Current Utilization Patterns Research Articles

Meaning of the experience of breast cancer patients in a university clinic in Bogotá, Colombia: A qualitative study

To understand the meaning of the experiences of breast cancer patients undergoing diagnostic and treatment processes. A descriptive qualitative study based on the hermeneutic-interpretative scientific paradigm and grounded in a phenomenological epistemological framework. The study included women aged 18 years or older diagnosed with breast cancer and treated at a university clinic in Bogotá, who were given a semi-structured interview. Procedure: Semi-structured interviews were conducted based on pre-established categories. Aspects evaluated: Knowledge about current breast cancer screening and detection patterns, current utilization patterns of healthcare services, and perceived healthcare needs. Regarding Current knowledge patterns on breast cancer screening and detection, patients demonstrated limited awareness. Concerning Current utilization patterns of healthcare services, there were noted dissatisfactions with the administrative process. Regarding Perceived healthcare needs, a feeling of abandonment was identified, stemming from a lack of continuity in the care process. Additionally, two emergent categories were identified: trust in the healthcare system and predisposition to feelings of guilt due to a lack of knowledge about the disease. A comprehensive care process is needed that addresses the real medical needs of patients, beyond administrative concerns, and is focused on the quality of the doctor-patient relationship across the entire multidisciplinary team.

Genetic testing in cancer care: An assessment of current practice in Africa.

e13784 Background: Genetic testing provides forprecision oncologic intervention, improving outcomes and minimizing traditional cytotoxicity. It has caused a dramatic change in the oncology landscape but remains underutilized in Africa. Data on genetic alterations associated with cancer in people of African descent continue to be inadequate due to multi-layered factors such as availability and cost of testing, provider awareness and knowledge, and availability and cost of targeted therapy. With cancer projected to be the leading cause of mortality in Africa within the next two decades, identifying the current patterns of testing and reasons for low uptake is crucial for developing strategies to improve cancer care and outcomes in Africa. This study aimed to map the current utilization pattern of cancer genetic testing among oncologists in Africa. Methods: An online cross-sectional survey was administered to oncologists practicing in Africa. Responses were collected between September 2023 and January 2024 following IRB approval from the Lagos University Teaching Hospital Health Research and Ethics Committee. Surveys were administered in English and French. Results: 245 oncologists across 28 African countries participated in this study. The mean age of respondents was 41.6 (SD: 8.3), with 64.5% being male and Nigerians comprising the largest proportion (33.0%). The majority of respondents practice in public/government-owned facilities (44.1%), and 64.5% held consultant/attending positions. Survey findings showed that 69.8% of oncologists lacked confidence in understanding/interpreting genetic test results, 93.5% expressed the need for assistance in interpreting results, and 64.1% were unable to discuss findings confidently with patients. The most ordered test was BRCA1/2 (47.3%), while ABC and RB1 genes were the least commonly ordered (0.008% and 0.02%, respectively). The primary reason for ordering genetic tests (63.3%) was the potential to guide treatment planning. However, 54.7% reported not referring any patients for genetic testing in the past year. Barriers to testing included the high cost of tests (78%) and targeted therapies (60.4%). Furthermore, 67.8% of respondents lacked previous formal training in cancer genetics with nearly all respondents (97.6%) expressing interest in formal training and a preference for online courses (71.8%). Conclusions: This survey highlights the critical need to develop the capacity for understanding cancer genetic testing and targeted treatment options among oncologists in Africa. To optimize uptake, strategies must be developed to reduce testing costs through resource pooling and to reduce the high cost of targeted treatment. Oncologists should be encouraged to prioritize testing that guides actionable targets to promote the uptake of targeted treatment options in Africa.

Integrated optimization modelling framework for low-carbon and green regional transitions through resource-based industrial symbiosis

The development and utilization of bulk resources provide the basic material needs for industrial systems. However, most current resource utilization patterns are unsustainable, with low efficiencies and high carbon emissions. Here, we report a quantitative tool for resource-based industries to facilitate sustainable and low-carbon transitions within the regional economy. To evaluate the effectiveness of this tool, the saline Qinghai Lake region was chosen as a case study. After optimizing the industrial structure, the benefits of economic output, resource efficiency, energy consumption, solid waste reduction, and carbon emission reduction can be obtained. The scenario analyses exhibit disparities in different transition paths, where the carbon mitigation, economic output, and resource efficiency that benefit from optimal development paths are significantly better than those of the traditional path, indicating the urgency of adopting cleaner technology and industrial symbiosis for regional industries.

Drug utilization and prescribing pattern in the treatment of urolithiasis: a perspective on World Health Organization recommendations

Background: Drug utilization research (DUR) is essential in promoting rational use of medicine, aimed at understanding the patterns of prescription, administration, and utilization of medications. It provides valuable insights into the actual drug usage patterns for specific disease conditions. To evaluate the current utilization pattern of drugs in patients of urolithiasis in the Department of General Medicine and Surgery at Integral Institute of Medical Science and Research Hospital, Lucknow. Methods: Following the approval of the institutional ethics committee, a prospective observational study was conducted at Integral Institute of Medical Science and Research Department of general medicine and surgery over a six-month period. Urolithiasis patients’ prescriptions were analyzed to study the prescribing patterns. Information about patient demographics, co-morbidities, and the number and types of medications prescribed were collected and analyzed. Results: Out of 102 patients studied, a female preponderance over male patients was observed. The co-morbidities that are encountered most commonly were hydronephrosis, cystitis, and renal cyst. There is averaged 7 medicines per prescription, 15.25% of medicines written by the generic name, 83.33% of patients receiving antibiotics, 54.70% of patients receiving injections, and 83% of drugs prescribed are mentioned in the essential medicine list. Analgesics, antibiotics, nutritional supplements, antiemetic, alkalizing agents, and antispasmodics were among the class of medicines given. Conclusions: This study highlights the current use of medicines and drug utilization in urolithiasis management. The findings show important insights for healthcare professionals to enhance medication therapy, encourage cost-effective healthcare delivery and improve quality of patient in urolithiasis management.

Use of LCP-Tacrolimus (LCPT) in Kidney Transplantation: A Delphi Consensus Survey of Expert Clinicians.

BACKGROUND LCPT (Envarsus XR®) is a common once-daily, extended-release oral tacrolimus formulation used in kidney transplantation. However, there are minimal evidence-based recommendations regarding optimal dosing and treatment in the de novo and conversion settings. MATERIAL AND METHODS Using Delphi methodology, 12 kidney transplantation experts with LCPT experience reviewed available data to determine potential consensus topics. Key statements regarding LCPT use were generated and disseminated to the panel in an online Delphi survey. Statements were either accepted, revised, or rejected based on the level of consensus, perceived strength of evidence, and alignment with clinical practice. Consensus was defined a priori as ≥75% agreement. RESULTS Twenty-three statements were generated: 14 focused on de novo LCPT use and 9 on general administration or LCPT conversion use. After 2 rounds, consensus was achieved for 11/14 of the former and 7/9 of the latter statements. In a de novo setting, LCPT was recognized as a first-line option based on its safety and efficacy compared to immediate-release tacrolimus. In particular, African Americans and rapid metabolizer populations were identified as preferred for first-line LCPT therapy. In a conversion setting, full consensus was achieved for converting to LCPT to address neurological adverse effects related to immediate-release tacrolimus and for the time required (approximately 7 days) for steady-state LCPT trough levels to be reached. CONCLUSIONS When randomized clinical trials do not replicate current utilization patterns, the Delphi process can successfully generate consensus statements by expert clinicians to inform clinical decision-making for the use of LCPT in kidney transplant recipients.

The use and timing of angioembolization in pediatric blunt liver and spleen injury.

Nonoperative management (NOM) is the standard of care for the management of blunt liver and spleen injuries (BLSI) in the stable pediatric patient. Angiography with embolization (AE) is used as an adjunctive therapy in the management of adult BLSI patients, but it is rarely used in the pediatric population. In this planned secondary analysis, we describe the current utilization patterns of AE in the management of pediatric BLSI. After obtaining IRB approval at each center, cohort data was collected prospectively for children admitted with BLSI confirmed on CT at 10 Level I pediatric trauma centers (PTCs) throughout the United States from April 2013 to January 2016. All patients who underwent angiography with or without embolization for a BLSI were included in this analysis. Data collected included patient demographics, injury details, organ injured and grade of injury, CT finding specifics such as contrast blush, complications, failure of NOM, time to angiography and techniques for embolization. Data were collected for 1004 pediatric patients treated for BLSI over the study period, 30 (3.0%) of which underwent angiography with or without embolization for BLSI. Ten of the patients who underwent angiography for BLSI failed NOM. For patients with embolized splenic injuries, splenic salvage was 100%. Four of the nine patients undergoing embolization of the liver ultimately required an operative intervention, but only one patient required hepatorrhaphy and no patient required hepatectomy after AE. Few angiography studies were obtained early during hospitalization for BLSI, with only one patient undergoing angiography within 1 hour of arrival at the PTC, and 7 within 3 hours. Angioembolization is rarely used in the management of BLSI in pediatric trauma patients with blunt abdominal trauma and is generally used in a delayed fashion. However, when implemented, angioembolization is associated with 100% splenic salvage for splenic injuries. Therapeutic/Care Management; Level IV.

Administration and effects of beta blockers and oxandrolone in severely burned adults: a post hoc analysis of the RE-ENERGIZE trial.

Prospective randomized trials in severely burned children have shown the positive effects of oxandrolone (OX), beta blockers (BB) and a combination of the two (BBOX) on hypermetabolism, catabolism and hyperinflammation short- and long-term post-burn. Although data on severely burned adults are lacking in comparison, BB, OX and BBOX appear to be commonly employed in this patient population. In this study, we perform a secondary analysis of an international prospective randomized trial dataset to provide descriptive evidence regarding the current utilization patterns and potential treatment effects of OX, BB and BBOX. The RE-ENERGIZE (RandomizEd Trial of ENtERal Glutamine to minimIZE Thermal Injury, NCT00985205) trial included 1200 adult patients with severe burns. We stratified patients according to their receipt of OX, BB, BBOX or none of these drugs (None) during acute hospitalization. Descriptive statistics describe the details of drug therapy and unadjusted analyses identify predisposing factors for drug use per group. Association between OX, BB and BBOX and clinical outcomes such as time to discharge alive and 6-month mortality were modeled using adjusted multivariable Cox regressions. More than half of all patients in the trial received either OX (n = 138), BB (n = 293) or BBOX (n = 282), as opposed to None (n = 487, 40.6%). Per study site and geographical region, use of OX, BB and BBOX was highly variable. Predisposing factors for the use of OX, BB and BBOX included larger total body surface area (TBSA) burned, higher acute physiology and chronic health evaluation (APACHE) II scores on admission and younger patient age. After adjustment for multiple covariates, the use of OX was associated with a longer time to discharge alive [hazard ratio (HR) 0.62, confidence interval (CI) (0.47-0.82) per 100% increase, p = 0.001]. A higher proportion of days on BB was associated with lower in-hospital-mortality (HR: 0.5, CI 0.28-0.87, p = 0.015) and 6-month mortality (HR: 0.44, CI 0.24-0.82, p = 0.01). The use of OX, BB and BBOX is common within the adult burn patient population, with its use varying considerably across sites worldwide. Our findings found mixed associations between outcomes and the use of BB and OX in adult burn patients, with lower acute and 6-month-mortality with BB and longer times to discharge with OX. Further research into these pharmacological modulators of the pathophysiological response to severe burn injury is indicated.

Characteristics and Outcomes of Patients Receiving Sequential Bruton's Tyrosine Kinase Inhibitor (BTKi)/B-Cell Lymphoma 2 Inhibitor (BCL2i) for Treatment of Chronic Lymphocytic Leukemia (CLL) in the Real-World (rw) Practice Setting

Introduction: Bruton's Tyrosine Kinase inhibitors (BTKis) and B-cell lymphoma 2 inhibitors (BCL2is) are targeted agents that have proven to be particularly effective in treating chronic lymphocytic leukemia (CLL). It is critical to understand the current utilization patterns and outcomes of patients receiving these therapies in a sequential manner in the real-world (rw). This study explored patient characteristics and treatment outcomes for patients who were exposed to and discontinued treatment with BTKis and BCL2is in two consecutive lines of therapy (LOTs) for CLL. Methods: Patients were identified in the COTA rw database, a Health Insurance Portability and Accountability Act-compliant database comprised of longitudinal data abstracted from the electronic health records of healthcare provider sites in the United States. Eligible patients met the following study criteria: Aged ≥ 18 years at diagnosis with a confirmed CLL/ small lymphocytic lymphoma (SLL) diagnosis who initiated second line (2L) therapy between January 1, 2014 - June 30, 2021 and discontinued two consecutive LOTs for the analysis in question. The treatment groups assessed were (1) patients who were exposed to and discontinued treatment with BTKi and BCL2i therapies in sequential LOTs, regardless of which agent(s) was initiated first (“BTKi/BCL2i treatment” group) and (2) patients who completed treatment in the same two LOTs, but who did not receive BTKi and BCL2i therapies in both LOTs (“other” group). Other non-BTKi/BCL2i therapies received included bendamustine+rituximab, rituximab monotherapy, investigational regimens, chlorambucil+obinutuzumab, and other regimens. Patients were considered to have discontinued a given LOT if the patient had a documented end date for the LOT for any reason, including treatment completion as indicated or premature discontinuation for any reason (i.e., toxicity, progression, etc.). Patients were ineligible if they had a documented diagnosis of a concurrent primary malignancy or histologic transformation at the time of CLL/SLL diagnosis or a history of other primary malignancies, excluding benign skin cancers, within 3 years prior to CLL/SLL diagnosis. The index date for the study was the initiation of the second LOT in the sequence. The observation period was defined as the duration of time from index date to the date of patient death or last visit date (if date of death was not available). Time to next treatment (TTNT) and rw progression-free survival (rwPFS) were evaluated using the Kaplan-Meier method. Rw overall response rate (rwORR) was the proportion of patients who had a clinician-documented PR or CR as the best response to a LOT. Results: A total of 67 patients were identified to have been exposed to and discontinued a BTKi/BCL2i treatment sequence (1L→2L: N=21, 2L→3L: N=23, 3L+: N=23). The median age at diagnosis was 63 years (IQR: 55, 70), and patients were predominantly White (76%), male (67%), and treated in the community setting (81%). 67.2% of patients who completed two consecutive BTKi/BCL2i therapies were diagnosed in 2014 or earlier. Median follow up time from diagnosis was 112.6 months (IQR: 72.4, 149.4). Outcomes analysis was conducted for patients who received a BTKi/BCL2i treatment sequence in 1L→2L relative to patients in the other treatment group in the same LOTs. Patients in the BTKi/BCL2i treatment group in 1L→2L (N=21) had more favorable rwPFS (41.8 months, HR 0.46, 95% CI: 0.23-0.93) relative to patients in the other treatment group in 1L→2L (N=833, 23.4 months). Median TTNT and rwORR for patients in the BTKi/BCL2i treatment group were not reached (NR) and 81.0%, respectively. Patients in the other treatment group experienced median TTNT of 21.4 months and rwORR of 78.3%. Conclusions: Our findings indicate that patients treated with BTKi/BCL2i sequences in 1L and 2L may have experienced improved outcomes relative to patients who received other sequences in the same LOTs. While research is beginning to investigate characteristics and outcomes for patients who received these therapies consecutively (Lew et al., Blood Adv 2021), future research should further examine these outcomes in a larger patient population and in patients who have already discontinued and relapsed on both BTKis and BCL2is.

A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance.

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.

Current Patterns of Treatment and Outcomes in Advanced Melanoma at a Single Institution

IntroductionTreatment of advanced melanoma has been transformed by novel systemic therapies. The purpose of this study is to describe the current utilization patterns of immunotherapies with respect to survival outcomes in advanced melanoma. MethodsWe performed a retrospective cohort study of patients with Stage 3 and 4 melanoma at our institution (2009-2019). Primary outcomes included overall survival (OS) and progression free survival (PFS). Kaplan–Meier survival analysis and Cox proportional hazards regression analysis evaluated associations between covariates and survival outcomes. ResultsOf 244 patients, 5-y OS was 62.4%. Lymphovascular invasion (hazard ratio [HR] = 2.462, P = 0.030) was associated with shorter PFS whereas female gender (HR = 0.324, P = 0.010) was associated with longer PFS. Residual tumor (HR = 146, P = 0.006) and Stage 4 disease (HR = 3.349, P = 0.011) were associated with shorter OS. Use of immunotherapy increased from 2% to 23% over the study period, and use of neoadjuvant immunotherapy also increased up to 2016. Timing of immunotherapy administration was not significantly associated with survival. Of the 193 patients who received 2 or more treatment types, the most common treatment sequence was surgery followed by immunotherapy (n = 117, 60.6%). ConclusionsImmunotherapy is increasingly used for treatment of advanced melanoma. In this heterogeneous cohort, there was no significant association between timing of immunotherapy and survival outcomes.

Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications.

Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.

A Retrospective Review on Encephalitis in the University of Colorado Health Care System and a Proposed Diagnostic Approach (P8-10.005)

<h3>Objective:</h3> To define current diagnostic testing and resource utilization patterns for patients hospitalized with encephalitis. <h3>Background:</h3> In the US, encephalitis results in &gt;20,000 hospitalizations, over 1,000 deaths, and more than $2 billion in hospital charges yearly (Vora et al, 2014). Correctly and rapidly distinguishing between infectious and non-infectious causes of encephalitis is critical for early initiation of therapeutic interventions. A systematic, electronic medical record (EMR)-based diagnostic pathway may improve the accuracy and cost-effectiveness of diagnostic investigations in encephalitis. Here we present demographic, clinical and resource utilization data from patients hospitalized with encephalitis within a single, large hospital system over a twelve-month period. A proposed diagnostic pathway and prospective intervention study are additionally outlined. <h3>Design/Methods:</h3> This is a retrospective study identifying cases of encephalitis using ICD-10 codes from University of Colorado Hospital (UCH) system EMR for chart review. Cases identified within a 12-month period (01 June 2021 to 31 May 2022), are under review for analysis of key clinical and outcome measures. <h3>Results:</h3> A diagnosis of encephalitis was identified in 140 patients hospitalized during a twelve-month period preceding diagnostic pathway implementation. Patient ages ranged from 20 to 90 years (mean 57). There was equal division between sexes. 78% of patients were white, 14% were Black or African American, and 14% the race was unknown. All patients had a lumbar puncture performed. Magnetic resonance imaging of the brain was obtained for 43% of patients. Additional clinical and resource utilization data will be extracted and analyzed. <h3>Conclusions:</h3> The UCH system has a high volume of encephalitis cases accompanied by a high utilization of diagnostic testing. Analysis of clinical, outcome and resource utilization metrics may identify areas for improvement, allowing for rational design, implementation, and subsequent prospective study of an EMR-based diagnostic pathway to facilitate the rapid and cost-effective determination of encephalitis etiologies. <b>Disclosure:</b> Dr. Garza has nothing to disclose. Dr. Matthews has nothing to disclose. Dr. Sauer has nothing to disclose. Mr. Engebretson has nothing to disclose. Ms. Valdez has a non-compensated relationship as a Valdez with The Rocky Mountain MS Center non-profit partner that is relevant to AAN interests or activities. The institution of Stefan Sillau has received research support from Alzheimer’s Association. The institution of Stefan Sillau has received research support from Hewitt Family Foundation; State of Colorado. The institution of Stefan Sillau has received research support from PCORI. The institution of Stefan Sillau has received research support from NINR. The institution of Stefan Sillau has received research support from Michael J. Fox Foundation. The institution of Stefan Sillau has received research support from Department of Defense. The institution of Stefan Sillau has received research support from Colorado Department of Public Health and Environment. The institution of Stefan Sillau has received research support from Benign Essential Blepharospasm Research Foundation. Stefan Sillau has a non-compensated relationship as a Statistician with Novartis that is relevant to AAN interests or activities. Stefan Sillau has a non-compensated relationship as a Statistician with Biogen that is relevant to AAN interests or activities. Dr. Carlson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medscape. Dr. Carlson has received research support from Horizon Therapeutics. Dr. Carlson has a non-compensated relationship as a Health Service Subcommittee Member with American Academy of Neurology that is relevant to AAN interests or activities. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Novartis. The institution of Dr. Piquet has received research support from Abbvie. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP.

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications.

The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future.

There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

813: OPIOID AND SEDATIVE USE IN ADULT ICUS: ADULT IATROGENIC WITHDRAWAL STUDY IN THE ICU (ALERT-ICU)

Introduction: Iatrogenic withdrawal syndrome (IWS) is associated with large doses and prolonged use of opioids-sedatives. This study aimed to determine current utilization patterns of opioids-sedatives in adult ICUs that may be associated with IWS. We hypothesized that cumulative doses would increase with prolonged ICU stay. Methods: We conducted an international, observational, point prevalence study on a single date between June 1 and September 30, 2021 for adult ICU patients (≥ 18 years). Demographic data, medication exposures in the preceding 24 hours, and outcomes were collected following institutional ethics approval. The primary outcome was the proportion of patients receiving continuous parenteral opioids-sedatives for ≥ 72 hours. We defined continuous use as continuous IV infusion, scheduled intermittent injections, or as needed parenteral doses with at least half of the possible doses administered in 24 hours. Outcomes were compared between patients receiving opioids-sedatives < 72 and ≥ 72 hours. Parametric and nonparametric statistical analyses were performed using IBM SPSS Statistics version 28.0.0 (Armonk, New York) according to level of measurement, data distribution and assumptions. The a priori alpha was 5%. Results: There were 1506 patients who received parenteral opioids-sedatives in 229 ICUs at 87 hospitals in 11 countries. Median ICU stay was 6 (IQR; 12) days, 31% had ARDS, and 71% were invasively mechanically ventilated. Continuous opioids were administered to 50% (647/1305), sedatives to 52% (600/1151), and both to 37% (561/1506) of patients ≥ 72-hr, with 84% receiving continuous IV infusion opioids and 98% sedatives ≥ 72-hr (p< 0.001). All median 24-hr total opioid-sedative doses were significantly greater when used ≥ 72 hr. There was no difference in opioid-sedative dose reduction in the previous 24-hr, but significantly more patients on opioids-sedatives < 72-hr received > 50% dose reductions (61% vs. 38%; p< 0.001) and had enteral opioids-sedatives initiated in the previous 24-hr (24% vs. 15%; p< 0.001). Three of 9 patients assessed had IWS, all of whom received opioids-sedatives ≥ 72-hr. Conclusions: Half of adult ICU patients receive continuous parenteral opioids-sedatives for ≥ 72-hr at higher doses than earlier in admission, which may increase the risk of IWS.

Current Utilization Patterns of Glucagon-Like Peptide-1 Receptor Agonists

&#x0D; The real-world use of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), which are funded for type 2 diabetes mellitus (T2DM) across public drug plans in Canada, was analyzed to determine their current utilization patterns and estimate their suspected use outside of T2DM.&#x0D; Drug plan expenditures in this drug class have increased significantly in recent months and we wanted to assess the extent of the utilization that was “off reimbursement criteria” (i.e., use outside of T2DM) because these drugs have demonstrated efficacy in other conditions that are not currently publicly funded but have regulatory approval (e.g., weight management).&#x0D; Ozempic (semaglutide injection) is the dominant GLP-1 RA brand (&gt; 99% market share among public PT drug plans) and expenditures on it have accelerated. Expenditures on Ozempic have increased from $13.5 million in 2019 to $227 million in 2021.&#x0D; Increasing use of Ozempic can be partially attributed to non-T2DM claims. The proportion of claimants with suspected use outside of T2DM was 15% in Ontario and ranged from 0% to 8% across the other PT public drug plans; suspected use outside of T2DM is projected to be 1 in 5 claimants in Ontario in 2022. Among non-formulary claims (e.g., federal public plans, private insurance), this proportion ranged from 36% to 74% (data from 2021).&#x0D;

Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children's Hospitals in Punjab, Pakistan.

Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics.

Utilization of Cholinesterase Inhibitors for Alzheimer Disease in Canada

&#x0D; Due to upcoming Canadian market approvals of biologics for Alzheimer disease, a utilization study was conducted to assess the current utilization patterns and funding criteria for cholinesterase inhibitors (ChEIs) in selected Canadian jurisdictions from 2017 to 2020.&#x0D; Most jurisdictions list ChEIs as exception status, special authorization, or limited use drugs except Manitoba; as of 2018, Manitoba lists donepezil and galantamine as regular benefits and rivastigmine as an exception status drug. Additionally, British Columbia and New Brunswick fund galantamine and rivastigmine after a patient is deemed intolerant to donepezil.&#x0D; The following are insights from the utilization analysis.&#x0D; &#x0D; Across Canada, there has been a decrease in the number of beneficiaries and claims for all ChEIs from 2017 to 2020 in all jurisdictions except Manitoba:&#x0D; &#x0D; There was a 12% reduction in number of beneficiaries and a 17% reduction in the number of total claims from 2017 to 2020.&#x0D; In Manitoba, there was an increase in the number of ChEI beneficiaries that peaked in 2018, which corresponds to the formulary changes for donepezil and galantamine during this period.&#x0D; &#x0D; &#x0D; Across Canada, donepezil had the highest market share among all ChEIs each year from 2017 to 2020, which increased from 71.2% in 2017 to 75.8% in 2020. Galantamine had the second-highest market share each year. The market shares for both galantamine and rivastigmine decreased over time, indicating there is a preference for prescribing donepezil to patients with Alzheimer disease.&#x0D; &#x0D; The greater use of donepezil may be explained by prescriber preferences or coverage criteria for ChEIs (e.g., donepezil is considered first line in British Columbia and New Brunswick).&#x0D; &#x0D; &#x0D; The cumulative costs of all ChEIs paid for by public drug plans across Canada in 2020 was $20,659,136, a decrease of 43% from $36,325,781 in 2017, which corresponds with the decrease in the total number of ChEI beneficiaries.&#x0D; &#x0D; Donepezil had the highest national total costs, followed by galantamine, then rivastigmine, which corresponds to the market share for each of these drugs. However, on a cost-per-beneficiary basis, donepezil was associated with the lowest cost estimates in each year from 2017 to 2020.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

A Prospective Observational Study on Utilization of Oral Anti Diabetic Drugs at Tertiary Care Hospital

Diabetes mellitus is a metabolic disorder with a common denominator of hyperglycemia, arising from a variety of pathogenic mechanisms. The study aimed to evaluate the drug utilization pattern of anti-diabetic drugs in type 2 diabetic patients and to observe the efficacy associated with anti-diabetic therapy. A prospective observational study was carried out in diabetic patients visiting the department of general medicine in a tertiary care teaching hospital over six months. The patients diagnosed with Type 2 diabetes mellitus were identified, and all the demographic details, drug prescriptions, and clinical data of patients were collected and documented in a suitably designed case report form. Based upon the study criteria, 100 people were enrolled in the study. Among the majority of study subjects, 57% were female and 43% were males. The large numbers of diabetic patients were between the age group of 41- 60yrs. Hypertension was the most common comorbid condition. The prescription pattern showed that the majority of patients were prescribed dual therapy and about 48%, Metformin was largely prescribed anti-diabetic drug in all the prescriptions. Among combinations, metformin with glimepiride was frequently prescribed. The present study helped to find out current drug utilization patterns of oral anti-diabetic drugs with different comorbidities concerning diagnosis. Among all the anti-diabetic drugs, metformin was most commonly prescribed. In second-generation sulfonylureas, glimepiride was most commonly prescribed. The practice of metformin monotherapy is limited and it is frequently prescribed in combination with other anti-diabetic drugs. The study also highlights the need for comprehensive management of diabetic patients, including lifestyle changes, dietary control, hypoglycemic agents, cardiovascular prevention, treatment of complications, and comorbidity. Therefore, through the drug utilization patterns, attempts can be made to improve the quality and efficiency of drug therapy.

Associated comorbidities, healthcare utilization & mortality in hospitalized patients with haemophilia in the United States: Contemporary nationally representative estimates.

IntroductionCurrent in‐hospital burden and healthcare utilization patterns for persons with haemophilia (PWH) A and B, including both children (ages < 18 years) and adults (ages ≥ 18 years), in the United States (US) are lacking.AimTo evaluate healthcare utilization, the prevalence of comorbidities, and mortality in hospitalized paediatric and adult PWH using a contemporary nationally representative cohort.MethodsHospitalizations of PWH either as the primary reason for admission (principal diagnosis) or one of all listed diagnoses were identified using ICD‐10 codes from the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available all‐payer inpatient discharge database in the US. Sampling weights were applied to generate nationally representative estimates.ResultsThe contemporary cohort included 10,555 hospitalizations (paediatrics, 18.3%; adults, 81.7%) among PWH as one‐of‐all listed diagnoses (n = 1465 as principal diagnosis). Median age (interquartile range) was 46 (24–66) years overall; adults, 54 (35–70) years and paediatric, 4 (1–11). The most common comorbidities in adults were hypertension (33.4%), hyperlipidaemia (23.6%), and diabetes (21.1%). In children, hemarthrosis (11.4%), contusions (9.6%), and central line infections (9.3%) were the most common. The overall mortality rate was 2.3%. Median hospital charges per haemophilia admission were $52,616 ($24,303–$135,814) compared to $26,841 ($12,969–$54,568) for all‐cause admissions in NIS.ConclusionBleeding and catheter‐related infections are the significant reasons for paediatric haemophilia admissions. Adult haemophilia admissions tend to be associated with age‐related comorbidities. Costs for haemophilia‐related hospitalizations are higher than the national average for all‐cause hospitalizations.