Time to get back to nature

The sights, smells and sounds of early years outdoor learning are more important than ever in our post-lockdown world, says Sian Marsh of Best Practice Network.

Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality

PURPOSE: Practice guidelines recommend the prophylactic use of granulocyte colony–stimulating factors (G-CSFs) in patients with high risk of febrile neutropenia, but evidence suggests that G-CSFs are frequently overused. The objectives of this study were (1) to determine the prevalence and prescribing patterns of G-CSF and (2) to evaluate the impact of a program initiative on G-CSF prescribing patterns, adherence to guidelines, and mortality. METHODS: In this retrospective cohort study, data were used from the electronic health records of patients with metastatic colorectal cancer who received care at a multicenter oncology practice network during two time periods: July 01, 2013, to December 31, 2014, and July 01, 2017, to December 31, 2017. Beginning 2016, a site-wide program initiative that involved educational materials, appropriate nonuse recommendations, and prior authorization was introduced in the oncology practice network with an aim of reducing G-CSF overutilization. Descriptive statistics, t tests, and chi-squared tests were employed to analyze program impact. RESULTS: There were 3,426 chemotherapy regimens corresponding to 2,968 patients. There were a total of 387 (11.3%) G-CSF–treated patients and 3,095 G-CSF administrations during the study period. G-CSF use was significantly lower in the postperiod, compared with the preperiod ( P < .0001). Adherence to guidelines was significantly higher in the postperiod, compared with the preperiod ( P < .0001). Mortality rates did not significantly differ between the two time periods. CONCLUSION: This study demonstrates that policy initiatives have the potential to positively affect G-CSF prescription patterns and promote guideline adherence. These findings could help prescribers adopt a cost-effective approach in patients with metastatic colorectal cancer, leading to enhanced clinical practice and value-based care.

A cultural revolution

A focus on the unique child is key to understanding how cultural capital relates to best practice. Here Sian Marsh of Best Practice Network highlights the approach of Kids Planet Day Nurseries.

Making Meaningful Improvements in Pharmacotherapy and Medication Management for Children and Youth—A Modest Proposal

The Special Issue, “Development of a National Pediatric Pharmacotherapy Collaborative Practice Network,” has illuminated the vital global need for better care coordination and interprofessional collaboration in pharmacotherapy and medication management of children with medical complexity and special healthcare needs (CSHCN-CMC) [...]

Guideline adherence and the strategy of chemotherapy dose reduction in metastatic colorectal cancer: A multicenter oncology practice experience.

24 Background: Current American Society of Clinical Oncology (ASCO) guidelines recommend prophylactic use of colony stimulating factors (CSF) for prevention of febrile neutropenia among cancer patients. ASCO also recommends chemotherapy dose reduction as a viable alternative to CSF administration, which may result in cost savings to patients and payers, but adherence to these guidelines has been less than ideal. The objectives of this study were i.) to determine the prevalence and prescribing patterns of CSF and dose reduction in metastatic colorectal cancer patients and ii.) to evaluate the impact of a program initiative on CSF prescribing patterns and on compliance to ASCO guidelines. Methods: In this retrospective study, we utilized data from the electronic health records of metastatic colorectal cancer patients who received care at a multi-center oncology practice network during two time periods: July 2013 to December 2014 and July to December 2017. In 2016, a site-wide program initiative that involved educational materials, appropriate non-use recommendations and prior authorization was introduced in the oncology practice network with an aim of reducing CSF overutilization. Descriptive statistics and chi squared tests were employed to explore CSF utilization across patient age, gender, disease, year of diagnosis, febrile neutropenia risk, line of therapy and duration of treatment. Results: There were 3426 chemotherapy regimens corresponding to 2968 patients. There was a total of 3095 CSF administrations and the CSF administered was pegfilgrastim. There were 343 (10%) CSF users. Among subjects who had data on dose reduction (N = 508), 58.7% received dose reduction. CSF use was significantly lower in the post-period, compared to the pre-period (p < 0.0001). Compliance to guidelines was significantly higher in the post-period, compared to the pre-period (p < 0.0001). Conclusions: Our results demonstrate that program initiatives have the potential to positively impact CSF prescription patterns. These findings could help prescribers adopt a cost-effective approach for this population, leading to enhanced clinical practice and value-based care.

Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network

Introduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists.Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed.Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%).Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists.Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists.