| Popis: |
Introduction: Endocrinologists at this institution have adhered since 2008 to a policy governing who and when to prescribe TRT, akin to Endocrine Society guidelines. The policy, which does not apply to PCPs, excludes patients with a history of VEs (MI/CAD, CVA, VTE, PVD) Data showed that 6 of 7 patients prescribed TRT by PCPs prior to 2014 (812/945 [85.9%]) did not meet criteria, and 3 of 10 had a prior VE (283/945[30.1%]). To change PCP prescribing behavior, two initiatives were implemented. One, in 7/2014, offered E-consultation to increase access to endocrinology input (EC ACCESS), and the other, in 5/2018, installed a Lab Order (LO) set with Education on how to order and interpret T levels (LO EDU). Objective: To determine the impact of the initiatives on TRT prescribing behavior and the risk of VEs. Methods: Retrospective cohort study of TRT prescribing behavior (adhering to diagnostic criteria and abiding by contraindications) before (2008-2014) and after implementation of EC ACCESS (2015-5/2018) and LO EDU (6/2018-6/2020) initiatives, and the impact on VE incidence. Results: TRT prescriptions decreased from 945 Pre-ACCESS (~135/y) to 121 after EC ACCESS (~31/y; p The initiatives changed TRT prescribing behavior in 3 significant ways. First, PCPs were more likely to use ≥2 early AM T levels by LC/MS/MS when considering TRT (Pre-ACCESS: 196/945 [20.7%]; EC ACCESS: 62/121 [51.2%]; LO EDU: 47/61 [77%]; p Conclusion: Changes in TRT prescribing behavior after EC ACCESS and amplified by LO EDU resulted in a 75% reduction in total TRT prescriptions, a nearly 5-fold increase in appropriate TRT (meeting strict criteria), and a 2.5-fold decrease in contraindicated TRT (with prior VEs). These changes were associated with a significant decrease in the incidence of VEs during TRT. |
