Communication practices and awareness of resources for acromegaly patients among endocrinologists.

PURPOSE: This study was designed to assess the awareness and utilization of resources to improve patients' treatment experiences among endocrinologists who currently treat patients with acromegaly. METHODS: A total of 4,280 US endocrinologists were randomly selected from the CMS National Plan and Provider Enumeration System and were invited by mail to participate in a 20-minute online survey. In order to qualify, respondents had to be the primary physician making treatment decisions for at least one patient for their acromegaly. RESULTS: Results are based on responses from 126 physicians from primarily urban and suburban practices, with a median of five acromegaly patients. A total of 70% of patients are currently receiving drug therapy; among these, 91% are on octreotide (51%), lanreotide (29%), or pasireotide (11%), alone or in combination with another therapy. Nearly half of the respondents thought that the impact of patient adherence on therapy outcome for acromegaly was either not very (40%) or not at all (7%) significant. Respondents who believe patient adherence significantly impacts treatment outcome were significantly more likely to discuss automated adherence reminders (50% vs 26%; P=0.015), mobile administration programs (57% vs 35%; P=0.029), and symptom tracking (72% vs 42%; P=0.002). Overall, 44% of respondents routinely recommend education/emotional support programs, and 25% routinely recommend financial assistance programs. Respondents who believe patient adherence significantly impacts treatment outcome generally were more familiar with individual education and emotional support programs compared to those who do not, although they were not more likely to routinely refer patients to any of these resources. CONCLUSION: There are unmet needs with respect to increasing awareness among physicians of the importance of patient adherence to therapy, resources available to patients, and how collaboration among patients, nurses, and physicians can improve adherence and overall treatment experiences.

Awareness of nonalcoholic steatohepatitis and associated practice patterns of primary care physicians and specialists.

BACKGROUND: The hepatic manifestation of metabolic syndrome is nonalcoholic fatty liver disease. Patients with nonalcoholic steatohepatitis, the progressive form of nonalcoholic fatty liver disease, have increased risk of fibrosis, cirrhosis and end-stage liver disease. Estimates of prevalence in the United States range from 20-30% for nonalcoholic fatty liver disease and 2-5% for nonalcoholic steatohepatitis; however, physician awareness of these diseases is limited. The purpose of this study was to determine the current level of physician awareness and practices in the diagnosis and management of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis within the United States. METHODS: Physicians were asked to participate in an online, 35-question survey about their awareness of various liver conditions and current practices. RESULTS: Of the 302 responding physicians, 152 were primary care physicians, and 150 were specialists (comprised of gastroenterologists and hepatologists). More specialists than primary care physicians reported that they were aware of the differences between nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (p < 0.001) and that they routinely screened for nonalcoholic fatty liver disease (p < 0.001) and nonalcoholic steatohepatitis (p < 0.001). Almost half of the responding primary care physicians reported being unfamiliar with the nonalcoholic fatty liver disease and nonalcoholic steatohepatitis differences even though they were aware of both, yet 58% of those primary care physicians were treating patients with nonalcoholic fatty liver disease and/or nonalcoholic steatohepatitis. In addition, those primary care physicians who reported being unfamiliar with nonalcoholic steatohepatitis were treating an average of 3.7 patients and reported being as likely as familiar primary care physicians to treat new patients with nonalcoholic steatohepatitis. More than half of the specialists used noninvasive diagnostic test to confirm nonalcoholic steatohepatitis, and 10% of the specialists reported treating patients with drugs not recommended by the current guidelines. CONCLUSIONS: Despite reporting they were not familiar with nonalcoholic steatohepatitis, primary care physicians reported they would likely continue to diagnose and manage patients with nonalcoholic steatohepatitis; therefore, more physician education on the recent practice guideline for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is needed.

Self-reported physician practices in pulmonary arterial hypertension: Diagnosis, assessment, and referral.

BACKGROUND: Numerous clinical trials have contributed to rapid advancements in the diagnosis and management of pulmonary arterial hypertension (PAH), yet patients often do not undergo right heart catheterization (RHC) with vasoreactivity testing and may receive a delayed or incorrect diagnosis. Efforts to improve standards of care include the designation of Pulmonary Hypertension Association (PHA)-Accredited PH Care Centers (PHCCs). This study evaluated current practices in the diagnosis and assessment of PAH. METHODS: A survey of 167 physicians who had ≥1 claim for PAH in the past 3 months was conducted. RESULTS: Of 167 respondents, 15% were affiliated with a PHCC, 40% had referred ≥1 patient with diagnosed PAH, and 79% had ≥1 patient referred to them by another physician who they then newly diagnosed with PAH. More than half (52%) reported having ≥1 patient who was previously misdiagnosed with PAH referred to them by another physician. RHC and vasoreactivity testing, respectively, were performed in 43% and 33% of patients with PAH who respondents referred to another physician, 86% and 67% of patients newly diagnosed by respondents, and 84% and 57% of patients who respondents considered accurately diagnosed prior to being referred to them. Respondents affiliated with a PHCC were more likely to try to refer to another physician affiliated with a PHCC, and to perform RHC and vasoreactivity testing. CONCLUSIONS: Self-reported clinical practices often deviated from established guidelines. Future research should focus on both clinical efficacy and ways to encourage clinicians to bring their practices in line with well-supported, evidence-based recommendations.