Gotowa bibliografia na temat „Physicians, Women – Colorado – Portraits”

Objective To evaluate the impact of personalized prescribing portraits on antibiotic prescribing for treating uncomplicated acute cystitis (UAC) by Family Physicians (FPs). Design Cluster randomized control trial. Setting The intervention was conducted in the primary care setting in the province of BC between December 2010 and February 2012. Participants We randomized 4 833 FPs by geographic location into an Early intervention arm (n = 2 417) and a Delayed control arm (n = 2 416). Intervention The Education for Quality Improvement in Patient Care (EQIP) program mailed to each FP in BC, a ‘portrait’ of their individual prescribing of antibiotics to women with UAC, plus therapeutic recommendations and a chart of trends in antibiotic resistance. Main outcome measures Antibiotic prescribing preference to treat UAC. Results Implementing exclusion criteria before and after a data system change in the Ministry of Health caused the arms to be unequal in size–intervention arm (1 026 FPs, 17 637 UAC cases); control arm (1 352 FPs, 25 566 UAC cases)–but they were well balanced by age, sex and prior rates of prescribing antibiotics for UAC. In the early intervention group probability of prescribing nitrofurantoin increased from 28% in 2010 to 38% in 2011, a difference of 9.9% (95% confidence interval [CI], 9.1% to 10.7. Ciprofloxacin decreased by 6.2% (95% CI: 5.6% to 6.9%) and TMP-SMX by 3.7% (95% CI: 3.1% to 4.2%). Among 295 FPs who completed reflective surveys, 52% said they were surprized by the E. coli resistance statistics and 57% said they planned to change their treatment of UAC. Conclusion The EQIP intervention demonstrated that feedback of personal data to FPs on their prescribing, plus population data on antibiotic resistance, with a simple therapeutic recommendation, can significantly improve prescribing of antibiotics. Trial registration: ISRCTN 16938907.

Background:The estimated prevalence of axial Spondyloarthritis (axSpA) in the U.S. is 0.4 to 1.3 percent. Undiagnosed axSpA patients suffer from symptoms on average 7 to 10 years, which can also contribute to psychological suffering and healthcare burden due to the prolonged search for diagnosis and treatment.Objectives:To explore the experiences of diagnostic delay of axSpA patients as part of the SpondyloArthritis Screening and Early Detection (SpA-SED) Study.Methods:We conducted exploratory semi-structured patient focus groups. English-speaking participants ≥18 years of age with a rheumatologist-verified clinical diagnosis of axSpA were recruited from three rheumatology practices in Massachusetts, Colorado, and Pennsylvania. Six focus groups were conducted with 26 total participants (16 men, 10 women, age range 21-76 years). Discussions ranged from 1.33 to 2.13 hours. Verbatim transcripts were deidentified, cleaned and coded using NVivo qualitative software. A coding list was generated and summary themes were constructed.Results:Participants described meandering and frustrating journeys in search of a diagnosis. When doctors gave up, it was experienced by patients as profoundly negative. Intermittent axSpA symptoms confused some physicians and caused some patients to either delay seeking medical care (e.g., sporadic flare-up) or use dramatic language to convey the magnitude of the impact on their symptoms. Patients explained their experiences where physicians presumed that patients were trying to obtain narcotics or were “imagining/exaggerating” symptoms. Early symptom stories fell into five areas of importance for patients: pain, stiffness and lack of mobility, impact on sleep, impact on daily life, and changes with weather. Tenacity on the part of the patient and/or their family, patient research and confidence to challenge their physicians were important. Self-advocacy was challenging but necessary and particularly difficult when patients were sick. During the typically lengthy time that participants waited to be diagnosed, they experienced frustration and mental suffering due to lack of answers and/or not being heard, believed, or taken seriously. Some participants described the fatigue they experienced after trying without success to obtain a diagnosis or receive treatment. Early administration of a definitive diagnostic test or screening tools for axSpA would have alleviated both physical and emotional suffering for these participants.Conclusion:Overall, participants expressed satisfaction with physicians who sought to understand them and believed them, took them seriously, and did not give up even with long delays. Patients with axSpA described significant suffering prior to diagnosis which could have been prevented and treated. Further research is needed with axSpA patients who are early in their diagnostic journey to determine best practices to support patients and reduce diagnostic delay.Disclosure of Interests:Catherine Dubé Grant/research support from: Novartis, as personnel on such studies, Kate Lapane: None declared, Katarina Ferrucci: None declared, Ariel Beccia: None declared, Sara Khan: None declared, Esther Yi Employee of: Novartis Pharmaceuticals, Jonathan Kay Consultant of: AbbVie, Inc.; Boehringer Ingelheim GmbH; Celltrion Healthcare Co. Ltd.; Jubilant Radiopharma; Merck & Co.,Inc.; Pfizer Inc.; Samsung Bioepis; Sandoz Inc.; Scipher Medicine; UCB, Inc., Grant/research support from: (paid to UMass Medical School) Gilead Sciences Inc.; Novartis Pharmaceuticals Corp.; Pfizer Inc., Kristine A. Kuhn Consultant of: UCB, Eli Lilly, Novartis, Grant/research support from: Pfizer, Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Shao-Hsien Liu Grant/research support from: Novartis

BackgroundPatients with chronic kidney disease (CKD) are at increased risk for developing gout1 and vice versa.2 Those with both gout and CKD present distinct challenges for patients and physicians because of the high prevalence of other comorbidities and restrictions on gout medication use, including non-steroidal anti-inflammatories3,4 and some oral urate-lowering therapies (ULTs).5 This unique patient population has not been well characterized using real-world data.ObjectivesThis retrospective chart review study of patients with coincident gout and CKD was conducted to better understand patient characteristics and treatment patterns of this population. This study is unique in that patient data were obtained from nephrologists, allowing a glimpse of how they view gout and its management.Methods111 nephrologists provided de-identified medical record data of their most-recently seen advanced (stage 3─5) CKD patients. Patients met study criteria for gout if any of the following were true: gout listed as a comorbidity, ULT use, or visible tophi or gout flares documented. A patient’s gout was determined to be uncontrolled if they had serum uric acid >6 mg/dL in addition to ≥1 visible tophus, ≥2 gout flares in the past year, or gouty arthritis (≥1 tender or swollen joint). Characteristics of this unique population were examined, along with gout management patterns. Differences between patients with controlled and uncontrolled gout were also investigated using data from patients’ most recent evaluation.Results173 patients with stages 3-5 CKD and who met study criteria for gout were included. Mean age was 58.3±18.1 years and BMI averaged 32.0 ± 11.8 kg/m2. A higher than expected proportion of patients were female (47%). The most common comorbidities were hypertension (85%), diabetes mellitus (47%), anemia of CKD (42%), CKD-mineral bone disorder (41%), ischemic heart disease (23%), and congestive heart failure (21%). Mean CKD duration was 4.1 ± 5.5 years, mean estimated glomerular filtration rate (eGFR) at most recent visit was 32.3 ± 13.9 ml/min/1.73 m2, and 62% were using a ULT. 23 patients (13%) had uncontrolled gout (48% female, 63.1 ± 16.4 years, mean eGFR 32.0 ± 14.6 ml/min/1.73 m2), all of whom had been prescribed a ULT. Compared with controlled gout patients, uncontrolled patients had higher rates of pulmonary hypertension (14% vs. 4%), gout-related chronic pain in the 12-months prior to data collection (63% vs. 42%), and joint involvement (joint swelling, tenderness, flexibility loss, and/or damage/lesions on x-ray; 26% vs. 9%). Colchicine was also used more frequently in uncontrolled gout patients (26% vs. 7%).ConclusionThe coincident gout with advanced CKD population described here shows unique differences from the general gout population, including a high proportion of females (47%). Given that women have a lower likelihood of developing gout at the same serum uric acid level,6 this finding was particularly surprising (general gout population: 67% male7). Importantly, nearly 40% of included patients were not utilizing a ULT, leaving them susceptible to developing the painful and debilitating sequalae of uncontrolled gout. Additionally, 41% of the study population had a CKD-related mineral bone disorder, indicating that patients with coincident gout and CKD may have bones that are more vulnerable to gout-related bone damage. Our study confirms a high prevalence of gout and its associated comorbidities in patients with advanced CKD and suggests another nephrology education opportunity to highlight the potential benefits of gout monitoring, earlier intervention, and management.References[1]Safiri S, et al. Arthritis Rheumatol 2020;72:1916-27.[2]Feig DI. Curr Opin Nephrol Hypertens 2009; 18: 526–530.[3]Stamp LK, et al. Nat Rev Rheumatol. 2021; 17(10): 633–641.[4]Wallace SL, et al. J Rheumatol 1991; 18(2): 264-9.[5]Abdelatif AA and Elkhalili N. Am J Ther 2014; 21: 523-34.[6]Bhole V, et al. Arthritis Rheum 2010;62:1069-76.[7]Francis-Sedlak M, et al. Rheumatol Ther 2021;8:183-97.Disclosure of InterestsLeonard Stern Speakers bureau: Horizon Therapeutics, Consultant of: Horizon Therapeutics, Richard Johnson Shareholder of: Colorado Research Partners LLC and XORTX Therapeutics, Speakers bureau: Horizon Therapeutics, Consultant of: Horizon Therapeutics, Payam Shakouri Speakers bureau: Horizon Therapeutics and Relypsa, Consultant of: Horizon Therapeutics, Amod Athavale Grant/research support from: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Sreedhar Mandayam Shareholder of: Medingenii Capital LLC and Prosalus Capital LLC, Speakers bureau: Otsuka and Alexion, Consultant of: US Renal Care and Aurinia, Grant/research support from: Travere, Norvartis, Omeros, Roche, Vertex, Equillium, Goldfinch Bio, and Pfizer

Objective: Pilot data was collected to examine providers’ beliefs, knowledge, self-efficacy, barriers, and practices related to perinatal depression and how they may differ across provider types. Background: High prevalence and detrimental impact of depression during pregnancy and the first year postpartum (i.e. perinatal period) on maternal and child health outcomes highlights the need for improving diagnosis and treatment during this critical period. Healthcare providers play a significant role in helping to identify and manage perinatal depression. Methods: Ninety-nine providers (e.g. physicians, nurses, mental health workers, public health practitioners) who provide care to pregnant women in Colorado completed a 64-item online survey. Results: Although 94% of providers reported it was their responsibility to recognize perinatal depression, variations across specialties with regards to responsibility to treat were found. Most providers (91%) reported use of a screening tool for depression, 60% of providers provide counseling on perinatal depression, and 80% of providers refer patients for treatment of perinatal depression on at least a monthly basis. Significant differences in knowledge, self-efficacy, current practices, and perceived patient barriers were found across provider specialties. Conclusion: These findings highlight the need for expansion of online training programs to increase awareness of mental health resources in the community, improve confidence related to diagnosis and treatment of perinatal mood disorders, and to enhance communication between mental health specialists and healthcare providers in order to effectively identify and manage maternal depression.