A Survey of Oncologists' Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors.

The purpose of the study is to describe oncologists' perceptions and opinions about patient eligibility, guidelines, and barriers for use of granulocyte colony-stimulating factor (G-CSF), overall and stratified by their affiliation with the Oncology Care Model (OCM). In May 2018, we invited and recruited practicing US oncologists from a national database for an online survey. Level of agreement was identified using a seven-point scale, ranging from strongly disagree to strongly agree. Of 200 participating oncologists, 70 were OCM-affiliated. Overall, 65% of oncologists agreed or strongly agreed that all patients at high risk of febrile neutropenia (FN) should receive prophylactic G-CSF, and half agreed or strongly agreed that benefits of G-CSF outweigh the potential adverse effects. The most common barriers to G-CSF use for patients at high risk of FN included patient refusal (37.1% of OCM-affiliated oncologists vs. 21.5% of non-OCM-affiliated oncologists), not on protocol/not supported by guidelines (32.9% vs. 23.1%), lack of reimbursement to practice (30.0% vs. 15.4%), and concerns about insurance coverage (22.9% vs. 26.9%). More OCM-affiliated oncologists reported that their practices offer and strongly encourage adherence to a specific protocol for G-CSF use (49.2%) versus non-OCM oncologists (31.3%). Despite recommendations from national guidelines and strong evidence from randomized, controlled clinical trials, only two thirds of oncologists agree or strongly agree that all patients at high risk of FN should receive primary G-CSF prophylaxis. Decisions about G-CSF prophylaxis may be affected by factors other than risk of FN, such as patient choice, practice protocols/guidelines, lack of reimbursement, and insurance coverage.

Is patient insurance type related to physician recommendation, administration and referral for adult vaccination? A survey of US physicians.

This study evaluated physician practices and perceived barriers for influenza, tetanus, diphtheria, pertussis (Tdap), and zoster vaccination of adults in the United States (US), with emphasis on patients with Medicare versus commercial insurance. A cross-sectional internet-based survey of board-certified general/family practitioners and internists (N = 1,000) recruited from a national US physician panel was conducted in May 2017. For influenza, rates of physician recommendation (84% of Medicare patients, 82% of commercially-insured patients), administration (80% Medicare, 78% commercial), and referral (11% Medicare, 11% commercial) were similar regardless of insurance type. Tdap recommendation was higher for commercial compared to Medicare patients (59% vs. 54%, p < 0.001); while zoster recommendation was higher for Medicare patients than commercial (59% vs. 55%, p < 0.001). For Tdap and zoster, higher administration rates were reported in commercial patients (64% Tdap, 36% zoster) than Medicare (56% Tdap, 32% zoster), and referral rates were higher for Medicare patients (19% Tdap, 49% zoster) than commercial (14% Tdap, 42% zoster). Over 40% of physicians would be much more likely to administer Tdap and zoster vaccines if they were covered under Medicare Part B, with more physicians indicating financial barriers as "major" or "moderate" for Medicare than commercial patients. These differences may be related to financial barriers associated with adult vaccinations that are covered under Medicare Part D and involve patient out-of-pocket costs. Efforts to reduce financial barriers associated with adult vaccinations covered under Medicare Part D and to improve patient and physician knowledge could positively impact physician recommendation, administration, and referral for adult vaccination in the US.