The use patterns of Wisconsin family physicians surrounding saline nasal irrigation

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The use patterns of Wisconsin family physicians
surrounding saline nasal irrigation

• 11-5-08
• David Rabago, MD
• Aleksandra Zgierska MD PhD, Amy Bamber BS, Paul
  Peppard PhD
• UW Department of Family Medicine, NIH
• David.Rabago_at_fammed.wisc.edu
• http//www.fammed.wisc.edu/research/past-projects/
  nasal-irrigation

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Why do we care?

• Viral upper respiratory infections (URIs)
• Rhinosinusitis
• Viral, bacterial, allergic, irritant, URI induced
  asthma
• Billions of clinic/ED visits annually
• Direct costs billions / year
• Patients care about it ? Quality of Life
• Often refractory to treatment
• Serious complications

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Adjunctive Nasal Irrigation (NI)?
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Biological Rationale
Sino-nasal Disease ? Mucus viscosity ? CBF ?
MCC ? Inflammation ? Edema
Nasal Irrigation ? Mucus viscosity ? CBF ?
MCC ? Inflammation (?) ? Edema (?)
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Anatomy
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NI Chronic Sinus Symptoms
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NI Other Indications/Techniques

• Chronic Sinus Symptoms
• 0.9-3 liquid saline 1-2 times daily
• Allergic Rhinitis 2 studies
• Spray or liquid
• Viral URI (Common Cold) 2 studies
• Spray or liquid
• Acute Bacterial Rhinosinusitis 0 studies

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NPR story
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Purchase of NI devices Climbing

• 100,000 households surveyed using consumer
  tracking techniques
• Ownership of NI spray device from March 2007 to
  March 2008 stable at 9
• Ownership of liquid NI device climbed from .6 to
  1.7 in same period

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What about the docs?

• What is the awareness of NI in Family Medicine?
• What are the characteristics of NI prescribers?
• For which conditions is NI recommended?
• How is NI recommended?

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Methods

• Summer 2007
• Electronic survey using WREN and WAFP docs
• Rigorously reviewed, professionally vetted
• (Family Medicine, ENT, Population Health)
• 5 minutes or less to complete
• 131 to WREN, 1695 to WAFP
• Greeting email, survey, 2 reminder emails

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Results

• Surveys returned 330
• WAFP 313 (18.5)
• WREN 17 (13)
• Users, 286
• Aware, non-users, 27
• Not aware, 17

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Physician Age
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Physician Gender
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Practice Location
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Physician Race

• Caucasian 94
• Non-Caucasian 6
• Missing 4

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Practice Years
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How did you learn about SNI?

• Colleague 71
• Conference or Journal 56
• Patient 34
• Missing 9
• Media 6

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Awareness and Recommendations of SNI Methods
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How is SNI recommended?

• Verbal 90
• Print 50
• Other 4
• Missing 1

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Who Shows SNI Method?
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Frequency of SNI Recommended
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What salinity of SNI is recommended?

• As printed 51
• 0.9 44
• Dont know 25
• 2-3 5
• gt3 1

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Do you advise adjusting salt, pH to comfort?
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For what age do you recommend SNI?

• Adult 98
• Child gt 7 yr 80
• Child lt 7 yr 26

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Conditions for which SNI is Recommended
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Patients Satisfied with SNI
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Do you recommend SNI ever prior to antibiotics?

• Yes 77
• No 23

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Correlations

• Women more likely to recommend NI (plt0.05)
• MDs 45 years old are likely to recommend NI
• more often (plt0.06)
• more often prior to Abx
• MDs practicing for 10 yrs recommend
• more often (plt0.06)
• more likely to recommend for children (plt0.02)
• more likely to advise gravity based method (neti
  pot) (plt0.03)

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Is our group representative of Wisconsin family
doctors?

• Respondents were more likely to be
• female (43 compared to 35)
• younger than 35 years old (18 compared to 9)

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Conclusions

• First study to assess physician use of NI
• Unable to draw conclusions about the true
  awareness of WI family physicians and NI
• Those who recommend NI do so for a number of
  indications c/w published studies
• Patient education, solution composition and
  dosing schedules inconsistent
• A majority of docs report having used NI prior to
  antibiotics
• More research needed

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Thanks! www.fammed.wisc.edu/research/past-proj
ects/nasal-irrigation