Results of a pilot study to increase adherence to ASCO G-CSF recommendations at community clinics.

Abstract

19 Background: An ASCO 2012 Choosing Wisely recommendation cautions against the use of primary prophylactic colony stimulating factors (PP-CSF) for chemotherapy regimens with <20% risk of febrile neutropenia (FN). Our pilot aimed to test the feasibility and impact of using academic detailing and an automated CSF ordering system on CSF prescribing at 6 regional community oncology clinics in Washington State. Methods: The intervention was 1) academic detailing for oncologists during a regular staff meeting and 2) reconfiguring ordering systems to show FN risk and PP-CSF recommendation in a passive alert and include or exclude PP-CSF standing orders with >20% or ≤20% FN risk regimens, respectively. Clinic tumor registries were queried for patients with stage II-IV breast, non-small cell lung, or colorectal cancer starting first-line chemotherapy pre- or post-intervention. PP-CSF use, FN risk factors, and chemotherapy regimens matching the study protocol were manually abstracted. A regimen order was coded as adherent if it is low (<10%) FN risk without PP-CSF use; intermediate (10-20%) FN risk without PP-CSF use or FN risk factors are present; or high (>20%) FN risk with PP-CSF use. Results: The intervention was successfully implemented at 4 out of 6 participating clinics. The remaining 2 clinics were transitioning from paper to electronic orders in 1-2 years or using a system managed by a non-participating hospital. Adherence across the four implementing clinics increased after the intervention. *=p<0.05 Implementation of the CSF order-entry intervention was successful across a variety of ordering systems, including paper-based systems. Overall, while adherence prior to the intervention was high for these clinics, the order entry systems significantly improved adherence. Population characteristics and data availability may account for variation in adherence. Conclusions: An intervention with both academic detailing and ordering system presets may help increase adherence to Choosing Wisely recommendations. [Table: see text]