Changes in Provider Treatment Patterns for Dupuytren’s Contracture: Analysis of Trends in Medicare Beneficiaries

Thayer, Mary Kate; Somerson, Jeremy S.; Huang, Jerry I.

doi:10.1097/gox.0000000000001932

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…In the United States, limited fasciectomy remains the treatment of choice for Dupuytren contracture; however, rates of collagenase injection have increased following Food and Drug Administration approval of the injection in 2010. 2,19 Because physicians’ bias may limit patients’ exposure to all available treatments, physicians should consider recent studies investigating long-term outcomes of collagenase injection and needle aponeurotomy that have demonstrated safety, efficacy, 20,21 and effectiveness 22,23 comparable to fasciectomy. In a 5-year follow-up study, the overall recurrence rate from collagenase injection was 47%, which was similar to recurrence rates from limited fasciectomy at the same follow-up.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

Kane

Wood

Cichocki

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear. Methods: An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment. Results: Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures. Conclusions: Physicians should help patients choose a treatment that aligns with the patient’s preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.

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Section: Discussionmentioning

confidence: 99%

Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

Kane

Wood

Cichocki

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…La tendencia de nuestros cirujanos parece orientar a la preferencia en la actualidad hacia técnicas mínimamente invasivas en el tratamiento de la ED, ya que permiten una rápida recuperación del paciente con el mínimo impacto, dejando solo las técnicas más exigentes para aquellos casos graves y de recurrencias marcadas, tal y como opinan diversos autores. 13,14 En cuanto a los casos primarios, hemos observado que los cirujanos participantes con más tiempo de especialistas en cirugía de la mano, tienen una tendencia a escoger CCH como tratamiento para la ED. De igual manera, aquellos que reportan mayor frecuencia de su uso en la práctica habitual tienen mayor probabilidad de seleccionar CCH como método de tratamiento.…”

Section: Discussionunclassified

Current Trends in the Treatment of Dupuytren Disease in Spain

Sanjuán-Cerveró

Herrero

Novoa-Parra

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Objective Assessment of the treatment trends of Spanish surgeons in clinical practice by making clinical assumptions in Dupuytren's disease (DD). Material and Method A survey was sent to the members of the Spanish Society for Surgery of the Hand (Sociedad Española de Cirugía de la Mano, SECMA) posing primary and secondary clinical cases. A relationship is established between the selected treatment, the characteristics of the participating surgeons, and the characteristics of the primary clinical cases. Treatment preferences in recurrences are assessed descriptively. Results In total, 127 surveys were answered. 62.2% of the participants had experience with the use of collagenase and were the basis of the analysis. In primary cases, surgeons with more practice time tended to choose collagenase as treatment for DD. Surgeons who reported higher frequency of collagenase use (67.4% vs. 25.7%) were up to 6 times more likely to indicate such treatment. The patient's age under 50 years was the variable with the greatest association strength for the choice of collagenase treatment (OR = 3.8; CI95% 1.9–7.6). In recurrences, among all clinical cases, the most common answer given by the surgeons was partial fasciectomy. Conclusions Partial fasciectomy continues to be the most widely used treatment for DD in Spain. In primary cases, collagenase is an alternative adopted by experienced surgeons, and in treatments for young patients. In recurrences, partial fasciectomy is the preferred technique.

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“…Las preguntas básicas de tratamiento general y los casos clínicos (5,9,(13)(14)(15)(16)(17)(18)(19)(20)22,25,26) presentaron una opción de múltiple respuesta igual para todas ellas, con 5 respuestas posibles y excluyentes (sólo se podía elegir una opción), siendo la última de ellas de campo abierto y que se analizó por separado pero que se consideró como única para el análisis estadístico. Las preguntas 7-8,10,12,27 y 30 eran de respuesta múltiple si lo deseaba el entrevistado.…”

Section: Instrumentounclassified

“…De hecho, los resultados de nuestra encuesta se ven corroborados por las ventas en España del fármaco como podemos ver en la figura 2, con un aumento progresivo en el tiempo. Otros estudios objetivan un descenso progresivo del tratamiento de la ED mediante FSC a expensas del tratamiento con CCH, [13][14][15] con un aumento añadido de los diagnósticos de ED. 13,15 Coincidimos en la opinión de esos autores, en que los pacientes antes reticentes a un tratamiento de la ED por sus consecuencias en tiempo de recuperación y la agresividad del mismo, accedan ahora a un tratamiento menos invasivo y con una recuperación más rápida.…”

Section: Discusionunclassified

Tratamiento de la Enfermedad de Dupuytren en España

R¹,

Herrero

Novoa-Parra³

et al. 2019

Rev Iberoam Cir Mano

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Resumen Objetivos Nuestro objetivo consiste en valorar la situación actual en España del tratamiento de la enfermedad de Dupuytren mediante una encuesta realizada a los cirujanos de mano españoles y compararla con una encuesta similar realizada en España antes de la comercialización de la colagenasa en Europa. Material y Métodos Se remite una encuesta a los socios de la Sociedad Española de Cirugía de la Mano (SECMA) con 30 preguntas divididas en 4 bloques: aspectos demográficos, opinión general del tratamiento de la enfermedad de Dupuytren, casos clínicos y repercusión de la introducción de la colagenasa Clostridium Histolyticum en el tratamiento. Resultados La tasa de respuesta fue del 38,2% sobre un total de 332 socios. La mayor parte de los participantes se consideró como cirujanos no noveles. La fasciectomía parcial es la técnica más frecuentemente utilizada (73% de los encuestados) y considerada de primera elección (61,9%) seguida por la colagenasa (23% y 31% respectivamente). Más de la mitad de los encuestados consideró que ha habido un cambio en el modo de afrontar la enfermedad de Dupuytren en los últimos 5 años. Con respecto a la colagenasa, actualmente el uso de los protocolos iniciales se ha abandonado, aunque el protocolo de tratamiento más habitual sigue siendo la administración de una dosis desechando el resto del vial. Conclusiones Actualmente la fasciectomía parcial es la técnica preferida y más frecuentemente utilizada en la enfermedad de Dupuytren seguida de la colagenasa en España.

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Changes in Provider Treatment Patterns for Dupuytren’s Contracture: Analysis of Trends in Medicare Beneficiaries

Cited by 6 publications

References 13 publications

Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

Current Trends in the Treatment of Dupuytren Disease in Spain

Tratamiento de la Enfermedad de Dupuytren en España

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