Evidence map›Paper›PMID 25849354›Full record

ArticleProstate cancer and prostatic diseases2015

Gonadotropin-releasing hormone agonist overuse: urologists' response to reimbursement and characteristics associated with persistent overuse.

S D Ellis, M E Nielsen, W R Carpenter, G L Jackson, S B Wheeler, H Liu, M Weinberger

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Prostate cancer and prostatic diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 3 pooled it
2.4field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
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  8. Sensitivity of Medicare Data to Identify Oncologists.Journal of the National Cancer Institute. Monographs · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

S D Ellis1] Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS, USA [2] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
M E Nielsen1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
W R Carpenter1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
G L Jackson1] Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA [2] Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.
S B WheelerDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
H LiuLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
M Weinberger1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
University of North Carolina at Chapel Hill · US

Funding

Cancer Training GrantR25CA116339 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI BASCH, ETHAN M., REEVE, BRYCE B · 2008 to 2017
$4.0M
NCI NIH HHS N01 PC035136NCI NIH HHS N01 PC035139NCI NIH HHS N01 PC-35136NCI NIH HHS N01-PC-35139NCI NIH HHS N02 PC015105NCI NIH HHS R25 CA116339NCI NIH HHS R25CA116339PHS HHS U55/CCR921930-02
6 · The paper itself

Abstract

backgroundMedicare reimbursement cuts have been associated with declining gonadotropin-releasing hormone (GnRH) agonist overuse in localized prostate cancer. Medical school affiliation and foreign training have been associated with persistent overuse. However, physician-level prescribing changes and the practice type of persistent overusers have not been examined. We sought to describe physician-level changes in GnRH agonist overuse and test the association of time in practice and solo practice type with GnRH agonist overuse.

methodsWe matched American Medical Association physician data for 2138 urologists to Surveillance, Epidemiology and End Result-Medicare data for 12,943 men diagnosed with early-stage and lower-grade adenocarcinoma of the prostate between 2000 and 2007. We conducted a population-based, retrospective study using multilevel modeling to control for patient and provider characteristics.

resultsThree distinct patterns of GnRH agonist overuse were observed. Urologists' time in practice was not associated with GnRH agonist overuse (odds ratio (OR) 0.89; 95% confidence interval (CI): 0.75-1.05). However, solo practice type (OR 1.65; 95% CI: 1.34-2.02), medical school affiliation (OR 0.65; 95% CI: 0.55-0.77) and patient race were. Compared with non-Hispanic whites, non-Hispanic blacks (OR 1.76; 95% CI: 1.37-2.27), Hispanics (OR 1.41; 95% CI: 1.12-1.79) and men of 'other' race (OR 1.44; 95% CI: 1.04-1.99) had greater odds of receiving unnecessary GnRH agonists.

conclusionsGnRH agonist overuse remains high among some urologists who may be professionally isolated and difficult to reach. These urologists treat more vulnerable populations, which may contribute to health disparities in prostate cancer treatment quality. Nonetheless, these findings provide guidance to develop interventions to address overuse in prostate cancer.

Indexed as

Prescription Drug OveruseAgedGonadotropin-Releasing HormoneHumansMaleMedicarePhysiciansPractice Patterns, Physicians'ProstateProstatic NeoplasmsRetrospective StudiesSEER ProgramUnited StatesGonadotropin-Releasing Hormone

Identifiers

PMID25849354
PMCPMC4430363
OpenAlexW2009616190

What OpenQuestion holds

Textmetadata
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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.