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Original Investigation |

Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis A Canadian Population-Based Analysis ONLINE FIRST

Luke Rudmik, MD, MSc1,2; Yuan Xu, MD, MSc2; Mingfu Liu, PhD3; Ceris Bird, BSc3; Edward Kukec, MBA3; Hude Quan, MD, PhD2
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
3Data Integration, Measurement and Reporting (DIMR), Alberta Health Services, Calgary, Canada
JAMA Otolaryngol Head Neck Surg. Published online August 25, 2016. doi:10.1001/jamaoto.2016.1110
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Importance  Practice guidelines have provided a strong recommendation for the daily use of topical intranasal steroid therapy for patients with chronic rhinosinusitis (CRS). Deficiencies in utilization of intranasal steroid therapy may represent a gap in quality of care.

Objective  To evaluate the utilization patterns of topical intranasal steroid therapy for CRS in the Canadian population.

Design, Setting, and Participants  Retrospective review of a Canadian population-based health care administrative database. A validated case definition for CRS was applied, and the utilization of topical intranasal steroid therapy within this cohort was quantified during the 2014-2015 fiscal year.

Interventions  Intranasal steroid spray for CRS.

Main Outcomes and Measures  Primary outcome was the rate (per 100 patients) and quantity (per patient) of intranasal steroid spray utilization in patients with CRS. Secondary outcome was the geographic variation in the rate and quantity of intranasal steroid spray utilization for CRS.

Results  A total of 19 057 adult patients with CRS were evaluated. The overall rate of intranasal steroid spray utilization was 20.1 per 100 patients with CRS (3821 of 19 057). In the 3821 patients with CRS who used an intranasal steroid spray during 2014 to 2015, the mean quantity of utilization was 2.4 U (1 U = 1 bottle per month) per patient (9314 U divided by 3821 patients with CRS). There was large geographic variation in both the rate and quantity of intranasal steroid spray utilization (P < .001 for both comparisons).

Conclusions and Relevance  Topical intranasal steroid therapy continues to be underutilized for patients with CRS. Given the negative impact of low-quality medical care, outcomes from this study indicate a need to further evaluate factors leading to the underutilization of a recommended treatment in patients with CRS to improve overall health system performance.

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Figure 1.
Analysis Scheme

CRS indicates chronic rhinosinusitis; INS, intranasal steroid.

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Figure 2.
Variations in the Rate and Quantity of Intranasal Steroid Utilization for Chronic Rhinosinusitis in Alberta, Canada

Source: Alberta Health Services geographic boundaries, 2010 (in public domain).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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