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Original Investigation
November 2016

Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic RhinosinusitisA Canadian Population-Based Analysis

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. 2016;142(11):1056-1062. doi:10.1001/jamaoto.2016.1110
Key Points

Question  What are the rate and quantity of topical intranasal steroid therapy utilization in patients with chronic rhinosinusitis?

Findings  In this Canadian population-based analysis of 19 057 patients with chronic rhinosinusitis, the rate of intranasal steroid utilization was 20 per 100 patients. When patients with chronic rhinosinusitis used topical intranasal steroid therapy, the mean quantity was 2 to 3 bottles per year.

Meaning  Given that there is a strong recommendation for the use of topical intranasal steroid therapy for chronic rhinosinusitis, increasing utilization of this treatment may represent an opportunity to improve the quality of care. Future studies need to elucidate the factors leading to under use of topical intranasal steroid therapy.

Abstract

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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