Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis

Abstract

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.

Current use of baseline medical treatment in chronic rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)

“…The rhinosinusitis commissioning guidelines produced by ENT UK in conjunction with the Royal College of Surgeons of England recommend that CRS patients have received ND and INCS for 3 months before referral to secondary care, and this is derived from the European position paper of which there is a summary version for GPs. However, this low use of primary medical treatment is not unique to the UK as shown by a recent Canadian study showing the same rate of INCS uptake (20%) and with large geographical variations. Another study of 60 patients following endoscopic sinus surgery found that overall, 57.4% of patients were non‐adherent to their prescribed nasal medication regime.…”

“…Looking at the wider picture, one international study demonstrated that one in three CRS patients in primary care has poorly con- showing the same rate of INCS uptake (20%) and with large geographical variations 11 . Another study of 60 patients following endoscopic sinus surgery found that overall, 57.4% of patients were non-adherent to their prescribed nasal medication regime 22 .…”

A framework for quality measurement in the presurgical care of chronic rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society

“…The goal of a quality metric that assesses pre‐surgical medical therapy would be to ensure that patients have tried a reasonable course of medicines that have been shown to improve patient‐centered outcomes and reduce unwarranted variation related to the under‐utilization of recommended medical therapies . In this regard topical high‐volume saline irrigations and topical intranasal corticosteroids have the highest level of available evidence, with both of these treatment courses showing an improvement in symptoms and QOL …”

“…Currently, there is only 1 quality metric for CRS that is being actively measured and it relates to computed tomography (CT) imaging overuse . In order to facilitate appropriate QI efforts for CRS, there is a need to define and validate further quality metrics that assess key components of the CRS care cycle …”

“…A recent Canadian study found that within 1 province of the country, the diagnosis of CRS between geographic regions can vary as much as 400% . Furthermore, the utilization of different medical and surgical treatments also varies widely between regions and providers, with endoscopic sinus surgery (ESS) utilization being more variable than coronary artery bypass grafting, spine surgery, and cholecystecomty . While the vast majority of patients received significant symptomatic relief and improvement in quality of life (QOL) from ESS, the surgical outcomes can vary between institutions and individual surgeons .…”