Time In Direct Patient Care Research Articles

Nursing processes analysis in district hospital in Lithuania

Abstract Background The aim of the study - to evaluate the time devoted to the activities of therapeutic profile nursing and wastes in the nursing processes. Methods Time-and-motion study was applied for investigation of clinical workflow in nursing at district hospital in neurology and internal medicine departments. A total of four nurses, two nurses from each department, were observed. Duration of observation was 2 940 minutes (49 hrs). Results Nurses devote most of their time to administering medicines. It has been noted that there are many additional, unnecessary actions in this process. Likewise nursing staff devotes a lot of time to documentation management work: refills the same dossier when the information is recorded in paper forms, and then transfer it to the computers. For communication with patients, nursing staff spend a very small part of their working time and it is due to insufficient staff and stress and fatigue of the nurses. It is observed that the nurses of neurology and internal medicine departments spent 50.3 percent of their working time for a direct patient care, 19.3 percent of time - for indirect patient care, 22.3 percent for personal time and 8.0 percent for unit-related functions. According to the Lean methodology waste of overproduction, waiting, defects, bureaucracy, transportation, motion and human potential were identified in these departments. Conclusions Nurses of neurology and internal medicine departments spend most of their time for direct patient care and the least of their time for unit-related duties. Seven out of eight types of waste prevails in therapeutic departments of the district hospital. Key messages Adaptation of the Lean methodology of ’Visual Management’ may aid for optimizing the process of medication administration and diminishing the paper work of nurses. The manifestation of the stress and fatigue of the nurses could be reduced if the workloads of nurses were adjusted and adequately distributed.

PIRFENIDONE ADVERSE EVENT MANAGEMENT USING DOSE MODIFICATIONS IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: RESULTS FROM AN ONLINE, SELF-ADMINISTERED SURVEY

SESSION TITLE: IPF: From Diagnosis to Treatment SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 01:30 pm - 02:30 pm PURPOSE: Pirfenidone is an approved treatment for idiopathic pulmonary fibrosis (IPF) that slows lung function decline. Although pirfenidone is generally well tolerated, some patients discontinue therapy due to adverse events (AEs). Temporary dose modifications may promote AE resolution and facilitate long-term treatment maintenance. To further understand which modification strategies may mitigate pirfenidone-related AEs in patients with IPF, a varied sample of US pulmonologists was surveyed. METHODS: An online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017, by MedPanel, Inc. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Pulmonologists answered questions about potential AE management in patients receiving pirfenidone maintenance therapy and rank ordered the steps they considered: temporary dose interruption, temporary dose reduction, prescribe/recommend additional agents, permanent discontinuation or unsure. Mean rankings were summarized by physician type (interstitial lung disease [ILD] specialists and community-based pulmonologists). RESULTS: A total of 169 pulmonologists responded; 69 (40.8%) and 100 (59.2%) were from ILD centers and community practices, respectively. Pulmonologists reported that a mean 58.6% (SD, 22.7%) of patients with IPF were receiving pirfenidone. For potential gastrointestinal (GI) AEs, such as nausea and vomiting, ILD pulmonologists ranked temporary dose reduction first followed by temporary dose interruption, prescribe/recommend additional agents and permanent discontinuation. Community pulmonologists also ranked temporary dose reduction first for potential GI AEs. For potential skin-related AEs, such as photosensitivity and rash, both groups ranked temporary dose interruption first before temporary dose reduction, followed by prescribe/recommend additional agents and permanent discontinuation of pirfenidone. Both ILD and community pulmonologist groups reported nearly half of patients (45% and 44%, respectively) achieved the maintenance dose of pirfenidone (2403 mg/d) after dose modification. Both pulmonologist groups had similar frequencies of patients discontinuing due to AEs, with the majority having CONCLUSIONS: Overall, pulmonologists typically use a temporary dose reduction first to manage pirfenidone-related GI AEs. For skin-related AEs, a temporary dose interruption is usually used first. Almost half of patients requiring dose modification can achieve the full maintenance dose of pirfenidone. CLINICAL IMPLICATIONS: Treatment persistence with pirfenidone can be maintained by effective dose-modification strategies. DISCLOSURES: Employee $100000 Added 03/14/2019 by Cindy Burg, source=Web Response, value=Salary Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/13/2019 by Tmirah Haselkorn, source=Web Response, value=Consulting fee Consultant relationship with Novartis Pharmaceuticals Corp. Please note: $1-$1000 Added 03/13/2019 by Tmirah Haselkorn, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/06/2019 by Peter LaCamera, source=Web Response, value=Consulting fee Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/06/2019 by Peter LaCamera, source=Web Response, value=Consulting fee Employee relationship with Roche Please note: >$100000 Added 03/14/2019 by John Stauffer, source=Web Response, value=Salary Employee $100000 Added 03/14/2019 by John Stauffer, source=Web Response, value=Ownership interest Speaker/Speaker's Bureau relationship with Genentech Please note: $1-$1000 Added 03/14/2019 by Mark Wencel, source=Web Response, value=Honoraria Employee relationship with Genentech, Inc. Please note: >$100000 Added 03/15/2019 by Ming Yang, source=Web Response, value=Salary

How Supervising Students Can Enrich Your Career—and Your Health Care Facility

How Supervising Students Can Enrich Your Career—and Your Health Care Facility

CN15 - Unmet needs in oncology research related to radiological response evaluation: A multi-center survey in three European countries

BackgroundA standardized evaluation approach in oncology is essential to optimize treatment and management of patients. In particular, a medical software designed to provide standard metrics and reports may help the communication among health care professionals, facilitating the decision process. To this aim, a large survey study was conducted across the United Kingdom (UK), Spain (ES) and Italy (IT) exploring existing unmet needs and questioning the way oncological data is tracked in daily routine practice with the aim of offering some ideas for improvement. MethodsPhysicians were enrolled by an independent Market Research Company according to diiferent inclusion criteria: a) 2-35 years in practice; b) ≥50% of practice time in direct patient care; c) involvement in making treatment decisions ; d) involvement in ordering and reviewing tumour assessment reports; e) to be an investigator or author of an oncology clinical trial in the past 5 years.The study was conducted in November-December, 2018. ResultsA total number of 270 physicians (medical oncologists: n=180, radio-oncologists: n=90) participated (UK/100, ES/95, IT/75). The vast majority of physicians use Response Evaluation Criteria in Solid Tumors (RECIST) criteria in their daily practice (86%). Guidelines for response criteria for use in trials testing immunotherapeutics (iRECIST) and modified RECIST (mRECIST) are also used by between third and a quarter of physicians. Of note, almost half of the physicians indicated that there is a low level of data management in oncology and 2 out of 3 agree that this negatively impacts therapeutic decisions. Over a third of ES physicians believe that there is a low level of data management in oncology and a similar proportion in IT and ES report that it is impacting therapeutic decision making. ConclusionsOnly a third of physicians view their current reporting systems as adequate. All participants agree that any reporting system is in need of a common shared template for radiologists and oncologists. Thus, physicians identify a lack of consistency in diagnostic assessments and delays in receiving the reports as key unmet needs in tumor reporting systems –indicating the need for a streamlined system. Legal entity responsible for the studyThe authors. FundingWehealth Digital Medicine. DisclosureAll authors have declared no conflicts of interest.

Simulated co-location of patients admitted to an inpatient internal medicine teaching unit: potential impacts on efficiency and physician-nurse collaboration

Effective communication between nurses and physician teams on the internal medicine unit is crucial for high quality, safe, and efficient patient care. In our hospital of interest, a large academic health sciences centre, the physical layout of the unit, current admission process, and the presence of three separate physician teams contribute to uneven workload and communication barriers. We address this by physically co-locating each physician teams’ patients so as to facilitate physician-nurse collaboration, and more evenly distribute workload across all three teams. Based upon one year of real-world data, we developed a simulation model of inpatient flow through the internal medicine unit and determined the impact of two proposed changes: co-locating each team’s patients, and new admission rules for how patients are assigned to those teams. Under the new arrangement, each physician team would interact with roughly half the number of nurses, and nurses in turn would have fewer individual team members with whom to communicate, thereby improving effective communication and increasing time for direct patient care for both physicians and nurses.

A chemotherapy privileging process for advanced practice providers at an academic medical center.

Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.

Less direct patient care delivered by medical trainees by the end of a hematology‐oncology ward rotation: Association with empathy and related factors

The education of trainee physicians in hematology-oncology is challenged by inherent stressors of hematology-oncology. Clinical work load, death and dying, and the known phenomenon of empathy decline during clinical education affect trainees. Time spent with patients or direct patient care time (DPCT) is influenced by many factors, which ultimately affect medical education. Therefore, DPCT may decrease by the end training on a busy hematology-oncology ward rotation. Internal medicine interns and residents (n=64) rotating on a hematology-oncology ward rotation were consecutively selected to participate. Questionnaires containing Likert scale questions assessing time spent with patients before and after the rotation, empathy/resilience/distress measurements (Interpersonal Reactivity Index [IRI], Connors-Davidson Resilience Scale [CD-RISC], and Impact of Events Scale-Revised [IES-R], respectively), and demographic and situational information were collected at the beginning and end of the rotation RESULTS: DPCT decreased from over 10 to 15minutes per patient to slightly over 1 to 5minutes with over half of the trainees spending less than 1minute per patient per day (P<.001, Cohen's d=1.05). Empathy scores decreased 2.01 points from 58.9 to 56.8 (P=.018, Cohen's d=0.33) during the rotation. DPCT decrease was associated mistreatment (P<.001) and lack of support (P=.001) while endorsing external issues (P=.002) and longer rotation time predicted for greater DPCT accounting for 67% of DPCT variance on multivariate analysis. Medical trainees in oncology who feel a lack of social/familial support and feel mistreated by mentors/superiors spend significantly less time with patients. Educational initiatives should replicate and utilize these associations to enhance patient-centric care in oncology.

Resident Supervision and Patient Care: A Comparative Time Study in a Community-Academic Versus a Community Emergency Department.

The objective was to compare attending emergency physician (EP) time spent on direct and indirect patient care activities in emergency departments (EDs) with and without emergency medicine (EM) residents. We performed an observational, time-motion study on 25 EPs who worked in a community-academic ED and a nonacademic community ED. Two observations of each EP were performed at each site. Average time spent per 240-minute observation on main-category activities are illustrated in percentages. We report descriptive statistics (median and interquartile ranges) for the number of minutes EPs spent per subcategory activity, in total and per patient. We performed a Wilcoxon two-sample test to assess differences between time spent across two EDs. The 25 observed EPs executed 34,358 tasks in the two EDs. At the community-academic ED, EPs spent 14.2% of their time supervising EM residents. Supervision activities included data presentation, medical decision making, and treatment. The time spent on supervision was offset by a decrease in time spent by EPs on indirect patient care (specifically communication and electronic health record work) at the community academic ED compared to the nonacademic community ED. There was no statistical difference with respect to direct patient care time expenditure between the two EDs. There was a nonstatistically significant difference in attending patient load between sites. EPs in our study spent 14.2% of their time (8.5 minutes/hour) supervising residents. The time spent supervising residents was largely offset by time savings related to indirect patient care activities rather than compromising direct patient care.

MANAGING HUMAN RESOURCES IN NURSING: THE RELATIONSHIP OF NURSES’ WORKING TIME AND PATIENTS’ INDEPENDENCE LEVEL

A skilled, competent, and motivated nursing workforce is crucial for a well-functioning health care system. Nurses’ professional activities done on a regular basis, their workload, and occupancy are related to the patient’s health status, dependence level and care needs. Therefore, managing human resources in nursing by effectively distributing nurses’ working time and monitoring their workload for safe and high quality care, managers should rely on the severity of patients’ health status and their independence level. In this article the results on how nurses’ working time depends on patients’ independence are provided. The research was carried out at a regional hospital, in departments of medical profile. The time-and-motion study was implemented with 72 observations made in total, which amounted to 777.2 hours of nursing time. A questionnaire was used to assess the level of patients’ independence by assessing the four activities of the patient’s daily living. The results revealed that the largest amount of nurses’ working time, i.e. almost half of a day’s shift, was spent on direct patient care by administrating medication use and performing various nursing procedures. Nurses would spend almost half of the time for direct patient care on completely dependent patients, while one third would be spent on dependent patients. The relative number of nurses’ contacts with a patient is directly proportional to patient’s level of independence; a strong or fairly strong linear relationship was established betweenn the level of patients’ independence and the relative amount of nurses’ working time.

Design of Smart Nurse Call (Caller Nurse) Based on Android

The limited number of nurses is a problem that often occurs in the world of health which has an impact on the high workload of nurses resulting in less optimal patient care and decreased patient satisfaction. According to Institute for Healthcare Improvement, nurses spend only 20-30% of their time in direct patient care, the rest on documentation and administration processes. So, hospitals generally provide nurse calls so families don't have to leave patients to find nurses.The purpose of this study was to make it easier for patients to use Smart Nurse Call, especially for patients with acute diagnosis conditions and it's easier for nurses to monitor patient's condition. It's also examines the distance of data transmission in one building to determine the performance of wireless (access points).Based on data from test results, the quality of data transmission using wireless media is known that access point has data transmission limit. In testing distance at AH building stated that data transmission based on the range on the 1st floor is able to reach the entire corridor, for 2nd floor it can reach a distance of 13 meters while on 3rd floor it cannot be reached. The data from suitability test of smart nurse call tool showed that the suitability level of the device was quite high and almost same as manual test at 97.65%. The data from stress test results from push button get average voltage value low position at 0 V and average high voltage at 4.675 V.

Physician characteristics associated with treatment initiation patterns in idiopathic pulmonary fibrosis.

Pirfenidone and nintedanib are oral antifibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF). Real-world data on factors that influence IPF treatment decisions are limited. Physician characteristics associated with antifibrotic therapy initiation following an IPF diagnosis were examined in a sample of US pulmonologists. An online, self-administered survey was fielded to pulmonologists between April 10, 2017, and May 17, 2017. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Participants answered questions regarding timing and reasons for considering the initiation of antifibrotic therapy after an IPF diagnosis. A total of 169 pulmonologists participated. The majority (81.7%) considered initiating antifibrotic therapy immediately after IPF diagnosis all or most of the time (immediate group), while 18.3% considered it only some of the time or not at all (delayed group). Pulmonologists in the immediate group were more likely to work in private practice (26.1%), have a greater mean percentage of patients receiving antifibrotic therapy (60.8%), and decide to initiate treatment themselves (31.2%) versus those in the delayed group (16.1%, 30.5%, and 16.1%, respectively). Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time versus using a “watch-and-wait” approach. Distinguishing characteristics between pulmonologists in the immediate group versus the delayed group included practice setting, percentage of patients receiving antifibrotic therapy, and the decision-making dynamics between the patient and the pulmonologist.

Understanding the role of advanced practice providers in oncology in the United States.

Advanced practice providers (APPs, which include NPs and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all APPs in oncology and, second, to understand personal and practice characteristics (including compensation) of those APPs. We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577 out of 3,055, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is about $10,000 higher than average pay for APPs not in oncology. We identified 5,350 APPs in oncology and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

ATTITUDES AMONG U.S.-BASED ALLERGISTS AND IMMUNOLOGISTS ABOUT IMMUNOTHERAPY, PEANUT EXPOSURE AND TREATMENT

Introduction Recent findings suggest that prevalence and severity of childhood food allergy is greater than previously reported. No approved therapy exists for peanut allergy (PA), suggesting substantial unmet need. A survey was conducted to assess allergist/immunologist attitudes toward PA and oral immunotherapy (OIT). Methods An online self-administered survey was fielded to allergists and/or immunologists in the U.S. between December 28, 2017-January 27, 2018. Participants were included if they completed training >5 years ago, spent >20% of their time in direct patient care, and annually managed ≥50 patients with food allergy. Results Of 101 participating allergists/immunologists from 28 cities, 46% practiced in/were affiliated with an academic medical center, 47% had practiced for 11-20 years, and 78% spent 81-100% of their time in direct patient care. Approximately half of respondents (48%) treated patients with OIT in the past year. Clinical/behavioral factors cited as “extremely” or “very” important to initiating immunotherapy included caregiver/patient motivation (94%) and no compliance concerns/challenges (85%). 81% of allergists/immunologists agreed that the dose tolerated in OIT was the most clinically meaningful for a patient to know. Of those respondents not implementing OIT, the most important reason for not doing so was lack of FDA approval (73%). Most allergists/immunologists (66%) recommended restricting activities of their patients to practice avoidance (Figure). Conclusions Patients with PA are subject to significant lifestyle restrictions to avoid accidental exposure. “Tolerated dose” was felt by physicians to be the most clinically relevant term for patients following OIT. Most allergists/immunologists would initiate OIT following FDA approval. Recent findings suggest that prevalence and severity of childhood food allergy is greater than previously reported. No approved therapy exists for peanut allergy (PA), suggesting substantial unmet need. A survey was conducted to assess allergist/immunologist attitudes toward PA and oral immunotherapy (OIT). An online self-administered survey was fielded to allergists and/or immunologists in the U.S. between December 28, 2017-January 27, 2018. Participants were included if they completed training >5 years ago, spent >20% of their time in direct patient care, and annually managed ≥50 patients with food allergy. Of 101 participating allergists/immunologists from 28 cities, 46% practiced in/were affiliated with an academic medical center, 47% had practiced for 11-20 years, and 78% spent 81-100% of their time in direct patient care. Approximately half of respondents (48%) treated patients with OIT in the past year. Clinical/behavioral factors cited as “extremely” or “very” important to initiating immunotherapy included caregiver/patient motivation (94%) and no compliance concerns/challenges (85%). 81% of allergists/immunologists agreed that the dose tolerated in OIT was the most clinically meaningful for a patient to know. Of those respondents not implementing OIT, the most important reason for not doing so was lack of FDA approval (73%). Most allergists/immunologists (66%) recommended restricting activities of their patients to practice avoidance (Figure). Patients with PA are subject to significant lifestyle restrictions to avoid accidental exposure. “Tolerated dose” was felt by physicians to be the most clinically relevant term for patients following OIT. Most allergists/immunologists would initiate OIT following FDA approval.

Understanding the Role of Advanced Practice Providers in Oncology in the United States.

Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims to identify all oncology APPs and to understand personal and practice characteristics (including compensation) of those APPs. We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as White (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs = 94%; PAs = 98%), prescribing (NPs = 93%; PAs = 97%), treatment management (NPs = 89%; PAs = 93%), and follow-up visits (NPs = 81%; PAs = 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care.

PHYSICIAN CHARACTERISTICS AND TREATMENT STRATEGIES BY PIRFENIDONE DISCONTINUATION RATES IN IDIOPATHIC PULMONARY FIBROSIS: RESULTS FROM AN ONLINE, SELF-ADMINISTERED SURVEY

SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Pirfenidone is approved for the treatment of idiopathic pulmonary fibrosis (IPF), reduces lung function decline and improves progression-free survival. Although pirfenidone is generally well tolerated, a subset of patients discontinue therapy due to gastrointestinal- and fatigue-related adverse events (AEs). Physician characteristics and treatment strategies stratified by physician-reported patient discontinuation rates due to AEs are described in a varied sample of US pulmonologists. METHODS: An online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017. Pulmonologists were included if they spend >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotic therapy. Physicians were stratified by their self-reported proportion of patients discontinuing pirfenidone (≤20% vs. >20%) after answering questions about initiating pirfenidone treatment and management of AEs. RESULTS: A total of 167 pulmonologists responded; 110 (65.9%) and 57 (34.1%) reported ≤20% and >20% of patients discontinuing pirfenidone due to AEs, respectively. In the ≤20% and >20% groups, 41.8% and 36.8%, respectively, practice in an interstitial lung disease center; in both groups, most spend >80% of their time in direct patient care and have 11 to 20 years of experience. More physicians in the ≤20% group practice at an academic medical center vs. the >20% group (63.6% vs. 45.6%, respectively). The mean (SD) number of patients with IPF in each practice was 70.3 (122.7) in the ≤20% group and 60.6 (80.3) in the >20% group. Most physicians in both groups specify when to take pirfenidone relative to a meal (e.g., before, during or after), with the majority counseling during the meal. However, a lower proportion in the ≤20% group recommend during a meal vs. those in the >20% group (56.7% vs. 71.9%, respectively), whereas a higher proportion in the ≤20% group recommend after a meal (28.3% vs. 18.8%, respectively). Physicians in the ≤20% group were less likely to suggest additional therapy to manage AEs, including anti-nausea and anti-diarrheal drugs. Physicians in the ≤20% group were more likely to report strategies to prevent fatigue as being effective than those in the >20% group (33.3% vs. 19.4%, respectively). CONCLUSIONS: Physicians who reported a lower rate of tolerability-related discontinuations (≤20%) had more patients with IPF in their practice. These physicians are more likely to recommend taking pirfenidone after a meal, use fewer additional therapies to manage AEs and reported more-effective strategies to prevent fatigue in their patients vs. physicians with a higher rate of discontinuations (>20%). CLINICAL IMPLICATIONS: Treatment persistence with pirfenidone can be maintained by effective dose titration and AE management strategies. DISCLOSURES: Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 02/21/2018 by Tmirah Haselkorn, source=Web Response, value=Consulting fee No relevant relationships by Peter LaCamera, source=Web Response Employee relationship with Genentech Please note: >$100000 Added 02/23/2018 by Susan Limb, source=Web Response, value=Salary Employee relationship with Genentech, Inc. Please note: >$100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Salary Stockholder relationship with Roche Please note: $5001 - $20000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Stockholder relationship with Bristol Myers Squibb Please note: $20001 - $100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Stockholder relationship with Zimmer Please note: $20001 - $100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Employee Removed 02/22/2018 by John Stauffer, source=Web Response Employee relationship with Genentech, Inc. Please note: $20001 - $100000 Added 02/22/2018 by John Stauffer, source=Web Response, value=Stock holder Speaker/Speaker's Bureau relationship with Genentech, Inc. Please note: $5001 - $20000 Added 02/27/2018 by Mark Wencel, source=Web Response, value=Consulting fee Employee relationship with Genentech, Inc. Please note: >$100000 Added 02/22/2018 by Ming Yang, source=Web Response, value=Salary

Understanding the Role of Advanced Practice Providers in Oncology in the United States

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/ oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/ gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

Understanding the Role of Advanced Practice Providers in Oncology in the United States.

Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

Real-World Practice Patterns for Prevention and Management of Potential Adverse Events with Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis.

IntroductionPirfenidone is an oral antifibrotic agent approved for idiopathic pulmonary fibrosis (IPF). Real-world data on adverse event (AE) management for pirfenidone are limited. Strategies for managing potential antifibrotic therapy AEs were examined in a sample of US pulmonologists.MethodsAn online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017. Pulmonologists were included if they spent > 20% of their time in direct patient care and had ≥ 5 patients with IPF on antifibrotic therapy. Participants answered questions regarding initiation of pirfenidone, dose titration, and management of potential AEs.ResultsA total of 169 pulmonologists participated. Gastrointestinal (GI) intolerance was the most important factor in implementing alternative titration schedules for pirfenidone. Approximately three-quarters of pulmonologists recommended the standard titration scheme for starting treatment; however, a range of titration schedules up to 8 weeks were described, with a 4-week schedule being most common. Pulmonologists reported that most patients treated with alternative titration schedules could achieve the full dose of pirfenidone. Pulmonologists who were most effective at mitigating pirfenidone-related GI AEs by advising dosing at mealtimes more frequently recommended taking pirfenidone during a substantial meal than pulmonologists who were less effective. For photosensitivity AEs, pulmonologists recommended sunscreen use, sun avoidance, wearing a hat, and ultraviolet protection factor clothing.ConclusionsPulmonologists reported that alternative titration schedules for initiating pirfenidone were common and can aid in maintaining the full dose. Proposed strategies to ameliorate pirfenidone-related GI and photosensitivity AEs included taking pirfenidone during a substantial meal and minimizing sun exposure, respectively.FundingF. Hoffmann-La Roche Ltd./Genentech, Inc.Plain Language SummaryPlain language summary available for this article.

Workforce Trends and Analysis of Selected Pediatric Subspecialties in the United States

ObjectiveTo update pediatric subspecialty workforce data to support evidence-based legislation and public policy decisions by replicating the American Academy of Pediatrics' 1998 Future of Pediatric Education (FOPE II) workforce survey. MethodsA descriptive and comparative analysis of survey responses from 9950 US pediatric subspecialists who completed an electronic survey. ResultsPediatric subspecialists are working fewer hours and spending less of their time in direct patient care than they did in 1998 but the mean hours worked differs significantly according to subspecialty. Most subspecialists continue to be board-certified, white, non-Hispanic men, although the percentage who are women and from minority groups has increased. The proportion of subspecialists practicing in an academic medical center has increased since 1998. Thirty percent of pediatric subspecialists reported appointment wait times of >2 weeks and pediatric subspecialists in developmental pediatrics, endocrinology, and neurology identified much longer wait times than other subspecialists. ConclusionThe demographic and practice characteristics of pediatric subspecialists have changed since the FOPE II survey and access to subspecialty care in a family's community remains a challenge. However, pediatric subspecialties are not monolithic and solutions to workforce shortages will need to take into account these differences to improve access to subspecialty care.

The Iowa new practice model: Advancing technician roles to increase pharmacists' time to provide patient care services

ObjectivesDetermine the effects of an 18-month pilot project using tech-check-tech in 7 community pharmacies on 1) rate of dispensing errors not identified during refill prescription final product verification; 2) pharmacist workday task composition; and 3) amount of patient care services provided and the reimbursement status of those services. DesignPretest–posttest quasi-experimental study where baseline and study periods were compared. Setting and participantsPharmacists and pharmacy technicians in 7 community pharmacies in Iowa. Outcome measuresThe outcome measures were 1) percentage of technician verified refill prescriptions where dispensing errors were not identified on final product verification; 2) percentage of time spent by pharmacists in dispensing, management, patient care, practice development, and other activities; 3) the number of pharmacist patient care services provided per pharmacist hours worked; and 4) percentage of time that technician product verification was used. ResultsThere was no significant difference in overall errors (0.2729% vs. 0.5124%, P = 0.513), patient safety errors (0.0525% vs. 0.0651%, P = 0.837), or administrative errors (0.2204% vs. 0.4784%, P = 0.411). Pharmacist’s time in dispensing significantly decreased (67.3% vs. 49.06%, P = 0.005), and time in direct patient care (19.96% vs. 34.72%, P = 0.003), increased significantly. Time in other activities did not significantly change. Reimbursable services per pharmacist hour (0.11 vs. 0.30, P = 0.129), did not significantly change. Non-reimbursable services increased significantly (2.77 vs. 4.80, P = 0.042). Total services significantly increased (2.88 vs. 5.16, P = 0.044). ConclusionPharmacy technician product verification of refill prescriptions preserved dispensing safety while significantly increasing the time spent in delivery of pharmacist provided patient care services. The total number of pharmacist services provided per hour also increased significantly, driven primarily by a significant increase in the number of non-reimbursed services. This was mostly likely due to the increased time available to provide patient care. Reimbursed services per hour did not increase significantly mostly likely due to lack of payers.