Prescribing In Primary Care Research Articles

Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders. The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs. A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data. Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties. The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Risk-stratified monitoring for sulfasalazine toxicity: prognostic model development and validation

BackgroundSulfasalazine-induced cytopenia, nephrotoxicity and hepatotoxicity is uncommon during long-term treatment. Some guidelines recommend 3 monthly monitoring blood tests indefinitely during long-term treatment while others recommend stopping monitoring after 1 year....

Evaluation of an automated feedback intervention to improve antibiotic prescribing among primary care physicians (OPEN Stewardship): a multinational controlled interrupted time-series study.

Tools to advance antimicrobial stewardship in the primary health care setting, where most antimicrobials are prescribed, are urgently needed. The aim of this study was to evaluate OPEN Stewarship (Online Platform for Expanding aNtibiotic Stewardship), an automated feedback intervention, among a cohort of primary care physicians. We performed a controlled, interrupted time-series study of 32 intervention and 725 control participants, consisting of primary care physicians from Ontario, Canada and Southern Israel, from October 2020 to December 2021. Intervention participants received three personalized feedback reports targeting several aspects of antibiotic prescribing. Study outcomes (overall prescribing rate, prescribing rate for viral respiratory conditions, prescribing rate for acute sinusitis, and mean duration of therapy) were evaluated using multilevel regression models. We observed a decrease in the mean duration of antibiotic therapy (IRR = 0.94; 95% CI: 0.90, 0.99) in intervention participants during the intervention period. We did not observe a significant decline in overall antibiotic prescribing (OR = 1.01; 95% CI: 0.94, 1.07), prescribing for viral respiratory conditions (OR = 0.87; 95% CI: 0.73, 1.03), or prescribing for acute sinusitis (OR = 0.85; 95% CI: 0.67, 1.07). In this antimicrobial stewardship intervention among primary care physicians, we observed shorter durations of therapy per antibiotic prescription during the intervention period. The COVID-19 pandemic may have hampered recruitment; a dramatic reduction in antibiotic prescribing rates in the months before our intervention may have made physicians less amenable to further reductions in prescribing, limiting the generalizability of the estimates obtained.IMPORTANCEAntibiotic overprescribing contributes to antibiotic resistance, a major threat to our ability to treat infections. We developed the OPEN Stewardship (Online Platform for Expanding aNtibiotic Stewardship) platform to provide automated feedback on antibiotic prescribing in primary care, where most antibiotics for human use are prescribed but where the resources to improve antibiotic prescribing are limited. We evaluated the platform among a cohort of primary care physicians from Ontario, Canada and Southern Israel from October 2020 to December 2021. The results showed that physicians who received personalized feedback reports prescribed shorter courses of antibiotics compared to controls, although they did not write fewer antibiotic prescriptions. While the COVID-19 pandemic presented logistical and analytical challenges, our study suggests that our intervention meaningfully improved an important aspect of antibiotic prescribing. The OPEN Stewardship platform stands as an automated, scalable intervention for improving antibiotic prescribing in primary care, where needs are diverse and technical capacity is limited.

Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer. Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups. Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19). Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.

TO EVALUATE THE PREVALENCE OF ANTISECRETORY MEDICATION USE AMONG HOSPITALIZED PATIENTS IN SURGERY WARD

Antisecretory medicines are often administered to patients in hospitals. However, there is currently limited knowledge on the comprehensive utilization of these treatments in the hospital environment. Aim: To assess the suitability of Antisecretory treatment in a major educational medical facility in western India, and the consequences of hospital prescriptions in primary care. Methods: The administration of antisecretory drugs was observed for a duration of one month in adult patients who were sequentially admitted to K.J Somaiya Medical College and Hospital. This was done by examining their medical records. Results: Out of the 800 patients that were admitted to the hospital, 46.8% of them were prescribed Antisecretory treatment. Ranitidine had the highest usage rate at 44.4%, followed by pantoprazole at 31.8% and omeprazole at 23.0%. Stress ulcer prophylaxis and prevention of non-steroidal anti-inflammatory drug-induced ulcer were the reasons for usage in 60.4% of cases. In all, 68% of prescriptions were deemed inappropriate based on consensus evaluation. Among patients who received unneeded preventive medication during their hospital stay, 56.4% were released while still on therapy, and 46% continued to receive the treatment three months later. Conclusions: There is excessive utilization of Antisecretory medications in patients who are admitted to the hospital. The majority of incorrect hospital prescriptions are to the administration of ulcer prevention in patients who have a low risk of developing ulcers. This over utilization may also encourage improper medication usage in the field of general medicine. KEYWORDS: Antisecretory medication, H2-receptor antagonists (H2RAs), proton pump inhibitors, Hospital

Building digital solutions to support brain health prescribing in primary care: Where to begin?

National and international policy goals on healthy ageing and dementia risk reduction are yet to be fully realised in community healthcare settings. Disease modification strategies through lifestyle and social interventions are viable, evidence-based solutions to reduce age-related disease burden. However, prescribing lifestyle interventions targeting dementia risk in primary care remains deficient. Using digital technologies to support older individuals and healthcare professionals through formal health checks and lifestyle management is likely to enable shared understanding and consequences of personalized care and treatment options. These tailored solutions may bridge the translation gap and support healthy ageing.

Acute and long-term outcomes of SARS-CoV-2 infection in school-aged children in England: Study protocol for the joint analysis of the COVID-19 schools infection survey (SIS) and the COVID-19 mapping and mitigation in schools (CoMMinS) study.

The symptom profiles of acute SARS-CoV-2 infection and long-COVID in children and young people (CYP), risk factors, and associated healthcare needs, are poorly defined. The Schools Infection Survey 1 (SIS-1) was a nationwide study of SARS-CoV-2 infection in primary and secondary schools in England during the 2020/21 school year. The Covid-19 Mapping and Mitigation in Schools (CoMMinS) study was conducted in schools in the Bristol area over a similar period. Both studies conducted testing to identify current and previous SARS-CoV-2 infection, and recorded symptoms and school attendance. These research data have been linked to routine electronic health record (EHR) data. To better understand the short- and long-term consequences of SARS-CoV-2 infection, and their risk factors, in CYP. Retrospective cohort and nested case-control analyses will be conducted for SIS-1 and CoMMinS data linked to EHR data for the association between (1) acute symptomatic SARS-CoV-2 infection and risk factors; (2) SARS-CoV-2 infection and long-term effects on health: (a) persistent symptoms; (b) any new diagnosis; (c) a new prescription in primary care; (d) health service attendance; (e) a high rate of school absence. Our study will improve understanding of long-COVID in CYP by characterising the trajectory of long-COVID in CYP in terms of things like symptoms and diagnoses of conditions. The research will inform which groups of CYP are more likely to get acute- and long-term outcomes of SARS-CoV-2 infection, and patterns of related healthcare-seeking behaviour, relevant for healthcare service planning. Digested information will be produced for affected families, doctors, schools, and the public, as appropriate. Linked SIS-1 and CoMMinS data represent a unique and rich resource for understanding the impact of SARS-CoV-2 infection on children's health, benefiting from enhanced SARS-CoV-2 testing and ability to assess a wide range of outcomes.

Exercise prescription for the prevention and treatment of chronic diseases in primary care: Protocol of the RedExAP study.

Existing evidence supports the effectiveness of exercise in preventing and treating chronic diseases, yet its integration into clinical practice remains limited. This study protocol aims to address the evidence-practice gap by exploring barriers to exercise prescription in primary care and developing a clinical practice guideline (CPG). Employing a qualitative approach, focus groups will be conducted to investigate primary care professionals' challenges in prescribing exercise and patients' adherence to recommendations. Phenomenological analysis will facilitate data interpretation. Data triangulation, expert analysis, and quality criteria will ensure study reliability. The CPG development process is outlined, emphasizing transdisciplinary collaboration and patient involvement. The RedExAP study responds to the imperative for evidence-based exercise integration in primary care. The study's combined qualitative exploration and CPG development present the potential to improve health outcomes and cost-effectiveness. By elucidating primary care professionals' and patients' perspectives, the study contributes to enhancing exercise prescription adoption. The innovative transdisciplinary approach aligns with the 2030 Agenda, promoting better population health and greater social well-being, showing promise in alleviating chronic disease burdens. This study's findings lay the groundwork for advancing evidence-based exercise interventions within primary care to transform chronic disease management.

PRESCRIPTION PERILS: SAFEGUARDING PATIENT WELFARE THROUGH ENHANCED ELECTRONIC PRESCRIBING PROTOCOLS IN PRIMARY HEALTH CARE

As electronic prescribing becomes ubiquitous in primary health care settings, the imperative to ensure patient safety is paramount. This paper delves into the potential hazards associated with electronic prescribing systems and proposes enhanced protocols to mitigate medication errors. The discussion encompasses the intricate landscape of electronic prescription processes, identifying vulnerabilities that may compromise patient welfare. Through an analysis of current practices, this paper outlines proactive measures and improved guidelines aimed at fortifying the electronic prescribing framework. By emphasizing the importance of a comprehensive approach to medication safety, this research contributes to the ongoing dialogue surrounding electronic prescribing in primary health care.

Improving prescribing and patient safety in primary care

Professor Tony Avery OBE is a GP, National Clinical Director for Prescribing and Professor of Primary Health Care at the University of Nottingham. Here, he speaks to Joy Ogden about how his clinical practice and research on improving prescribing safety in primary care complement his leadership role in the implementation of the National Overprescribing Review.

Trends in antibiotic prescribing in primary care out-of-hours doctors' services in Ireland.

Infections are a common reason for patient consultation in out-of-hours (OOH) doctors' services. Surveillance of antibiotic prescribing in OOH settings is important to develop tailored antimicrobial stewardship (AMS) interventions. To evaluate antibiotic prescribing patterns in OOH services in the Cork Kerry region, Ireland to inform future AMS interventions. A retrospective, observational cohort study was conducted of all oral antibiotic prescriptions in OOH doctors' consultations between 1 December 2019 and 31 December 2021 in the region. Data were gathered on age, gender, date and time of consultation, consultation method (in person, remote), antibiotic and its indication. Data were analysed using Microsoft Excel v.2018 and SPSS v.28. Overall, 17% (69 017 of 406 812) of the OOH doctors' consultations resulted in an antibiotic prescription during the study period. This varied from 31% of OOH consultations in December 2019 to less than 2% of OOH consultations in April 2020. Of the antibiotics prescribed, 21% were for children under 6 years old. Respiratory tract infections (RTIs) were the most common indication for antibiotics (59%). Amoxicillin was the most commonly prescribed antibiotic (40% of all prescriptions). Red (reserved) antibiotics accounted for 19% of all prescriptions. During the COVID-19 pandemic period of the study, 66% of 49 421 of antibiotic prescriptions were issued from remote consultations. Low antibiotic prescribing levels during the early stages of the pandemic were not sustained. Antibiotic prescriptions from remote consultations were common. A key opportunity for AMS is addressing the volume of antibiotic prescribing for RTIs, particularly in children.

Los colirios antibióticos acortan la duración de las conjuntivitis infecciosas en niños

Authors´ conclusions: topical antibiotics were associated with significantly shorter durations of conjunctival symptoms in children with acute infective conjunctivitis. Reviewers´ commentary: the use of topical antibiotics modestly benefits the patient, shortening the clinical cure in acute conjunctivitis. However, given the self-limited course of this pathology and the lack of cost-effectiveness studies in this area, its generalized prescription in primary care does not seem justified. Such studies should be carried out to assess the overall impact on society of the treatment of these patients.

Co-occurring substance use disorders among patients with opioid use disorder in rural primary care clinics

BackgroundCo-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. MethodsSecondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. ResultsWe identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor. ConclusionsMore than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.

The long-term impacts of opioid use before and after joint arthroplasty: matched cohort analysis of New Zealand linked register data.

Opioids are commonly used both before and after total joint arthroplasty (TJA). The objective of this study was to estimate the long-term effects of pre- and perioperative opioid use in patients undergoing TJA. We used linked population datasets to identify all (n =18,666) patients who had a publicly funded TJA in New Zealand between 2011 and 2013. We used propensity score matching to match individuals who used opioids either before surgery, during hospital stay, or immediately post-discharge with individuals who did not based on a comprehensive set of covariates. Regression analysis was used to estimate the effect of opioid use on health and socio-economic outcomes over 5 years. Opioid use in the 3 months prior to surgery was associated with significant increases in healthcare utilization and costs (number of hospitalizations 6%, days spent in hospital 14.4%, opioid scripts dispensed 181%, and total healthcare costs 11%). Also increased were the rate of receiving social benefits (2 percentage points) and the rates of opioid overdose (0.5 percentage points) and mortality (3 percentage points). Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects. Opioid use before TJA is associated with significant negative health and economic consequences and should be limited. This has implications for opioid prescribing in primary care. There is little evidence that peri- or post-operative opioid use is associated with significant long-term detriments.

Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation.

Inappropriate prescribing of antibiotics has been widely recognised as a leading cause of antimicrobial resistance, which in turn has become one of the most significant threats to global health. Given that most antibiotic prescriptions are issued in primary care settings, investigating the associations between primary care prescribing of antibiotics and subsequent infection-related hospitalisations affords a valuable opportunity to understand the long-term health implications of primary care antibiotic intervention. A narrative review of the scientific literature studying associations between primary care antibiotic prescribing and subsequent infection-related hospitalisation was conducted. The Web of Science database was used to retrieve 252 potentially relevant studies, with 23 of these studies included in this review (stratified by patient age and infection type). The majority of studies (n = 18) were published in the United Kingdom, while the remainder were conducted in Germany, Spain, Denmark, New Zealand, and the United States. While some of the reviewed studies demonstrated that appropriate and timely antibiotic prescribing in primary care could help reduce the need for hospitalisation, excessive antibiotic prescribing can lead to antimicrobial resistance, subsequently increasing the risk of infection-related hospitalisation. Few studies reported no association between primary care antibiotic prescriptions and subsequent infection-related hospitalisation. Overall, the disparate results in the extant literature attest to the conflicting factors influencing the decision-making regarding antibiotic prescribing and highlight the necessity of adopting a more patient-focussed perspective in stewardship programmes and the need for increased use of rapid diagnostic testing in primary care.

UTI Friday: The Review of Antibiotic Prophylaxis for Recurrent Urinary Tract Infection (rUTI) in Primary Care

Abstract Introduction There is an established link between antibiotic use and the emergence of resistant organisms. Current NICE guidelines [NG15, NG112] state that patients on antibiotic prophylaxis for rUTI should be reviewed within 6 months and consideration given to discontinue the antibiotic. Self-care measures should be promoted instead. Aim This project aims to assess current practice in relation to rUTI management in Primary Care and identify opportunities for improved antimicrobial stewardship. Methods An audit was developed to review rUTI management and it was used in three GP practices (patient population 35,134) within the Bridgend Locality of Cwm Taf Morgannwg University Health Board. A search for all repeat prescriptions issued between 1st July 2017 and 30th June 2018, for any strength of antibiotic, was run and 179 patients were identified as being on antibiotic prophylaxis for rUTI. The results of the audit were fed back to the practice and a co-designed action plan agreed to review the identified patients. The outcome of this activity was the proof of concept for national roll-out and lead to the audit being included in a ‘basket’ of Quality Improvement Projects as part of the Welsh General Medical Services (GMS) 2019/20 contract, remaining until 2022 due to the COVID pandemic. Ethical approval not required. Results Primary care initiated prophylaxis accounted for 69% of the total number of patients identified (n=123). Of those taking prophylaxis for &amp;gt;6 months (n=160), 24% had a prophylactic review within the previous 6 months as per NICE guidance. Patients taking prophylaxis for &amp;gt;3 years accounted for 39% of the total (n=70). Whilst taking antibiotic prophylaxis, 98 patients (54.7%) had at least one documented acute UTI in the previous 12 months. For an acute UTI, 35 patients (19.6%) were prescribed the same antibiotic as they were taking prophylactically. When an MSU showed resistance to the prophylactic antibiotic, prophylaxis was changed 17.5% of the time, n = 57. Therefore 82.5% were continued on a potentially ineffective antibiotic. Results from the Welsh GMS contract for the Bridgend Locality (patient population 152,041) identified 431 patients on antibiotic prophylaxis for rUTI. Of these, 334 (77.5%) were reviewed and of those reviewed 171 (51%) were stopped (confirmed on re-audit after 6 months). This equates to a 40% locality reduction in antibiotic prophylaxis for rUTI, which is estimated to be in the region of 2,223 fewer antibiotic prescriptions per year. Discussion/Conclusion Initial results suggest that there can be marked improvement in antibiotic use for rUTI management. Through a multi-disciplinary approach, this project has demonstrated how pharmacists can support GPs in the review and management of patients with rUTI. The impact of this in terms of antimicrobial resistance is not yet known but, with increased guideline awareness/compliance, a positive step has been made towards improving rUTI management and meeting the antimicrobial stewardship targets set by the UK Antimicrobial Resistance National Action Plan 2019-2024. In order to tackle high rates of antibiotic prescribing in primary care, innovative approaches to quality improvement and prescriber feedback will be essential and should be further developed.

Strategic insight into the thresholds &amp; barriers to uptake of Electronic Repeat Dispensing (eRD) by therapeutic area

Abstract Introduction The use of eRD offers a simplified process compared to paper based repeat dispensing and electronic repeat prescribing, and has several benefits for GP practices, community pharmacies and patients. It is estimated that up to 80% of all repeat prescriptions could be replaced with repeat dispensing potentially saving 2.7 million hours of GP and practice time. eRD also has the benefit of reduced medicines and can contribute towards reducing overprescribing and supporting the NHS sustainability agenda. Aim To determine if there are specific thresholds of eRD implementation by GP practices at which barriers to uptake occur. Subsequently to understand if these thresholds are associated with specific therapeutics and if the difficulty in increasing uptake is related to drug specific requirements or differing prescription management processes needed. Methods Dispensed medicines data (Oct-Dec 22, ePACT2) was analysed at practice level nationally to test the hypothesis that there are multiple thresholds of eRD implementation uptake. The percentage of practices achieving less than or equal to each incremental %eRD value was plotted against % eRD implementation. Thresholds were identified by a change in the rate of implementation uptake. Prescribing data was then analysed by BNF chapter at the identified thresholds to determine how this variation was represented clinically. Dispensed medicines data (Jul-Sept 21, North of England (NoE)) was also reviewed by pharmacists at presentation level for appropriateness as an eRD item (excludes patient level considerations). The items considered prescribable by eRD were tagged and the data re-run to estimate the maximum %eRD that might have been achieved. Ethical approval was not required for this study as it utilised non-patient identifiable population level primary care prescribing data. Results There were 8 thresholds (changes in rate of implementation) identified from the national data; occurring at 3, 9, 35, 42, 50, 57, 64 and 72% eRD. There is consistency in three of the most prescribed drug groups for eRD across all the NoE Integrated Care Systems (ICSs), which includes: lipid regulating drugs, proton pump inhibitors and renin-angiotensin system; readily implemented as eRD from the 3% threshold. The other most commonly prescribed drugs by eRD were: Beta-blockers, calcium channel blockers, antiplatelets and antidiabetics. Retrospective data analysis by pharmacists determined that a maximum of 66.6% of items Jul-Sept 21 in the NoE could have been prescribed by eRD if patient factors at individual review had also considered it appropriate. Discussion/Conclusion Further clinical review and guidance on the appropriateness and requirements of specific therapeutics to be prescribed by eRD is required. For instance, rheumatic disease suppressant drugs, which require GP practices to establish monitoring arrangements in conjunction with eRD, increase from the 9% threshold. Whereas adrenoceptor agonists, requiring respiratory/inhaler reviews, increase from the 35% threshold. Further qualitative analysis is ongoing to understand the barriers occurring at different thresholds of eRD uptake. The maximum percentage of eRD achievable in the snapshot data was significantly lower than expected. This work is limited by the volume of items at presentation level that could potentially be prescribed.

Physical activity on prescription in Swedish primary care: a survey on use, views, and implementation determinants amongst general practitioners

Introduction Swedish Physical Activity on Prescription (PAP) has been shown to increase physical activity levels, which is known to lead to positive health effects. PAP is being implemented in Swedish healthcare to various extents. However, there is a lack of knowledge about how Swedish general practitioners (GPs) work with PAP and what hinders and facilitates wider implementation. Aims This study aimed to survey GPs’ use and views of PAP, identify barriers and facilitators for implementing PAP, and explore associations to gender, practice location, and experience. Methods The study was framed by the Normalization Process Theory. A survey was sent to 463 GPs at 69 different healthcare centres in Region Västra Götaland. Data were analysed using multiple logistic and linear regressions. Results A total of 143 GPs completed the survey (response rate 31%). Views on PAP were generally positive amongst respondents, but only 27% reported using PAP regularly. The most prominent reported barriers were insufficient training and resources. Positive views and willingness to collaborate in using PAP were identified as facilitators. Responding GPs in Gothenburg used PAP more often (OR 6.4; 95% CI 2.7–14.8) and were significantly more positive to the method than GPs in other areas of the region. GPs with more than 10 years of practice used PAP more often (OR 2.5; 95% CI 1.1–6.0) than less experienced GPs. Few of the investigated variables were associated with gender. Conclusions The positive views amongst responding GPs are helpful, but more education, training and resources are needed for successful implementation of PAP in Swedish primary health care.

Adherence to antibiotics among adults at state sector primary care in a district of Sri Lanka &amp;ndash; a descriptive cross sectional study

Objectives: To assess the adherence and factors associated with oral antibiotic prescriptions among adults in state sector primary care while assessing the intention to use leftover antibiotics (LOAB).Methodology: A descriptive cross sectional study was conducted in outpatient departments including 407 adults (18-75) using an interviewer administered questionnaire at consultation and a telephone interview at due completion of antibiotic. Adherence was measured by a self-report supplemented by remaining pill count. Factors associated with adherence were determined. The statistical significance was considered as p≤0.05.Results: Adherence to antibiotic prescription was 45.5%. Female gender (p=0.029, OR=1.86) and awareness on the current antibiotic prescription (p=0.000, OR=6.37) were positive associations. Adherence was inversely proportionate to increasing daily dosage frequency (p=0.001). Patient’s belief, they can stop medicine once they feel better (p=0.000), fast improvement of symptoms with medication (p=0.000), interference to lifestyle by the antibiotic dosage schedule (p=0.000) and using LOAB in the past (p=0.000,) were negatively associated. Of the non-adherent patients 20.3% intended to use LOAB later.Conclusions: Adherence to oral antibiotic prescriptions was poor. Patient’s gender, patient beliefs and practices towards medicine and complexity of dosage schedule were associated factors. Patient awareness on the current prescription promoted adherence. Intension to use LOAB was high.Recommendations: Primary care prescribers should make patients aware on antibiotic prescriptions while using less complex regimens.

Abstract 17514: Changing Default Prescription Length to Reduce Barriers to Statin Adherence

Introduction: Statins substantially reduce cardiovascular risk, yet adherence is suboptimal. 90-day prescription fills are associated with better adherence than 30-day fills, though many prescriptions are not written for 90 days. We evaluated the effect of changing default prescription length to 90 days within the electronic health record (EHR) on the proportion of statin prescriptions written for 90 days. Methods: At a single academic health system, we changed the default duration for statin prescriptions written using the primary care preference list within the EHR to 90 pills with 3 refills, while still allowing providers to make a manual change. We compared the proportion of prescriptions written for 90 days over the 4 months before the change (pre-intervention) and 4 months after the change (post-intervention) using a chi-square test, along with need to change prescription dose or drug during the 90-day period after the prescription was written, a potential unintended consequence. Results: Among statin prescriptions written using the primary care prescription preference list, the rate of prescriptions written for 90 days increased from 70.6% pre-intervention to 90.1% post-intervention (p&lt;0.001). Pre-intervention, patients with Medicaid insurance, median ZIP code household income &lt; $50,000, and Black race were significantly less likely to be prescribed a 90-day statin supply (p &lt;0.05). The intervention increased the proportion of 90-day prescriptions more in these groups (interaction p &lt; 0.01), and they were no longer less likely to be prescribed a 90-day supply in the post-intervention period. Post-intervention, there was no change in the proportion of patients that needed a change in prescription during the active prescription time period (p=0.15). Conclusion: Changing default options significantly increased the proportion of statin prescriptions written for 90 days and closed baseline equity gaps without restricting patient or physician choice.