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Mon, Sep 12, 2016

Clinical News Room

NEW YORK (Reuters Health) – Topical intranasal steroid therapy is underused in patients with chronic rhinosinusitis despite consistent recommendations supporting it, researchers from Canada report.

“The most surprising finding is the low level of utilization for topical steroid therapy despite multiple practice guidelines providing ‘strong recommendation’ for their use in patients with chronic sinusitis,” Dr. Luke Rudmik from the University of Calgary, Alberta, Canada told Reuters Health. “Ideally this treatment should be close to 100% utilization, but it was only 20%. This is a serious gap in quality of care for this chronic disease.”

Dr. Rudmik’s team used information from the Data Integration, Measurement, and Reporting administrative database of the Alberta Health Services to investigate the rate and quantity of topical intranasal steroid therapy utilization among 19,057 adults who were diagnosed with chronic sinusitis during a three-year period and did not undergo endoscopic sinus surgery.

The overall crude rate of utilization was 20.1 patients using a topical intranasal steroid spray per 100 chronic rhinosinusitis patients, according to the August 25th JAMA Otolaryngology-Head and Neck Surgery online report.

In terms of quantity, about 80% of chronic rhinosinusitis patients failed to use a single unit of intranasal steroid spray within the past year.

Even among patients who were prescribed a topical intranasal steroid spray for chronic rhinosinusitis, therapy was used on average for approximately two to three months.

Intranasal steroid spray utilization for chronic rhinosinusitis varied widely across the 64 geographic regions within Alberta, from 14.7% to 41.77% of patients.

“Topical steroid therapy should be considered in all patients with chronic sinusitis,” Dr. Rudmik said. “We need to design better delivery of care systems for chronic sinusitis to improve quality of care.”

Why the significant underuse?

“I feel there may be multiple factors involved some of which involve a lack of understanding of chronic sinusitis, which leads to a lack of knowledge on recommended treatments,” Dr. Rudmik speculated. “There may also be a disconnect between provider beliefs about the clinical effectiveness of topical steroids and practice guideline recommendations. More specifically, through experience in practice, some providers may feel topical steroids don’t work and therefore don’t like prescribing them. Ultimately, there is very strong evidence to support topical steroids for management of chronic sinusitis and we need to somehow improve the utilization.”

“Although we are not at the stage where we can begin designing improved systems of care for this disease, I think strategies to improve the utilization of topical steroid sprays need to target both ‘provider’ (i.e., physician and pharmacist) and ‘patient,’” he concluded. “It is hard to suggest specific strategies until we identify reasons for the underutilization but improving education on the importance of this treatment for this disease to both stakeholders may be one strategy.”

Reuters Health Information, 2016-09-01

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