Prescribing Preferences Research Articles

PCSK9 inhibitor experiences and preferences of patients and healthcare professionals in decision-making: A mixed methods study.

This study investigated how patients experience and which outcomes matter to patients and healthcare professionals in the decision to initiate proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) as add-on lipid-lowering treatment (LLT). We performed a mixed methods study: very high-risk patients qualifying for PCSK9i reimbursement were interviewed about their experiences and preferences. Subsequently, patients using PCSK9i completed an anonymous online survey about their experiences. Additionally, healthcare professionals (HCPs) filled in an online survey about their PCSK9i prescription preferences and perceived patient preferences. We interviewed 25 patients (median [IQR] age 58 [48-65] years, 56% women, 64% established cardiovascular disease) at different decision-making stages. The majority (72%) chose efficacy over side-effects (16%) and ease of use (12%) as most important attribute of add-on LLT. Most patients (72%) prefer shared decision-making. Subsequently, 170 patients using PCSK9i completed a survey (age 64 [56-69], 44% women, 63% established cardiovascular disease). Here again, the most important attribute (83%) in deciding on add-on LLT was efficacy. Almost all (90%) patients favoured shared decision-making. Of the 59 HCPs (age 44 [40-50], 49% women, 78% medical specialist), only 27% indicated to consider patient preferences when selecting the PCSK9i type. HCPs identified patient characteristics influencing their PCSK9i prescription preferences. For patients and HCPs, efficacy was the most important aspect in choosing a PCSK9i. Even though shared decision-making is recommended by the guidelines and preferred by patients, in clinical practice only a minority of the HCPs apply this. To facilitate shared decision-making, future research should investigate the development and impact of a decision aid for patients.

Comparative cardiovascular safety of romosozumab versus bisphosphonates in Japanese patients with osteoporosis: a new-user, active comparator design with instrumental variable analyses.

This study analyzed the association of romosozumab, a human monoclonal antibody with bone-forming and bone resorption-inhibiting effects, and bisphosphonates with the development of cardiovascular disease among patients with osteoporosis. A new-user design was employed to address selection bias, and instrumental variable analysis was used to address confounding by indication. Japanese patients aged ≥40years, diagnosed with osteoporosis or experienced a fragility fracture, were admitted to medical facilities covered by a commercial administrative claims database, and newly prescribed romosozumab or bisphosphonates after the commercialization of romosozumab in Japan (March 4, 2019) were included based on verification of a 180-day washout period. Cardiovascular disease (myocardial infarction or stroke) was identified based on information regarding diagnosis, medical procedures, and drug codes. Facility-level prescription preference for romosozumab was used as an instrumental variable, defined as the proportion of romosozumab prescribed at the patient's facility within 90days prior to the index date. Of the 59 694 included prescriptions, 8808 were for romosozumab and 50 886 were for bisphosphonates. The mean age in the romosozumab group was higher than that in the bisphosphonates group (80.5 vs. 78.2years, respectively), and most patients were females (85.3 vs. 80.2%, respectively). The incidence of cardiovascular disease within 1year of prescription was 12.3 per 100 person-years for romosozumab versus 11.4 for bisphosphonates (unadjusted incidence rate ratio: 1.08, 95% confidence interval: 1.00-1.18). An instrumental variable analysis using the two-stage residual inclusion method yielded a hazard ratio of 1.30 (95% confidence interval: 0.88-1.90) for romosozumab compared with bisphosphonates over 1year. Although possibly underpowered, this study showed that no definitive evidence of increased cardiovascular risk associated with romosozumab use compared with bisphosphonates was observed in patients with osteoporosis. These findings should be further validated by larger pharmacoepidemiological studies to alleviate clinicians' concerns about romosozumab's safety.

OP29 Determinants Of The Financial Impact Of Rare Disease Drugs In Italy: Differences Between Expected And Observed Pharmaceutical Expenditure

IntroductionIn Italy, a fixed proportion of health spending is allocated to pharmaceutical expenditure. While the main objective of setting a budget for pharmaceuticals is to control spending, the effectiveness of this ceiling is questionable. This study aims to investigate the determinants of pharmaceutical expenditure for orphan drugs and gather information for effective planning and programming of pharmaceutical spending.Methods Data analysis relied on pharmaceutical companies’ pricing and reimbursement (P&R) dossiers submitted to the Italian Medicines Agency (AIFA) for drug-reimbursement approval, along with AIFA’s internal procedural documents. The study encompassed all rare disease drugs reimbursed from January 2013 to January 2019. For each drug, a comparison was made between the expected post-negotiation expenditure and the actual spending observed over the three years following reimbursement approval. Potential determinants of the normalized ratio between observed and expected spending were identified using univariate and multivariate beta regression models. The same methodology was replicated to identify potential determinants of the difference between expected spending before and after negotiation.Results Fifty-two rare disease drugs admitted for reimbursement during the study period were analyzed. The median expenditure in the first three commercialization years was 7.6 percent lower than the expected post-negotiation spending. Beta regression analysis indicated a significantly lower reduction for innovative drugs (β 0.736, p-value 0.011 univariate, β 0.585, p-value 0.045 multivariate). Similar effects were observed for P&R procedures (β 0.902, p-value 0.007) and the number of indications presented (β 0.754, p-value 0.021), but only in univariate model. Beta regression analysis for the expected expenditure ratio before/after negotiation revealed a significant effect only for the payment-by-result variable (β 1.485, p-value 0.001).ConclusionsObserved expenditure for orphan drugs aligns with the expected spending post-negotiation. However, in the subgroup of innovative orphan drugs, the observed pharmaceutical spending was higher than estimated. This could be attributed to prescriber preferences and to a prevalent patient pool awaiting innovative treatment. It appears that the recognition of innovativeness favors orphan drugs that are rewarded with faster market access.

National Survey of Factors Associated with Physician Antibiotic Prescribing Preferences.

The development of new infectious disease therapies has become a public health priority given the suboptimal efficacy and adverse effects with current drugs for some patients. Understanding the factors associated with physician antibiotic prescribing preferences can help guide policymakers seeking to incentivize the development of interventions that improve patient outcomes for the treatment and prevention of infectious diseases. To determine the factors associated with physician decision-making when prescribing antibiotics for community-acquired pneumonia (CAP), uncomplicated urinary tract infection (UTI), and cellulitis. A cross-sectional online survey in April 2023. Physicians enrolled in an online panel who reported having prescribed antibiotics within the past year. Respondents were asked to select 1 to 15 characteristics that they deemed most important. From their selected characteristics, for each type of infection, they were then asked to rank up to five on a scale with 5 points given to the top-scoring characteristic and 1 point to the bottom-scoring. The primary outcome was the mean score for each characteristic across the three types of infections weighted by the number of respondents in the sample, with higher scores indicating higher importance. Among the 130 physician participants, 106 (82%) completed the survey. Just under half (46%) were female; 89% of respondents were White, 3% Black, and 9% another race, while 15% reported Hispanic ethnicity. The highest-scored factors influencing antibiotic prescription preferences were the cure rate (treatment efficacy) (mean score: 2.87), severity of the infection (1.88), rare but major side effects (1.33), interactions with other drugs (1.33), previous experience and knowledge of the drug (1.19), and future risk of resistant infection to the patient (1.15). Out-of-pocket patient costs were prioritized lowest (mean score: 0.25). In considering which antibiotic to prescribe, physicians prioritize clinical outcomes related to drug efficacy and safety over public health- or economics-focused factors.

Antibiotic Prescription for Treatment and Prevention of Odontogenic Infections: A Cross-Sectional Survey of Lithuanian Dentists.

Background and Objectives: The inappropriate use of antibiotics can lead to antimicrobial resistance. Overprescribing in dental practice has been reported. This study aimed to describe patterns of antibiotic prescription for treating and preventing odontogenic infections based on reports from Lithuanian dentists. Materials and Methods: Questionnaires were sent to all 4751 Lithuanian dentists registered in the database of the Lithuanian Dental Chamber who had consented to participate in surveys. The questionnaire addressed antibiotic prescription preferences for the treatment and prevention of various dental pathologies. The statistical analysis included chi-square tests and a factor analysis to evaluate prescription frequences in different clinical scenarios considering the respondents' specialty and age. Results: Of 647 responses, 497 were from general dentists, 35 from oral surgeons, 40 from endodontists, 20 from periodontists, and 35 from prosthodontists. Respondents were grouped by age: A (≤35 years, n = 207), B (36-50 years, n = 224), and C (≥51 years, n = 209). Amoxicillin was the first-choice antibiotic for 81.1% of respondents (group A more frequently than other groups, p = 0.001). A 7-day treatment duration was preferred by 60.8%, while 33.6% chose 5 days. For patients allergic to β-lactam antibiotics, 63% preferred clindamycin. Over 90% cited acute apical abscess with systematic involvement as an indication for antibiotic prescription. A factor analysis of 18 clinical scenarios revealed prescription differences among dental specialists, oral surgeons, and periodontists prescribing antibiotics more frequently than general dentists and endodontists. For prophylaxis, 87.5% recommended antibiotics for patients at risk of infectious endocarditis after a cardiologist's consultation (group C less frequently than other groups, p = 0.021). Conclusions: Lithuanian dentists generally prefer narrow-spectrum antibiotics for the treatment of odontogenic infections. There are notable differences in prescription patterns among dental specialists, with younger dentists showing a trend towards more rational antibiotic use.

Venous thromboembolism prophylaxis prescribing patterns for patients with orthopedic trauma: a clinical vignette survey

BackgroundA recent clinical trial suggested aspirin is a viable alternative to enoxaparin for venous thromboembolism (VTE) prophylaxis in patients after orthopedic trauma. The initial impact of these findings on VTE...

Physician preferences for treatment of low-density lipoprotein cholesterol among patients with atherosclerotic cardiovascular disease (ASCVD)–A discrete choice experiment

Approximately 80% of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve the guideline-based target for low-density lipoprotein (LDL-C) levels in current clinical practice, particularly the 95% of ASCVD patients receiving oral statin monotherapy. The objective was to determine physician prescribing preferences for LDL-C lowering therapies beyond statins for patients with ASCVD. A discrete choice experiment (DCE) survey was administered to cardiologists and primary care physicians in the United States, presenting a series of treatment choices systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient monthly out-of-pocket cost (mOOP), and adherence. Data were analyzed using logistic regression to estimate preference weights for each attribute. A total of 200 cardiologists and 50 primary care physicians (PCPs) completed the survey. Both exhibited similar prescribing preferences, highly valuing efficacy in reducing LDL-C levels and minimization of patients OOP cost. Each additional 10% reduction in LDL-C was associated with a 69% relative increase in physician preference. By contrast, a 10% relative decrease in preference was observed for each $10 additional monthly mOOP. Compared to PCPs, cardiologists tended to place more emphasis on LDL-C reduction, being more willing to accept higher mOOP or side effects. Although oral therapies were preferred, injectable therapies, like the PCSK9 siRNA-like drug, administered less frequently that allowed for greater LDL-C reduction were seen as having considerable utility, especially among patients with a history of medication nonadherence. These results document considerable preference similarities among cardiologist and PCP prescribers of LDL-C lowering therapies for ASCVD. Broad availability of several therapies with varying administration frequencies and product profiles are likely of great value to prescribing physicians aiming to achieve target LDL-C concentrations. Considering all aspects of treatment, most participants preferred a PCSK9 siRNA-like drug.

Real-world use and outcomes of targeted therapy and immunotherapy for adjuvant treatment of BRAF -mutated melanoma patients in the United States.

Using a customized, harmonized US electronic health record database, real-world prescription patterns of first-line adjuvant immunotherapy and targeted therapy were retrospectively assessed for BRAF V600-mutated melanoma. Adults with BRAF V600 mutation-positive stage IIIA-D cutaneous melanoma who received first-line adjuvant immunotherapy (nivolumab or pembrolizumab) or targeted therapy (dabrafenib plus trametinib) between 1 January 2014 and 30 August 2020 in the NOBLE database were included. Patients were followed from first-line adjuvant therapy initiation for at least 6 months, until death, progression, follow-up loss, or data cutoff. Primary endpoints were proportion of patients receiving either therapy in first-line and second-line, treatment switching, treatment timing, and status at the end of first-line therapy. Secondary endpoints included discontinuation rates, recurrence-free survival (RFS), and overall survival (OS). Of 318 patients evaluated, 67.6% received nivolumab, 14.2% pembrolizumab, and 18.2% targeted therapy as first-line adjuvant therapy. Median treatment duration was longest for nivolumab (292 days) and shortest for targeted therapy (115 days). Reason for discontinuation was recorded for 195 of 274 patients who discontinued first-line therapy; most common reasons were treatment completion and treatment-related toxicity [87/158 (55.0%) and 29/158 (18.4%), respectively, in immunotherapy-treated patients; 9/37 (24.3%) and 21/37 (56.8%) in targeted therapy-treated patients]. Median RFS and OS for targeted therapy and nivolumab were not reached and were 34.6 and 38.1 months, respectively, for pembrolizumab. These results inform on prescription preferences and clinical outcomes for BRAF V600-mutated melanoma patients in the first-line adjuvant setting.

Clinicians Perspectives of Linagliptin Monotherapy and Linagliptin + Dapagliflozin Combination Therapy in the Management of Type 2 Diabetes Mellitus with Chronic Kidney Disease in Indian Settings

Objective: The objective of the study was to gather clinician’s perspectives on the use of linagliptin monotherapy and the linagliptin + dapagliflozin fixed-dose combination (FDC) in the management of patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) in the Indian clinical settings. Methodology: The cross-sectional study employed a 25-item, multiple-response questionnaire to collect expert opinions from specialists experienced in managing T2DM with CKD. The survey covered topics such as current prescribing practices, clinical observations, preferences, and experiences regarding the use of linagliptin monotherapy and linagliptin + dapagliflozin FDC in routine settings. Data analysis was conducted using descriptive statistics. Results: Overall, 1848 participants were included and the majority (77%) of them preferred linagliptin as the dipeptidyl peptidase-4 inhibitor (DPP4i) of choice, while 65% observed improved estimated glomerular filtration rate (eGFR) with linagliptin in their practice. Nearly 44% of the respondents noted that 11%–25% of patients needed multiple drugs alongside metformin for glycemic control. Nearly 76% favored linagliptin when combined with dapagliflozin, and 61% preferred the dapagliflozin + linagliptin FDC for elderly diabetic patients with obesity or cardiac/renal issues. Approximately 68% of the clinicians reported a 3–6 mmHg reduction in blood pressure with dapagliflozin. About 60% of the clinicians stated the occurrence of urinary tract infections with the DPP4i and sodium–glucose co-transporter-2 inhibitor combination, and approximately 42% indicated effective synergy between dapagliflozin + linagliptin. Conclusion: The study findings indicated that linagliptin monotherapy and linagliptin + dapagliflozin FDC were preferred in managing T2DM with CKD due to their potency, minimal side effects, and efficacy. The study has also underscored the additional benefits conferred by linagliptin, including improved eGFR and reduced blood pressure.

Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach.

Older adults are under-represented in trials, meaning the benefits and risks of glucose-lowering agents in this age group are unclear. The aim of this study was to assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in people with type 2 diabetes aged over 70 years using causal analysis. Hospital-linked UK primary care data (Clinical Practice Research Datalink, 2013-2020) were used to compare adverse events and effectiveness in individuals initiating SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i). Analysis was age-stratified: <70 years (SGLT2i n=66,810, DPP4i n=76,172), ≥70 years (SGLT2i n=10,419, DPP4i n=33,434). Outcomes were assessed using the instrumental variable causal inference method and prescriber preference as the instrument. Risk of diabetic ketoacidosis was increased with SGLT2i in those aged ≥70 (incidence rate ratio compared with DPP4i: 3.82 [95% CI 1.12, 13.03]), but not in those aged <70 (1.12 [0.41, 3.04]). However, incidence rates with SGLT2i in those ≥70 was low (29.6 [29.5, 29.7]) per 10,000 person-years. SGLT2i were associated with similarly increased risk of genital infection in both age groups (incidence rate ratio in those <70: 2.27 [2.03, 2.53]; ≥70: 2.16 [1.77, 2.63]). There was no evidence of an increased risk of volume depletion, poor micturition control, urinary frequency, falls or amputation with SGLT2i in either age group. In those ≥70, HbA1c reduction was similar between SGLT2i and DPP4i (-0.3 mmol/mol [-1.6, 1.1], -0.02% [0.1, 0.1]), but in those <70, SGLT2i were more effective (-4 mmol/mol [4.8, -3.1], -0.4% [-0.4, -0.3]). Causal analysis suggests SGLT2i are effective in adults aged ≥70 years, but increase risk for genital infections and diabetic ketoacidosis. Our study extends RCT evidence to older adults with type 2 diabetes.

Hungarian general practice paediatricians’ antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study

ObjectivesInappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners’ (GP Peds) antibiotic prescription practice in suspected respiratory...

Comparing the performance of two-stage residual inclusion methods when using physician's prescribing preference as an instrumental variable: unmeasured confounding and noncollapsibility.

Aim: The first objective is to compare the performance of two-stage residual inclusion (2SRI), two-stage least square (2SLS) with the multivariable generalized linear model (GLM) in terms of the reducing unmeasured confounding bias. The second objective is to demonstrate the ability of 2SRI and 2SPS in alleviating unmeasured confounding when noncollapsibility exists. Materials & methods: This study comprises a simulation study and an empirical example from a real-world UK population health dataset (Clinical Practice Research Datalink). The instrumental variable (IV) used is based on physicians' prescribing preferences (defined by prescribing history). Results: The percent bias of 2SRI in terms of treatment effect estimates to be lower than GLM and 2SPS and was less than 15% in most scenarios. Further, 2SRI was found to be robust to mild noncollapsibility with the percent bias less than 50%. As the level of unmeasured confounding increased, the ability to alleviate the noncollapsibility decreased. Strong IVs tended to be more robust to noncollapsibility than weak IVs. Conclusion: 2SRI tends to be less biased than GLM and 2SPS in terms of estimating treatment effect. It can be robust to noncollapsibility in the case of the mild unmeasured confounding effect.

Assessing the performance of physician's prescribing preference as an instrumental variable in comparative effectiveness research with moderate and small sample sizes: a simulation study.

Aim: This simulation study is to assess the utility of physician's prescribing preference (PPP) as an instrumental variable for moderate and smaller sample sizes. Materials & methods: We designed a simulation study to imitate a comparative effectiveness research under different sample sizes. We compare the performance of instrumental variable (IV) and non-IV approaches using two-stage least squares (2SLS) and ordinary least squares (OLS) methods, respectively. Further, we test the performance of different forms of proxies for PPP as an IV. Results: The percent bias of 2SLS is around approximately 20%, while the percent bias of OLS is close to 60%. The sample size is not associated with the level of bias for the PPP IV approach. Conclusion: Irrespective of sample size, the PPP IV approach leads to less biased estimates of treatment effectiveness than OLS adjusting for known confounding only. Particularly for smaller sample sizes, we recommend constructing PPP from long prescribing histories to improve statistical power.

Anti-seizure medication prescription preferences: a Moroccan multicenter study.

The management of epilepsy is mainly based on antiseizure medications (ASMs). More than 20 ASMs have been introduced in clinical practice, providing a multitude of prescription choices. To date, there are no published data on the trends in ASMs prescriptions in Morocco. Therefore, we conducted a survey among practicing neurologists in seven tertiary referral hospitals in Morocco to study the current ASMs prescription preferences and their modifying factors. Our descriptive and analytical cross-sectional study was based on a survey sent between January and April 2022 to neurologists practicing in seven tertiary referral hospitals in Morocco. Information regarding the prescription of ASMs was collected using an exploitation form and analyzed using the SPSS version 13 software. Based on questionnaire responses, our results showed that Valproic acid (96.3%) and Lamotrigine (59.8%) were the two most prescribed ASMs for generalized seizure types. For focal seizure types, Carbamazepine (98.8%) and Levetiracetam (34.1%) were the most commonly prescribed drugs, whereas for combined focal and generalized seizure types, the combination of Valproic acid and Carbamazepine (38.55%) was the most prescribed. Phenobarbital was the most commonly prescribed ASM for status epilepticus (40.2%). These prescription preferences were mainly due to seizure types, cost, health insurance coverage, years of experience, and additional epileptology training (p < 0.05). Our results show a shift in the prescription of ASMs in Morocco. Similar to many other countries, valproic acid and carbamazepine are considered the first-line treatments for generalized and focal seizure types. Some factors remain as major challenges in enhancing epilepsy management in Morocco.

The Practice of Prescribing Antidepressants During Pregnancy and Breastfeeding Among Mental Health Practitioners in Tertiary Care Centers in Oman.

This study sought to determine the confidence level of mental health practitioners in Oman regarding the use of antidepressants during pregnancy and breastfeeding, assess their knowledge and need for further training in this area, and examine their current prescribing patterns and preferences. A questionnaire-based survey was conducted from May to June 2017 among all practitioners in the psychiatry specialty, including medical officers authorized to prescribe medications, at the Behavioral Medicine Department of Sultan Qaboos University Hospital and Al Masarra Hospital. Forty-two practitioners (response rate = 89.4%) responded to the questionnaire. Of them, 10 (23.8%) had no experience, while 30 (71.4%) had experience in prescribing antidepressants during both pregnancy and breastfeeding periods. Twenty-seven (64.3%) respondents felt that they were confident in prescribing antidepressants for women during their perinatal period, while 30.0% were neutral. Moreover, 35 (83.3%) participants expressed the need for more training in this area. Furthermore, 34 (81.0%) believed that more training in perinatal psychiatry should be included in the psychiatry curriculum. There was no consistent prescribing pattern (either prescribing or avoiding) among our participating practitioners during the first trimester of pregnancy and breastfeeding periods. The drug of choice in the first trimester of pregnancy was fluoxetine preferred by approximately 85.0% of the practitioners, but avoided by 10.0% of practitioners in the same period. This was followed by amitriptyline (50.0% vs. 23.0%), sertraline (50.0% vs. 9.0%), imipramine (28.0% vs. 84.0%). During breastfeeding, the drug of choice for approximately 74.0% of the practitioners was paroxetine, but avoided by 15.0% of practitioners. This was followed by sertraline (50.0% vs. 8.0%). The most common reasons for prescription during pregnancy were safety, evidence-based practice, and low teratogenicity. For breastfeeding, the main reasons for prescription were low levels of the drug in breast milk, safety, and evidence-based practice. On the other hand, high teratogenicity, neonatal side effects, limited data, and lack of evidence were among the most common reasons behind avoiding prescribing during pregnancy, while high levels of breast milk, neonatal side effects, limited evidence, and safety concerns were the most common reasons during the breastfeeding period. There was inconsistency among mental health practitioners in making prescription decisions and in their prescribing patterns.

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.

A Questionnaire Survey of Prescription Preferences and Leftover Medication Conversations: Comparisons Among Kidney Disease Patients and Healthcare Professionals.

Patients with chronic kidney disease (CKD) and patients with kidney failure receiving hemodialysis (HD) receive various types of medications. However, little is known about the differences in medication preference and how to deal with leftover medication among CKD patients and HD patients. The purpose of this study was to investigate the differences in medication preference and ways of dealing with leftover medication between CKD patients, HD patients, physicians, and pharmacists via a questionnaire survey. The ethics committee of Oita University, Oita, Japan, approved this survey. Outpatients undergoing treatment by a nephrologist in four facilities in Oita prefecture, Japan, were asked to answer a questionnaire on their preference for medication and how to deal with leftover medication. Respondents gave their informed written consent. The same questionnaire was administered to nephrologists and pharmacists online. In this survey, 383 patients (260 patients with CKD and 123 patients with HD), 22 nephrologists, and 28 pharmacists responded. The response rate of valid responses was more than 90% for each of the groups. In particular, 41% of patients with CKD and 56% of patients with HD never inform their doctor about leftover medication or only inform them when there is a lot of leftover medication. On the other hand, 23% of physicians have never asked their patients about them. Ordinary logistic regression analysis indicated that there is no significant relationship between how often patients talk about leftover medication, patients' preferences, or patient states. Despite the age and state of the patients, it is important to discuss the perception of medication with each other and confirm the condition of the remaining medication to improve concordance and obtain the desired treatment effect.

PE005 - ‘Do as I say, not as I do’; A survey on clinician prescribing and self administration preferences for management of male Lower Urinary Tract Symptoms (LUTS)

PE005 - ‘Do as I say, not as I do’; A survey on clinician prescribing and self administration preferences for management of male Lower Urinary Tract Symptoms (LUTS)

PE008 - ‘Here’s my take...’; A survey on clinician prescribing and self administration preferences for management of female Lower Urinary Tract Symptoms (LUTS)

PE008 - ‘Here’s my take...’; A survey on clinician prescribing and self administration preferences for management of female Lower Urinary Tract Symptoms (LUTS)

Experiences of postpartum mothers and a significant other in a dyadic physical activity programme

Experiences of postpartum mothers and a significant other in a dyadic physical activity programme