Drug Dispensing Research Articles

Impacts of Chronic Obstructive Pulmonary Disease Care Pathway on Healthcare Utilization and Costs: A Matched Multiple Control Cohort Study in Saskatchewan, Canada

ObjectivesThis study aimed to evaluate the real-world impacts of a chronic obstructive pulmonary disease (COPD) care pathway program on healthcare utilization and costs in Saskatchewan, Canada. MethodsA difference-in-differences evaluation of a real-life deployment of a COPD care pathway, using patient-level administrative health data in Saskatchewan, was conducted. The intervention group (n = 759) included adults (35+ years) with spirometry-confirmed COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018 and March 31, 2019. The 2 control groups comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (n = 759) or Regina between April 1, 2015 and March 31, 2016 (n = 759) who did not participate in the care pathway. ResultsCompared with the individuals in the Saskatoon control groups, individuals in the COPD care pathway group had shorter inpatient hospital length of stay (average treatment effect on the treated [ATT] −0.46, 95% CI −0.88 to −0.04) but a higher number of general practitioner visits (ATT 1.46, 95% CI 1.14 to 1.79) and specialist physician visits (ATT 0.84, 95% CI 0.61 to 1.07). Regarding healthcare costs, individuals in the care pathway group had higher COPD-related specialist visit costs (ATT $81.70, 95% CI $59.45 to $103.96) but lower COPD-related outpatient drug dispensation costs (ATT −$4.81, 95% CI −$9.34 to −$0.27). ConclusionsThe care pathway reduced inpatient hospital length of stay, but increased general practitioner and specialist physician visits for COPD-related services within the first year of implementation.

The future of pharmacy: How AI is revolutionizing the industry

The application of Artificial Intelligence (AI) is rapidly transforming various industries, and the pharmaceutical industry is no exception. AI is increasingly being used to automate, optimize and personalize various aspects of the pharmacy industry, from drug discovery to drug dispensing. In this context, this paper explores the potential of AI to revolutionize the pharmacy industry, by discussing the current and future applications of AI in the industry. We will examine how AI is being used in drug discovery, personalized medicine, drug safety and quality control, inventory management, and patient counselling. We will also discuss the challenges and limitations of AI in the pharmacy industry, such as data privacy, ethical concerns and regulatory barriers. The paper will argue that AI has the potential to revolutionize the pharmacy industry by enabling faster drug discovery, improving patient outcomes, reducing costs, and increasing the efficiency and accuracy of various pharmacy operations. The old pharmacy system relied on manual processes and human decision-making, while the new AI pharmacy system automates routine tasks, provides personalized treatment plans, and reduces costs while improving patient outcomes. However, it is important to ensure that AI is used ethically and responsibly, and that its impact on the workforce and society is carefully considered. The major benefit of integrating AI into specific applications within the pharmacy field is improved accuracy and efficiency in patient care. Overall, this paper will provide an insight into the future of the pharmacy industry, and the transformative potential of AI in this field.

A Survey Based Study on Effect of Covid-19 on Indian Pharmacists using Chi-Square Approaches

Pharmacist is the health professionals which deal with dispensing of drugs, counseling of patients. Covid pandemic has effected in a drastic manner on the professional and personal aspects of l pharmacist’s life. In this study, Chi-square method is used to evaluate the effect of covid on pharmacists. It was observed that in spreading awareness and false perception regarding corona virus, the chi square value is chi (1,52) =59.49, p<0.001. Yes category dominated and difference between the two is 76%. In comparing, whether the the knowledge and study of pharmacy students get affected in this pandemic difference between both the values is 64% while the chi square value is chi (1,52)=42.18 P<0.0001 Yes category dominated and difference between the two is 64%. In comparing, whether the job prospective and importance of Pharmacist have been increased after this pandemic in health care sector difference between both the values is 28% while the chi square value is chi (1,52)=8.07 P=0.0045 yes category dominated and difference between the two is 28%.

Trends and Prevalence of Hospital Admissions Related to Deliberate Self-Poisoning and Used Substances in Romanian Adolescents between 2016 and 2022.

Rates of self-poisoning are increasing substantially all around the world, with self-poisoning being the most common form of self-harm leading to hospitalization in children and adolescents. This study aims to investigate the trends in the number of deliberate self-poisoning admissions in Romanian adolescents during the period of 2016-2022, as well as the most frequently used substances and the impact of the COVID-19 pandemic on hospital admissions due to self-poisoning and substance use in relation to these episodes. The sample included 178 patients admitted to the Clinic of Pediatric Psychiatry in Cluj-Napoca from 2016 to 2022 due to an episode of self-poisoning. Data were collected on patients' sociodemographic characteristics, psychosocial characteristics, and medical histories. We report a slight overall increase in the self-poisoning admission rate during the studied period. There was a decrease during the initial period of the pandemic, with significantly increasing rates in the second year of the pandemic. The mean prevalence rate of hospital admissions due to self-poisoning episodes during the study period was 3.14% (95% CI 2.72, 3.63). Adolescent girls were identified as the most vulnerable group, with the female-to-male ratio increasing dramatically. In terms of substance use, benzodiazepines; over-the-counter analgesics, including paracetamol; and antidepressants were the most frequently used substances. We emphasize the importance of careful consideration in prescribing psychotropic drugs, as well as the need for regulation of over-the-counter drug dispensation.

Disease pattern and satisfaction about health care services among patients attending a selected geriatric hospital in Dhaka city

Background: The proportion of elderly people is increasing at an unprecedented rate globally as well as in Bangladesh. Exploring the current situation it terms of magnitude and pattern of diseases suffered by elderly people would be a good resource for the policy makers in considering health care services and other supports for the elderly.
 Methods: A cross sectional descriptive study was done during January 2021 to December 2021 among elderly patients aged 60 years and above. A total of among 203 Patients form both indoor and outdoor department were included. A pretested questionnaire was used to collect the data collection. SPSS V23 software program were using analyzed data.
 Results: Among them 98 (48.25%) patients were suffering from communicable disease of which the most common (38.9%) was tuberculosis. On the other hands 201 patients were suffering from non- communicable disease of which the most common was Hypertension (HTN) (73.4%) followed by diabetes mellitus (DM) (36.5%), peptic ulcer (33%) and COPD (31%). The higher educated patients were significantly more dissatisfied compared to lower educated patients about drug dispensing (77.9% vs. 59.6%). Similarly, higher educated patients were significantly more dissatisfied compared to lower educated patients about nursing care (41.3% vs. 26.3%). The patients from urban area were significantly more dissatisfied compared to that of rural area about drug dispensing (76.7% vs. 58.6%).
 Conclusions: The study findings reveal that non-communicable diseases are the major bulk of diseases in elderly population in comparison to communicable diseases and HTN, DM, peptic ulcer, COPD were the common non-communicable diseases.

Pharmacist as Doctor’s Assistant – Prescription Less Drug Dispensation in A Rural Setting

Pharmacist as Doctor’s Assistant – Prescription Less Drug Dispensation in A Rural Setting

Pharmacist as Doctor’s Assistant – Prescription Less Drug Dispensation in An Urban Setting

Pharmacist as Doctor’s Assistant – Prescription Less Drug Dispensation in An Urban Setting

Drug Dispensing and Counselling: Challenges and Practices in Patient-Pharmacist Communication

The role of communication in healthcare is crucial, particularly when dealing with patients. Effective communication ensures that healthcare personnel can approach and deliver information to patients with the aim of improving their medical conditions. This study aimed to explore the practices and challenges encountered in patient-pharmacist communication and factors affecting it among pharmacists and Provisional Registered Pharmacists (PRPs) in a public hospital in Malaysia. A cross-sectional study was conducted, and a self-administered questionnaire was distributed to the pharmacists and PRPs working in various pharmacy departments in a district hospital in Peninsula Malaysia. The questionnaire consists of demographic information, challenges faced during patient-pharmacist communication, types of resources used to overcome communication barriers, communication difficulties and their communication practices. Descriptive statistics were used to analyse the data. The study found that most of the participants were young adults (21-30 years old), Malay, and held a bachelor’s degree in pharmacy. Most of them worked in the outpatient department and had between 2 to 5 years of work experience. The self-rated communication skills of most of the participants were good, and the majority expressed interest in attending communication-related workshops, seminars, or training. However, the study also identified some limitations, including language barriers and communication difficulties faced by the pharmacists and PRPs when dealing with patients with communication disabilities. Effective communication between pharmacists and patients is essential for providing pharmaceutical care and improving medication adherence. Therefore, efforts should be made to enhance communication skills among pharmacists and PRPs, including organizing more communication-related workshops, seminars, or training. Furthermore, addressing language barriers and communication difficulties in dealing with patients with communication disabilities is crucial. Overall, this study highlights the need to improve patient-pharmacist communication and identifies some of the challenges and opportunities to achieve this goal.

Prescription trends for preservative free glaucoma medication in a public health system.

To analyze the prescribing trends over a 7-years period, between 2013 and 2020, in a tertiary hospital (Hospital Clinico San Carlos, Madrid, Spain) and its health area. A retrospective study on the data collected from the information systems, "farm@web" and "Farmadrid", of glaucoma prescriptions in the framework of a public health system (Spanish National Health System) during the last seven years. Prostaglandin analogues were the most commonly used drugs in monotherapy during the study period (range: 36.82% - 47.07%). Fixed combinations of topical hypotensives had an upward trend since 2013 (range: 39.99% - 54.21%), becoming the most dispensed drugs in 2020 (48.99%). Preservative-free eye drops (lacking benzalkonium chloride, BAK) have displaced preservative containing topical treatments in all pharmacological groups. In 2013, BAK-preserved eye drops accounted for 91.1% of the total prescriptions, however in 2020 they only accounted for 34.2% of total prescriptions. The results of the present study highlight the current trend to avoid BAK-preserved eye drops for the treatment of glaucoma.

Risk of antidepressant initiation among users of cardiovascular agents and metformin. Findings from the Trøndelag Health Study (HUNT) and Norwegian Prescription Database (NorPD), Norway: Findings from the Trøndelag Health Study (HUNT) and Norwegian Prescription Database (NorPD), Norway.

Cardiovascular disease and diabetes are risk factors for depression, yet the relationship between the drug treatments for these diseases and the risk of antidepressant initiation remains unclear. This study aimed to examine possible associations between the use of angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEI), acetylsalicylic acid (ASA), beta-blockers (BB), calcium channel blockers (CCB), diuretics, or metformin and risk of antidepressant initiation. The Trøndelag Health Study (HUNT3), Norway, was linked to the Norwegian Prescription Database (NorPD). Participants with no prescriptions of cardiovascular agents, metformin, or antidepressants for at least 6 months before HUNT3 (baseline) were eligible and followed for 10 years. The exposure was the use of cardiovascular agents or metformin, defined as mono- or polytherapy from baseline to end of follow-up. The outcome was the initiation of antidepressant use, indicated by the first drug dispensation during the study period and expressed as hazard ratios (HRs) with 95% confidence intervals (CI). Among 20 227 adults aged 40-70 years at baseline, we observed different associations between cardiovascular agents or metformin and the risk of antidepressant initiation. ARBs or CCB monotherapy was associated with a lower risk of initiating antidepressant use (HR 0.70; 95%CI 0.56-0.88 and HR 0.81; 95%CI 0.61-1.06, respectively) compared to no use of any drugs included in the study (reference). Reduced risk of antidepressant initiation was among ASA or statin polytherapy users, whereas there was a small increased risk among participants on ASA monotherapy. In contrast, there was no statistical evidence of associations between ACEI, BB, diuretics, or metformin and increased or decreased risk of antidepressant initiation. Our mixed findings indicate the possibility that some cardiovascular agents may be associated with a reduced risk of initiating antidepressant use while others may not. However, bias due to the limitations of the study design is possible.

The Effect of Biological Treatment on Stress Parameters Determined in Saliva in Patients with Severe Psoriasis.

Background and objectives: In psoriatic patients, stress is the most common aggravating factor. Despite the use of quality-of-life assessment questionnaires, diagnosing stress in psoriatic patients is not a flawless procedure. This study aimed to assess the usefulness of potential stress biomarkers in saliva for monitoring the treatment of psoriasis. Materials and methods: A total of 104 adult patients with severe psoriasis were included and randomly treated via biological treatment or symptomatic therapy: 84 received biological treatment, with 20 formed a control group receiving symptomatic therapy. The administered biological treatment was adalimumab, whilst in controls calcipotriol/betamethasone dipropionate topical gel and emollients were used. Patients were monitored monthly with a dermatological examination and the dispensing of a biological drug. During each of the four visits, the severity of the disease was assessed (PASI, BSA, and DLQI), and a sample of the patient's saliva was taken. In all the participants, the saliva concentrations of immunoglobulin A (sIgA), α-amylase (sAA), and chromogranin A (CgA) were measured. Results: The majority of patients in both the study and control groups achieved clinical improvement, though favoring the group receiving biological treatment. The concentration of sIgA in the saliva was constantly increasing in the study group during subsequent visits (Fr = 27.26; p < 0.001). Meanwhile, there were no statistically significant changes in the control group during the same follow-up period (Fr = 6.66; p = 0.084). Levels of sAA underwent statistically significant changes in both groups (Fr = 58.02; p < 0.001-study group and Fr = 13.74; p = 0.003-control group). In the study group, a steady, statistically significant increase in sAA was observed from the first to the third visit. In the study group, a downward trend in CgA concentration was observed. In the control group, no significant differences in the level of CgA were obtained. Conclusions: sIgA, sAA, and CgA are potential markers of the severity of psoriasis and the associated stress reaction. Based on the presented observations, only sIgA and CgA seem to be valuable biomarkers for monitoring the effectiveness of the systemic treatment of psoriasis.

Evaluating attitudes, behaviors, and relevant factors in dispensing antibiotics without prescription by pharmacies: a cross-sectional study in Vietnam.

To standardize a questionnaire about drug dispensers' attitudes and behaviors in dispensing antibiotics without prescription, and to evaluate drug dispensers' attitudes, behaviors, and relevant factors in dispensing antibiotics without prescription at community pharmacies in Can Tho City, Vietnam. A descriptive cross-sectional study was conducted among community pharmacists in Can Tho City, Vietnam from June to December 2022. A self-administered questionnaire designed according to the Theory of Planned Behavior was used for data collection. The questionnaire was composed of 33 statements scored on the 5-point Likert scale, which was completed by interviews with 180 pharmacy dispensers to Can Tho. Exploratory Factor Analysis was also utilized to uncover major determinants of dispensing antibiotics without prescription. Of the 180 participants, 65% of drug dispensers were female (n=117), 59.4% were university graduates (n= 107), and 80.6% had experience of less than 10 years (n=145). A pharmacy is the first destination people think about when they have a health issue. Unfortunately, dispensing antibiotics without a valid prescription is not in compliance with governmental regulations. In the study, perceived behavioral control factors were found to be the most critical determinants of the behavior, followed by subjective norms. By contrast, attitudinal factors presented no impact on intention to dispensing antibiotics without prescription. The provision of non-prescription is primarily influenced by the perception of the distributors and external factors. Developing interventions is necessary to increase public awareness of the misuse and misunderstanding of antibiotics.

Non-toxic and biodegradable κ-carrageenan/ZnO hydrogel for adsorptive removal of norfloxacin: Optimization using response surface methodology

Antibiotic resistance is increasing globally due to increased prescription and easy dispensing of antibiotic drugs universally. Hence, to mitigate this effect, efficient, biodegradable, and non-toxic adsorbents are required to be developed. Carrageenan (CG), a natural polymer, having multiple functional groups, provides a backbone for crosslinking with borax and incorporation of ZnO nanoparticles that formed borax-cross-linked κ-carrageenan (CG/Bx/ZnO) hydrogel which is used for efficient adsorption of norfloxacin from water. Surface morphology of as-synthesized hydrogel revealed the rough surface, which was determined by FESEM. Surface area of CG/Bx/ZnO hydrogel was found to be 22.90 m2/g with 3.41 nm pore radius. Systematic batch adsorption studies revealed that 99.4 % removal efficiency could be achieved at a dosage level of 20 mg/L of norfloxacin with 10 mg of hydrogel at pH of 4 in 8 h at room temperature. Experimentally optimized key parameters affecting the overall efficiency of adsorption matched well with the results assessed from ANOVA using Box-Behnken composite design model. The adsorption process was well fitted with the pseudo-second-order model and Langmuir isotherm with 1282.05 mg/g adsorption capacity. Thermodynamic study results show that adsorption is spontaneous and endothermic. The CG/Bx/ZnO hydrogel demonstrated excellent repeatability with minimal loss in norfloxacin adsorption for seven cycles.

Favorable Impact of Community Adherence Support Groups on Retention in Care and Viral Suppression Rates Among Persons with HIV Receiving Antiretroviral Therapy in Mozambique.

The community adherence support group (CASG) was one of the first differentiated service delivery (DSD) models introduced in Mozambique. This study assessed the impact of this model on retention in care, loss to follow-up (LTFU), and viral suppression among antiretroviral therapy (ART)-treated adults in Mozambique. A retrospective cohort study included CASG-eligible adults enrolled between April 2012 and October 2017 at 123 health facilities in Zambézia Province. Propensity score matching (1:1 ratio) was used to allocate CASG members and those who never enrolled in a CASG. Logistic regressions were performed to estimate the impact of CASG membership on 6- and 12-month retention and viral load (VL) suppression. Cox proportional regression was used to model differences in LTFU. Data from 26,858 patients were included. The median age at CASG eligibility was 32 years and 75% were female, with 84% residing in rural areas. A total of 93% and 90% of CASG members were retained in care at 6 and 12 months, respectively, while 77% and 66% non-CASG members were retained during the same periods. The odds of being retained in care at 6 and 12 months were significantly higher among patients receiving ART through CASG support (adjusted odds ratio [aOR] = 4.19 [95% confidence interval; CI: 3.79-4.63], p < .001, and aOR = 4.43 [95% CI: 4.01-4.90], p < .001, respectively). Among 7,674 patients with available VL measurements, the odds of being virally suppressed were higher among CASG members (aOR = 1.14 [95% CI: 1.02-1.28], p < .001). Non-CASG members had a significantly higher likelihood of being LTFU (adjusted hazard ratio = 3.45 [95% CI: 3.20-3.73], p < .001). While Mozambique rapidly scales up multi-month drug dispensation as the preferred DSD model, this study emphasizes the continued importance of CASG as an efficacious DSD alternative, especially among patients residing in rural areas, where CASG acceptability is higher.

Post-COVID condition: dispensation of drugs and diagnostic tests as proxies of healthcare impact.

With the goal to increase knowledge on the healthcare impact of the post-COVID-19 condition we exploited the administrative claims database of Lombardy, the largest Italian region and the first after China to be heavily hit by the SARS-CoV-2 pandemic in February-May 2020. We chose to employ the dispensation of drugs and diagnostic tests as proxies of the impact of the post-COVID condition in 46,574 cases who recovered from COVID-19 and were negative at PCR testing within June 20, 2020. Data were obtained throughout the 18-month post-negativization period until December 2021 and results on the use of drugs and diagnostic tests were compared with those accrued in the same cases during the pre-COVID period in July-December 2019. After an increase in the first semester after SARS-CoV-2 negativization (July-December 2020), trends in the dispensation of drugs according to the broad ATC classes and of diagnostic tests decreased or remained substantially stable. However, dispensation of drugs for acid related disorders (A02), diabetes (A10), heparins (B01AB), direct oral anticoagulants (B01AP), antipsychotics (N05A), antidepressants (N06A) and for obstructive airways diseases (R03) was still higher than in the pre-COVID period. These findings, based upon drug and diagnostic test dispensation as proxies of the healthcare impact of the post-COVID condition, show that in a substantial proportion of recovered cases the post-COVID condition is active and clinically relevant 18months after the acute disease. The findings also provide indirect evidence of the body organs and systems more compromised in the post-COVID period.

Client Satisfaction regarding Drug Dispensing Services in Tertiary Public Hospital during COVID-19 Pandemic

Background: Client satisfaction is the degree of positive feeling that patients or clients having used a service. It indicates also the gap between quality-of-service expectation and the actual experience of the service provided from the patients’ point of view. Patient satisfaction has become an integral component of the quality of health care services. Objective: This study was conducted to assess the client satisfaction regarding drug dispensing services in tertiary public hospital during COVID-19 pandemic Methods &amp; materials: The study was a cross-sectional study, which was conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from January to December 2021. The study includedpurposively selected 407patients who were received prescribing drugs according to prescription in selected hospital. Data were collected by face-to-face interview with a pretested, semi- structured questionnaire and data were analyzed by current Statistical Package for Social Sciences (SPSS) 25 version. Associations of the categorical data were assessed by using Chi-square (x2) test. Prior to data collection, informed written consent was taken from each patient. Results: The study revealed that males (44%) and females (56%) were portion with mean age of 33.71 years. Among 407 respondents, 89.4% (364) were dissatisfied and only 10.6% (43) of the respondents were satisfied with staff explanation on medication side effect, maximum 85% (346) of the respondents were dissatisfied and only 15% (61) of the respondents were satisfied with given counseling to proper storage of medication by the pharmacy staff, 76.9% (313) of the respondents were dissatisfied for attention during drugs supply and only 23.1% (94) of the respondents were satisfied for attention during drugs supply from pharmacy staff. Maximum 70.8% (288) of the respondents were satisfied and only 29.2% (119) of the respondents were dissatisfied for the medication storage of the dispensary. Mostly 98.5% (401) of the respondents were satisfied with labeling and packaging and rest of the 1.5% (6) of the respondents were dissatisfied and 61%, (247) of the respondents were dissatisfied with availability of required medicine and only 39% (160) of the respondents were satisfied on availability of necessary medicine in dispensary. Among 407 respondents, almost all of them around 91.9% (374), of the respondents were satisfied for wearing mask in the COVID-19 pandemic and minimum only 8.1% (33) of the respondents were dissatisfied for wearing mask in the COVID-19, around 91.9% (374) of the respondents were satisfied and only 8.1% (33) of the respondents were dissatisfied for not maintain etiquette of coughing and sneezing courtesy during drug dispensing by another person. The overall satisfactions among the total respondents were, 66.1% (269) respondents satisfied 33.9% (138) of the respondents were dissatisfied for overall satisfaction during drug dispensing. Conclusion: In conclusion, this study showed that the overall mean satisfaction level of clients of the outpatient’s pharmacy was average. Many of the clients described pharmacist as polite and just about half the patients rated the pharmaceutical service as good.

Recurrence of hypertensive disorders of pregnancy: results from a nationwide prospective cohort study (CONCEPTION).

To assess the risk of gestational hypertension (GH) and pre-eclampsia (PE) during a second pregnancy after occurrence during a first pregnancy. Prospective cohort study. CONCEPTION is a French nationwide cohort study that used data from the National Health Data System (SNDS) database. We included all women who gave birth for the first time in France in 2010-2018 and who subsequently gave birth. We identified GH and PE through hospital diagnoses and the dispensing of anti-hypertensive drugs. The incidence rate ratios (IRR) of all hypertensive disorder of pregnancy (HDP) during the second pregnancy were estimated using Poisson models adjusted for confounding. Incidence rate ratios of HDP during the second pregnancy. Of the 2 829 274 women included, 238 506 (8.4%) were diagnosed with HDP during their first pregnancy. In women with GH during their first pregnancy, 11.3% (IRR 4.5, 95% confidence interval [CI]4.4-4.7) and 3.4% (IRR5.0, 95% CI 4.8-5.3) developed GH and PE during their second pregnancy, respectively. In women with PE during their first pregnancy, 7.4% (IRR 2.6, 95% CI 2.5-2.7) and 14.7% (IRR 14.3, 95% CI 13.6-15.0) developed GH and PE during their second pregnancy, respectively. The more severe and earlier the PE during the first pregnancy, the stronger the likelihood of having PE during the second pregnancy. Maternal age, social deprivation, obesity, diabetes and chronic hypertension were all associated with PE recurrence. These results can guide policymaking that focuses on improving counselling for women who wish to become pregnant more than once, by identifying those who would benefit more from tailored management of modifiable risk factors, and heightened surveillance during post-first pregnancies.

Testing of Coding Algorithms for Inflammatory Bowel Disease Identification, as Indication for Use of Biological Drugs, Using a Claims Database from Southern Italy.

Inflammatory bowel diseases (IBDs), Crohn's disease (CD) and ulcerative colitis (UC), are chronic diseases that have been increasingly treated with biological drugs in recent years. Newly developed coding algorithms for IBD identification using claims databases are needed to improve post-marketing surveillance of biological drugs. To test algorithms to identify CD and UC, as indication for use of biological drugs approved for IBD treatment, using a claims database. Data were extracted from the Caserta Local Health Unit database between 2015 and 2018. CD/UC diagnoses reported by specialists in electronic therapeutic plans (ETPs) were considered as gold standard. Five algorithms were developed based on ICD-9-CM codes as primary cause of hospital admissions, exemption from healthcare service co-payment codes and drugs dispensing with only indication for CD/UC. The accuracy was assessed by sensitivity (Se), specificity (Sp), positive (PPV) and negative predicted values (NPV) along with computation of the Youden Index and F-score. In the study period, 1205 subjects received at least one biological drug dispensing approved for IBD and 134 (11.1%) received ≥1 ETP with IBD as use indication. Patients with CD and CU were 83 (61.9%) and 51 (38.1%), respectively. Sensitivity of the different algorithms ranged from 71.1% (95% CI: 60.1-80.5) to 98.8 (95% CI: 93.5-100.0) for CD and from 64.7% (95% CI: 50.1-77.6) to 94.1 (95% CI: 83.8-98.8) for UC, while specificity was always higher than 91%. The best CD algorithm was "Algorithm 3", based on hospital CD diagnosis code OR CD exemption code OR [IBD exemption code AND dispensing of non-biological drugs with only CD indication] (Se: 98.8%; Sp: 97.2%; PPV: 84.5%, NPV: 99.8%), achieving the highest diagnostic accuracy (Youden Index=0.960). The best UC algorithm was "Algorithm 3", based on specific hospital UC diagnosis code OR UC exemption code OR [IBD exemption code AND golimumab dispensing] OR dispensing of non-biological drugs with only UC indication (Se: 94.1%; Sp: 91.6%; PPV: 50.0%; NPV: 99.4%), and achieving the highest diagnostic accuracy (Youden Index=0.857). In a population-based claims database, newly coding algorithms including diagnostic and exemption codes plus specific drug dispensing yielded highly accurate identification of CD and UC as distinct indication for biological drug use.

Abstract P642: Assessment of Health Literacy in Colombia: A First Step for a Cardiovascular Education Program for the Community

Introduction: Adequate health literacy enables patients and caregivers to make appropriate decisions and achieve better health outcomes. However, much information about health literacy comes from developed and English-speaking countries. There is very little information about health literacy levels in countries such as Colombia and these data, therefore, cannot be used as an input in the development of cardiovascular education programs for the community. Our objective was to optimize and adapt the Spanish validation of the short version of the Test of Functional Health Literacy in adults (s-TOFHLA) to the context of the Colombian health system. This test was chosen because its multiple questions and sections can guide the skills that should be emphasized in a health education course for patients and caregivers (i.e. navigation in the health care system, interpretation of medical instructions, understanding of doses and forms of drug dispensing). This test consists of two parts: numerical and reading comprehension (Readings A and B). The TOFHLA is graded using a score between 1 and 100 points, which classifies the participant into categories of adequate, marginal or inadequate health literacy. Methods: The validation process was carried out in the following steps 1) cultural and language adaptation, 2) expert consensus (n=7), 3) a cognitive survey (n=10), 4) piloting (n=40), and 5) application in the community (n=148). The study was conducted in 6 cities, from 5 departments (equivalent to an state) in Colombia. Results: In the piloting (n=40) Cronbach's α was 0.76 for numerical comprehension, 0.58 for reading A, and 0.95 for reading B. In the broader sample (n=148) the Cronbach's α for numerical comprehension, reading A and reading B was 0.84, 0.89, and 0.95, respectively. Most of the sample had an adequate level of literacy (77.1%), however, the percentages in the marginal (6%) and inadequate (16.7%) categories can still be considered high. Health literacy levels are lower in people with the lowest level of schooling and socioeconomic strata. In addition, there seem to be differences between urban and rural populations. No differences have been observed according to the sex of the participants. Conclusions: It is critical to assess health literacy with instruments that have been adequately validated and adapted to the conditions of each health system. This process requires the participation of health and language experts. The piloting and cognitive surveys provide a good idea of how communities interpret psychometric tests. Our results confirm differences in health literacy among populations with different levels of income and schooling. Health literacy assessment can guide the instructional design of community-directed health education programs.

Data-Driven Assessment of Adolescents’ Mental Health During the COVID-19 Pandemic

Adolescents' mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents' mental health outcomes based on electronic health records (EHR). A retrospective cohort study utilizing the computerized database of a 2.5 million members' state-mandated health organization in Israel. Rates of mental health diagnoses, and psychiatric drug dispensations were measured among adolescents aged 12-17 with and without pre-existing mental history, for 2017-2021 years. Relative risks were computed between the years and interrupted time series (ITS) analysis evaluated changes in monthly incidence rates of psychiatric outcomes. Average population size was 218,146 in 2021. During the COVID-19 period a 36% increase was observed in the incidence of depression (95%CI: 25-47), 31% in anxiety (95%CI: 23-39), 20% in stress (95%CI: 13-27), 50% in eating disorders (95%CI: 35-67), 25% in antidepressants (95%CI: 25-33) and 28% in antipsychotics (95%CI: 18-40). A decreased rate of 26% (95% CI: 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, females, general secular Jewish population, medium-high SES, and 14-15 years age group. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to previous years. This real-world study highlights the deterioration of adolescents' mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making.