The use patterns of Wisconsin family physicians surrounding saline nasal irrigation

1. 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@fammed.wisc.edu http://www.fammed.wisc.edu/research/past-projects/nasal-irrigation

2. 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

3. Adjunctive Nasal Irrigation (NI)…?

4. Biological Rationale Sino-nasal Disease: ↑ Mucus viscosity ↓ CBF ↓ MCC ↑ Inflammation ↑ Edema Nasal Irrigation: ↓ Mucus viscosity ↑CBF ↑MCC ↓Inflammation (?) ↓ Edema (?)

5. Anatomy

7. NI: Chronic Sinus Symptoms

8. 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

10. NPR story

11. 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

12. 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?

13. 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

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

15. Physician Age

16. Physician Gender

17. Practice Location

18. Physician Race • Caucasian 94% • Non-Caucasian 6% • Missing 4%

19. Practice Years

20. How did you learn about SNI? • Colleague 71% • Conference or Journal 56% • Patient 34% • Missing 9% • Media 6%

21. Awareness and Recommendations of SNI Methods

22. How is SNI recommended? • Verbal 90% • Print 50% • Other 4% • Missing 1%

23. Who Shows SNI Method?

24. Frequency of SNI Recommended

25. What salinity of SNI is recommended? • As printed 51% • 0.9 % 44% • Don’t know 25% • 2-3% 5% • >3% 1%

26. Do you advise adjusting salt, pH to comfort?

27. For what age do you recommend SNI? • Adult 98% • Child > 7 yr 80% • Child < 7 yr 26%

28. Conditions for which SNI is Recommended

29. Patients Satisfied with SNI

30. Do you recommend SNI ever prior to antibiotics? • Yes 77% • No 23%

31. Correlations • Women more likely to recommend NI (p<0.05) • MDs ≤ 45 years old are likely to recommend NI… • more often (p<0.06) • more often prior to Abx • MDs practicing for ≤ 10 yrs recommend: • more often (p<0.06) • more likely to recommend for children (p<0.02) • more likely to advise gravity based method (neti pot) (p<0.03)

32. 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%)

33. 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

35. Thanks!www.fammed.wisc.edu/research/past-projects/nasal-irrigationThanks!www.fammed.wisc.edu/research/past-projects/nasal-irrigation