of six months for 15–24-year-old males (31% reduction—equivalent to 16,615 cases prevented) following the tax. For no other gender or age combination did the change in test positivity rates reach significance. This study adds to the evidence base supporting the use of alcohol taxation to reduce health-related harms experienced by young people and offers a novel method for calculating sexually transmitted infection rates for policy evaluation.

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