Pulmonary Vascular Disease |

Current Clinical Practices in PAH: Challenges and Opportunities to Improve Care FREE TO VIEW

Nimish Mehta*, PhD; Tara Herrmann, PhD; Justin Wolfe, MS; Steven Nathan, MD
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Medscape, LLC, New York, NY

Chest. 2012;142(4_MeetingAbstracts):836A. doi:10.1378/chest.1387945
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SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary arterial hypertension (PAH) is under-recognized and inadequately treated. This study’s objective was to assess current clinical practices of pulmonologists, cardiologists, and primary care physicians in PAH management to identify knowledge, competency, and practice gaps and barriers to improving patient care.

METHODS: An educational needs assessment survey was developed consisting of 25 survey items. The assessment design included knowledge- and case -based, multiple-choice questions made available online to healthcare providers without monetary compensation or charge. Confidentiality of survey respondents was maintained and responses were de-identified and aggregated prior to analyses. The case vignettes and questions were based on current evidence-based consensus guidelines. The survey launched on February 17, 2012 and participant responses were collected over the following 4 weeks.

RESULTS: In total, 377 physicians responded to the survey. Over 65% of pulmonologists, 75% of cardiologists, and 85% of PCPs reported that their practices do not have an algorithm for PAH management. Moreover, nearly 20% of pulmonologists, 30% of cardiologists, and 40% of PCPs did not recommend right heart catheterization to confirm a diagnosis of PAH. In conjunction with this finding, a wide variation in recognition of the definition of pulmonary hypertension as mPAP > 25 mmHg was observed among pulmonologists (75%), cardiologists (50%), and PCPs (30%). Additionally, significant gaps were identified in PAH pathogenesis, risk stratification, monitoring for disease activity, treatment goals and rationale for combination therapy in all clinical specialties. Barriers to appropriate management cited most frequently by respondents included lack of familiarity and expertise with PAH.

CONCLUSIONS: This assessment of healthcare providers’ clinical practices identified gaps in PAH diagnosis and treatment among pulmonologists, cardiologists, and primary care physicians. Further assessment of physicians after participating in educational interventions is planned to demonstrate improvement in clinical practice.

CLINICAL IMPLICATIONS: The study identified knowledge, competency, and practice gaps in the diagnosis and management of patients with PAH, which can be used to inform the design of focused educational interventions to improve patient care.

DISCLOSURE: Nimish Mehta: Other: Employees of an organization that received educational grant from Gilead

Tara Herrmann: Other: Employees of an organization that received educational grant from Gilead

Justin Wolfe: Other: Employees of an organization that received educational grant from Gilead

Steven Nathan: Consultant fee, speaker bureau, advisory committee, etc.: Actelion Pharmaceuticals, Ltd; Gilead Sciences, Inc; United Therapeutics Corporation, Grant monies (from industry related sources): Actelion Pharmaceuticals Ltd; Gilead Sciences, Inc; United Therapeutics Corporation

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