The effect of impactful papers on clinical practice in the US: Corticosteroid injection for patients with lateral epicondylitis

Background: Following the publication of high level evidence demonstrating that corticosteroid inject is not an effective treatment for lateral epicondylitis, a reduction in the rate of corticosteroid injection would be expected. We aimed to clarify the current clinical practice pattern for lateral epicondylitis and to identify which factors hinder or encourage the introduction of evidence into clinical practice. Methods: In this administrative claims analysis, we used the 2009 to 2015 Truven MarketScan databases. We extracted claims for corticosteroid injection, physiotherapy, platelet-rich-plasma injection, and surgery for lateral epicondylitis. We performed multivariable analysis using generalized estimating equation model to identify the variables that potentially affect the odds of receiving a given treatment. Results: We included a total of 711,726 claims. The odds of receiving a corticosteroid injection slightly increased after publication of these impactful papers (OR: 1.7 95% CI: 1.04-1.11 in 2015). Patient-related factors such as male sex (OR: 1.21 95% CI: 1.19-1.23), older age (OR: 1.16 95% CI: 1.13-1.19), and managed care insurance (OR: 1.15 95% CI: 1.13-1.18) significantly contributed to increased odds of receiving corticosteroid injections. Patients seen at facilities in the South (OR: 1.33 95% CI: 1.30-1.36 compared with Northeast) and by plastic or orthopaedic surgeons (OR: 2.48 95% CI: 2.43-2.52) also had increased odds of receiving corticosteroid injection. Conclusions: Corticosteroid injection use did not decrease after publication of impactful papers, regardless of provider specialty or other patient-related factors. This finding implies that there are various barriers for even high level evidence to overcome the inertia of current practice. Funding Sources: Though our study was supported by a Midcareer Investigator Award in Patient-Oriented Research (2K24AR053120-06) to Kevin C. Chung, Principal Investigator, the National Institutes of Health did not have any role in preparation of the manuscript or in the decision to submit it for publication. This work was also funded by the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS Section of Plastic Surgery, University of Michigan Health System,, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340, kecchung@med.umich.edu Phone: 734-998-6022 ©2018American Society of Plastic Surgeons