Trigger Finger Treatment: Identifying Predictors of Nonadherence and Cost.
Aged
Costs and Cost Analysis
/ statistics & numerical data
Diabetes Mellitus
/ epidemiology
Evidence-Based Medicine
/ economics
Female
Follow-Up Studies
Glucocorticoids
/ administration & dosage
Health Care Costs
/ statistics & numerical data
Humans
Injections, Intralesional
/ economics
Male
Middle Aged
Orthopedic Procedures
/ economics
Patient Compliance
/ statistics & numerical data
Risk Factors
Sex Factors
Treatment Outcome
Trigger Finger Disorder
/ economics
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
entrez:
3
8
2020
pubmed:
3
8
2020
medline:
10
9
2020
Statut:
ppublish
Résumé
Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. Risk, III.
Sections du résumé
BACKGROUND
Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations.
METHODS
The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost.
RESULTS
A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care.
CONCLUSIONS
Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, III.
Identifiants
pubmed: 32740586
doi: 10.1097/PRS.0000000000006983
pii: 00006534-202008000-00023
doi:
Substances chimiques
Glucocorticoids
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
177e-186eRéférences
Centers for Medicare and Medicaid Services. Projections of national health expenditures. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ForecastSummary.pdf. Accessed June 1, 2019.
Neubauer MA, Hoverman JR, Kolodziej M, et al. Cost effectiveness of evidence-based treatment guidelines for the treatment of non-small-cell lung cancer in the community setting. J Oncol Pract. 2010;6:12–18.
Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: Can better care cost less? JAMA 2004;291:1850–1856.
Allen L. Evidence-based beta blockers. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@swa/documents/downloadable/ucm_460997.pdf. Accessed June 1, 2019.
Heidenreich PA, Gholami P, Sahay A, Massie B, Goldstein MK. Clinical reminders attached to echocardiography reports of patients with reduced left ventricular ejection fraction increase use of beta-blockers: A randomized trial. Circulation 2007;115:2829–2834.
Heart Failure Society of America. Executive summary: HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006;12:10–38.
Lange-Riess D, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg. 2009;129:1617–1619.
Ryzewicz M, Wolf JM. Trigger digits: Principles, management, and complications. J Hand Surg Am. 2006;31:135–146.
Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: Etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1:92–96.
Matthews A, Smith K, Read L, Nicholas J, Schmidt E. Trigger finger: An overview of the treatment options. JAAPA 2019;32:17–21.
Dala-Ali BM, Nakhdjevani A, Lloyd MA, Schreuder FB. The efficacy of steroid injection in the treatment of trigger finger. Clin Orthop Surg. 2012;4:263–268.
Akhtar S, Bradley MJ, Quinton DN, Burke FD. Management and referral for trigger finger/thumb. BMJ 2005;331:30–33.
Kerrigan CL, Stanwix MG. Using evidence to minimize the cost of trigger finger care. J Hand Surg Am. 2009;34:997–1005.
Benson LS, Ptaszek AJ. Injection versus surgery in the treatment of trigger finger. J Hand Surg Am. 1997;22:138–144.
Baumgarten KM, Gerlach D, Boyer MI. Corticosteroid injection in diabetic patients with trigger finger: A prospective, randomized, controlled double-blinded study. J Bone Joint Surg Am. 2007;89:2604–2611.
Wojahn RD, Foeger NC, Gelberman RH, Calfee RP. Long-term outcomes following a single corticosteroid injection for trigger finger. J Bone Joint Surg Am. 2014;96:1849–1854.
Pruzansky JS, Goljan P, Lundmark DP, Shin EK, Jacoby SM, Osterman AL. Treatment preferences for trigger digit by members of the American Association for Hand Surgery. Hand (N Y) 2014;9:529–533.
Halim A, Sobel AD, Eltorai AEM, Mansuripur KP, Weiss AC. Cost-effective management of stenosing tenosynovitis. J Hand Surg Am. 2018;43:1085–1091.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.
TransUnion. Patient payment responsibility increases 11% in 2017. Available at: https://newsroom.transunion.com/patient-payment-responsibility-increases-11-in-2017. Accessed June 1, 2019.
Billig JI, Speth KA, Nasser JS, Wang L, Chung KC. Provider variation in adherence to evidence-based treatment recommendations for treatment of trigger finger. JAMA Netw Open 2019;2:e1912960.
Wang AA, Hutchinson DT. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. J Hand Surg Am. 2006;31:979–981.
Franks P, Clancy CM. Referrals of adult patients from primary care: Demographic disparities and their relationship to HMO insurance. J Fam Pract. 1997;45:47–53.
Ayres I. Pervasive Prejudice? Unconventional Evidence of Race and Gender Discrimination. 2003.Chicago: University of Chicago Press;
Bernstein B, Kane R. Physicians’ attitudes toward female patients. Med Care 1981;19:600–608.
Gustafsson L, Bishop S; The Commonwealth Fund. Hospital price transparency: Making it useful for patients. Available at: https://www.commonwealthfund.org/blog/2019/hospital-price-transparency-making-it-useful-patients. Accessed June 1, 2019.
Surescripts. Enhancing provider and patient choice from within the EHR. Available at: https://surescripts.com/docs/default-source/products-and-services/real_time_benefit_check_overview_december_2013_surescripts.pdf. Accessed June 1, 2019.
Shah L, Carino T, Hanger M, Barnes L, Weinstein A. Barriers to clinical practice guidelines adherence in the community oncology setting. J Clin Oncol. 2011;29(Suppl):e19687–e19687.
Hope K, Jason L, Valerie F; New England Healthcare Institute. Improving physician adherence to clinical practice guidelines. Available at: https://www.nehi.net/writable/publication_files/file/cpg_report_final.pdf. Accessed July 1, 2019.
American Society of Plastic Surgeons. Evidence-based clinical practice guidelines. Available at: https://www.plasticsurgery.org/for-medical-professionals/quality/evidence-based-clinical-practice-guidelines. Accessed June 1, 2019.
American Academy of Orthopaedic Surgeons. Clinical practice guideline on the treatment of carpal tunnel syndrome. Available at: https://www.aaos.org/research/guidelines/CTSTreatmentGuideline.pdf. Accessed June 1, 2019.
Coroneos CJ, Antoniou SA, Florez ID, Brouwers MC. Thomas A, Sprague S, Voineskos S, Goldsmith C. Introduction to clinical practice guidelines. In: Evidence-Based Surgery. 2019:New York: Springer; 337–345.
Coroneos CJ, Voineskos SH, Cornacchi SD, Goldsmith CH, Ignacy TA, Thoma A. Users’ guide to the surgical literature: How to evaluate clinical practice guidelines. Can J Surg. 2014;57:280–286.
Kwaan MR, Melton GB. Evidence-based medicine in surgical education. Clin Colon Rectal Surg. 2012;25:151–155.
Meakins JL. Evidence-based surgery. Surg Clin North Am. 2006;86:1–16, vii.
Lee MJ. Evidence-based surgery: Creating the culture. Surg Clin North Am. 2006;86:91–100, ix.
McKee D, Lalonde J, Lalonde D. How many trigger fingers resolve spontaneously without any treatment? Plast Surg (Oakv.) 2018;26:52–54.
Patel MR, Bassini L. Trigger fingers and thumb: When to splint, inject, or operate. J Hand Surg Am. 1992;17:110–113.