(1273) Why Aren't Biologics Routinely Implemented in ENT Practice for CRSwNP? Insights From Medical Education

Introduction: Biologic therapies have expanded treatment options for chronic rhinosinusitis with nasal polyps (CRSwNP). Otolaryngologists play a central role in identifying appropriate candidates, however, biologic initiation and long-term management often occur outside ENT practice.

Methods: A mixed-methods analysis was conducted on 8 educational activities (including live and online programming) which launched between April 2024 - October 2025. Quantitative data were derived from aggregated pre- and post-activity assessments completed by >5,300 otolaryngologists. Qualitative data were collected through structured open-ended surveys administered to otolaryngologists, allergists, and pulmonologists.

Results: Across 8 programs, otolaryngologists demonstrated consistent post-education gains of 21–31 percentage points across five biologic-related domains. Post-activity performance reached approximately 78–82% for identifying appropriate candidates, selecting biologic therapy, assessing response, and adjusting treatment, despite lower baseline performance. Qualitative analysis revealed otolaryngologists frequently identify biologic-eligible patients but defer biologic initiation and long-term management to allergists or pulmonologists. This referral-dependent co-management model appears to be driven by administrative burden, insurance authorization requirements, infrastructure limitations, and uncertainty surrounding biologic efficacy and long-term therapy.

Conclusions: The additional steps between recognizing patients who may benefit from biologic therapy and initiating that treatment, can lead to delays in care. These findings suggest this model may be driven by largely modifiable implementation gaps, highlighting opportunities for targeted education and care-pathway optimization to support timely, integrated biologic management within ENT practice.