Preventive Care Measures Research Articles

Athletes and the prevalence of trauma involving the buco-maxillo-facial structure: knowledge and use of mouthguards

Introduction: Epidemiological analysis of buco-maxillo-facial (BMF) fractures is important to provide measures for preventive care and effective treatment of these injuries. Objectives: To verify the prevalence of sport-related accidents involving the BMF structure and factors associated with sport modality, and knowledge and use of mouthguards. Method: This was a cross-sectional, descriptive, survey-based study involving 647 athletes participating in different sports in a Brazilian city in 2019. Respondents answered a questionnaire that addressed the primary outcome - occurrence of trauma to the head and neck region during sporting activities - and the knowledge and use of mouthguards. The following variables were investigated: marital status, sex, age, education, sport, affected region, and cause and consequence of trauma. Results: One hundred forty-eight athletes (22.87%) sustained trauma during sporting activities/competition. The mouth was the most affected site (30.40%) and contact with an elbow was the main cause. In 80 (54.05%) athletes, trauma occurred during game conditions and 68 (45.95%) during training. A total of 536 athletes (82.84%) were familiar with the concept of wearing a mouthguard; however, only 169 (26.12%) actually used one, 13 (7.69%) of whom were fitted with a custom mouthguard recommended by a dentist. There was a significant association between the occurrence of BMF trauma (BMFT) and knowledge of mouthguards (p=0.0042), sport modality (p<0.0001), education (p<0.0001), age (p< 0.0001), and sex (p=0.0421). Conclusion: The occurrence of BMFTs in athletes was high. Although most were familiar with mouthguards, their use was not a usual practice.

The risk and prognosis of COVID-19 infection in cancer patients: A systematic review and meta-analysis

Numerous studies have been published regarding outcomes of cancer patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) infection. However, most of these are single-center studies with a limited number of patients. To better assess the outcomes of this new infection in this subgroup of susceptible patients, we performed a systematic review and meta-analysis to evaluate the impact of COVID-19 infection on cancer patients. We performed a literature search using PubMed, Web of Science, and Scopus for studies that reported the risk of infection and complications of COVID-19 in cancer patients and retrieved 22 studies (1018 cancer patients). The analysis showed that the frequency of cancer among patients with confirmed COVID-19 was 2.1% (95% confidence interval [CI]: 1.3–3) in the overall cohort. These patients had a mortality of 21.1% (95% CI: 14.7–27.6), severe/critical disease rate of 45.4% (95% CI: 37.4–53.3), intensive care unit (ICU) admission rate of 14.5% (95% CI: 8.5–20.4), and mechanical ventilation rate of 11.7% (95% CI: 5.5–18). The double-arm analysis showed that cancer patients had a higher risk of mortality (odds ratio [OR] = 3.23, 95% CI: 1.71–6.13), severe/critical disease (OR = 3.91, 95% CI: 2.70–5.67), ICU admission (OR = 3.10, 95% CI: 1.85–5.17), and mechanical ventilation (OR = 4.86, 95% CI: 1.27–18.65) than non-cancer patients. Furthermore, cancer patients had significantly lower platelet levels and higher D-dimer levels, C-reactive protein levels, and prothrombin time. In conclusion, these results indicate that cancer patients are at a higher risk of COVID-19 infection-related complications. Therefore, cancer patients need diligent preventive care measures and aggressive surveillance for earlier detection of COVID-19 infection.

ANALYSES OF PREVENTIVE CARE MEASURES WITH INCOMPLETE HISTORICAL DATA IN ELECTRONIC MEDICAL RECORDS: AN EXAMPLE FROM COLORECTAL CANCER SCREENING.

The calculation of quality of care measures based on electronic medical records (EMRs) may be inaccurate because of incomplete capture of past services. We evaluate the influence of different statistical approaches for calculating the proportion of patients who are up-to-date for a preventive service, using the example of colorectal cancer (CRC) screening. We propose an extension of traditional mixture models to account for the uncertainty in compliance, which is further complicated by the choice of various screening modalities with different recommended screening intervals. We conducted simulation studies to compare various statistical approaches and demonstrated that the proposed method can alleviate bias when individuals with complete prior medical history information were not representative of the targeted population. The method is motivated by and applied to data from the National Cancer Institute-funded consortium Population-Based Research Optimizing Screening through Personalized Regiments (PROSPR). Findings from the application are important for the evaluation of appropriate use of preventive care and provide a novel tool for dealing with similar analytical challenges with EMR data in broad settings.

Otolaryngology during COVID-19: Preventive care and precautionary measures.

Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery. Therefore, infection prevention and control measures for this specialty are essential. Literatures on the epidemiology, clinical characteristics and infection control measures of COVID-19 were reviewed, practical knowledge from first-line otolaryngologists in China, the United States, and Brazil were reviewed and collated. It was recommended that otolaryngology professionals should improve screening in suspected patients with relevant nasal and pharyngeal symptoms and signs, suspend non-emergency consultations and examinations in clinics, and rearrange the working procedures in operating rooms. The guidelines of personal protective equipment for swab sampling, endoscopy and surgery were listed. Indications for tracheotomy during the pandemic should be carefully considered to avoid unnecessary airway opening and aerosol-generation; precautions during surgery to reduce the risk of exposure and infection were illustrated. This review aimed to provide recommendations for otolaryngologists to enhance personal protection against COVID-19 and reduce the risk of nosocomial infection.

Racial and Gender Disparity in Aortoiliac Disease Open Revascularization Procedures

BackgroundThe impact of race and gender on surgical outcomes has been studied in infrainguinal revascularization for peripheral arterial disease. The aim of this study is to explore how race and gender affect the outcomes of suprainguinal bypass (SIB) for aortoiliac occlusive disease. Materials and methodsPatients who underwent SIB were identified from the procedure-targeted National Surgical Quality Improvement Program data set (2011-2016). Patients were stratified into four groups: nonblack males, black males (BM), nonblack females, and black females (BF). Primary outcomes were 30-d major adverse cardiac events, a composite of myocardial infarction, stroke, or death; postoperative bleeding requiring transfusion or intervention; major amputation and prolonged length of stay (>10 d). Predictors of outcomes were determined by multivariable logistic regression analysis. ResultsAbout 5044 patients were identified. BM were younger, more likely to be smokers, less likely to be on antiplatelet drug or statin, and to receive elective SIB (all P ≤ 0.01). BFs were more likely to be diabetic and functionally dependent (all P ≤ 0.02). Major adverse cardiac events were not significantly different among all groups. BM had a threefold higher risk of amputation (adjusted odds ratio [OR] [95% confidence interval (95% CI)], 3.10 [1.50-6.43]; P < 0.002). Female gender was associated with bleeding in both races, that association was more drastic in BF (OR [95% CI], 2.43 [1.63-3.60]; P < 0.0001), whereas nonblack females (OR [95% CI], 1.46 [1.19-1.80]; P < 0.0001). BF had higher odds of prolonged length of stay (OR [95% CI]: 1.62 [1.08-2.42]; P < 0.019). ConclusionsIn this large retrospective study, we demonstrated the racial and gender disparity in SIB outcomes. BM had more than threefold increase in amputation risk as compared with nonblack males. Severe bleeding risk was more than doubled in BF. Race and gender consideration is warranted in risk assessment when patients are selected for aortoiliac disease revascularization, which in turn necessitate preoperative risk modification and optimization in addition to enhancing their access to primary preventive care measures.

A patient-centered medical home model for comprehensive sickle cell care in infants and young children.

The patient-centered medical home (PCMH) has been proposed as a model for comprehensive care coordination and delivery for children with sickle cell disease (SCD), yet little is known regarding the implementation of PCMH core concepts on adherence to preventative care measures, health care utilization, and parent satisfaction. We implemented the newborn cohort clinic (NCC) to explore the application of the PCMH model for infants and children with SCD from birth to age 3years in 2011. In July 2017, we conducted a retrospective chart review to evaluate subjects currently or previously followed in the clinic. We surveyed parents in the NCC to assess their satisfaction with their experience. A total of 112 patients have been managed in the NCC. All patients received penicillin prophylaxis, while 70% and 73% of patients, respectively, received the 23-valent pneumococcal vaccine and an initial transcranial Doppler by age 36months. Most (92 of 112) of the subjects utilized the emergency department (569 encounters), with 86% of encounters for fever or other sickle cell-related complications. The majority of parents indicated satisfaction with the clinic, with 71% saying clinic providers always or usually spent enough time with their child, listened carefully to them (81%) and were sensitive to family values and customs (77%). A comprehensive sickle cell clinic as a component of a PCMH is feasible and can achieve high levels of preventative care. Parents are largely satisfied with this model of care.

Changes in Preventative Health Care After Medicaid Expansion.

Medicaid expansion substantially increased health insurance coverage, but its effect on the delivery of preventative health care is unclear. The objective of this study was to assess the impact of Medicaid expansion on the receipt of 15 different measures of preventive care including cancer screening, cardiovascular risk reduction, diabetes care, and other primary care measures. We performed serial cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2012 to 2017. We used a quasi-experimental design with difference-in-differences (DiD) analyses to examine changes in preventative health care delivery over 3 time periods in Medicaid expansion compared with nonexpansion states. We included low-income (<138% federal poverty level) nonelderly (age younger than 65 y) adults residing in 46 US states. Our predictor was residing in a Medicaid expansion state (24 states) versus nonexpansion state (19 states). Our primary outcomes were preventative health care services, which we categorized as cancer screening (breast cancer, cervical cancer, and colorectal cancer); cardiovascular risk reduction (serum cholesterol screening in low-risk groups, serum cholesterol monitoring in high-risk groups, and aspirin use); diabetes care (serum cholesterol monitoring, hemoglobin A1c monitoring, foot examination, eye examination, and influenza vaccination, and pneumonia vaccination); and other primary care measures [influenza vaccination, alcohol use screening, and human immunodeficiency virus (HIV) screening]. Survey responses from 500,495 low-income nonelderly adults from 2012 to 2017 were included in the analysis, representing 68.2 million US adults per year. Of the 15 outcomes evaluated, we did not detect statistically significant differences in cancer screening (3 outcomes), cholesterol screening or monitoring (2 outcomes), diabetes care (6 outcomes), or alcohol use screening (1 outcome) in expansion compared with nonexpansion states. Aspirin use (DiD 8.8%, P<0.001), influenza vaccination (DiD 1.4%, P=0.016), and HIV screening (DiD 1.9%, P=0.004) increased in expansion states compared with nonexpansion states. Medicaid expansion was associated with an increase in aspirin use, influenza vaccination, and HIV screening in expansion states. Despite improvements in access to care, including health insurance, having a primary care doctor, and routine visits, Medicaid expansion was not associated with improvements in cancer screening, cholesterol monitoring, diabetes care, or alcohol use screening. Our findings highlight implementation challenges in delivering high-quality primary care to low-income populations.

Burnout and quality of life among correctional officers in a women's correctional facility.

Introduction:The correctional officer career is considered a stressful and risky occupation that can affect the mental health of workers due to stress and burnout; this syndrome presents itself with physical, psychological, behavioral, and defensive symptoms, ultimately affecting quality of life.Objectives:To evaluate the sociodemographic profile, burnout levels, and quality of life of female correctional officers in a women’s correctional facility, as well as to verify possible correlations between these variables.Methods:This is a descriptive cross-sectional study performed in a women’s correctional facility located in Aquiraz, in the state of Ceará, through the use of 3 evaluation instruments: the Maslach Burnout Inventory-General Survey, the abbreviated version of the World Health Organization Quality of Life instrument, and a general information questionnaire.Results:Most of the correctional officers were married or cohabiting, aged between 31 and 40 years old, with complete or partial undergraduate education, and at least 1 child. In the burnout investigation, mean scores were 1.9±1.43, indicating a moderate level of burnout. Regarding quality of life, the environment domain presented the lowest scores (57.34%). We observed a correlation between burnout and quality of life, in which the higher the burnout scores, the lower the quality of life reported by correctional officers.Conclusions:Our data demonstrate that correctional officers face a risk of developing burnout, thus affecting their quality of life; therefore, preventive health care measures are required for these professionals.

Time Preferences and Medication Adherence: A Field Experiment With Pregnant Women in South Africa

The effectiveness of health recommendations and treatment plans depends on the extent to which individuals follow them. For the individual, medication adherence involves an inter-temporal trade-off between expected future health benefits and immediate effort costs. Therefore examining time preferences may help us to understand why some people fail to follow health recommendations and treatment plans. In this paper, we use a simple, real-effort task implemented via text message to elicit the time preferences of pregnant women in South Africa. We find evidence that high discounters are significantly less likely to report to adhere to the recommendation of taking daily iron supplements daily during pregnancy. There is some indication that time-inconsistency also negatively affects adherence. Together our results suggest that measuring time preferences could help predict medication adherence and thus be used to improve preventive health care measures.

Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study.

To assess the efficacy of treatment using a minimally invasive approach (selective removal of carious tissue, restoration and preventive strategies) in immature permanent molars with MIH. A total of 281 patients, aged 6-8years, with carious lesions (ICDAS 5-6), severe MIH, and incomplete root formation (one tooth/patient) were included. After clinical and radiographic examinations, selective carious tissue removal was performed, and the teeth received interim restoration for 6months and were then restored with composite resin. Clinical and radiographic follow-up was undertaken, 6, 12, 18, and 24months. A protocol of preventive oral care measures was established and repeated at each follow-up, including diet counselling, oral hygiene instruction, dental plaque control, and topical application of fluoride varnish containing CPP-ACP. All clinical procedures and evaluations were done by a single operator. Clinical and radiographic success was observed 24months after treatment in 96.8% of the cases. Failures were due to enamel fracture at restoration margins, resulting in pulpitis and absence of apex closure. Selective removal of carious tissue, interim, and subsequently definitive restoration, combined with home and professional preventive measures, maintained marginal integrity of restorations in immature permanent molars with severe MIH, confirmed by pulp vitality and occurrence of apexogenesis.

PREVENTIVE HEALTH CARE IN RELATION TO HEALTH INSURANCE SYSTEM IN SLOVAKIA

Introduction: Preventive measures in a field of health care are cheaper than addressing the consequences of neglected diagnosis and treatment. Aim of this study is to present the Slovak legislation and national plans in the field of preventive health care. This issue is discussed in relation to financing of health care from the health insurance.&#x0D; Methods: This study was conducted by using the method of content analysis of selected legislative and non-legislative documents and statistical reports of the Slovak ministries (finance, health) and of health insurance companies.&#x0D; Results: In Slovakia, universal and selective preventive health care is available for health care payers. Number of people who undergo the preventive examination differs in selected areas and the expenditure on medical treatment and addressing the consequences of neglected prevention are still high. Control plans are vague and do not cover concrete steps leading to achievement of goals presented. Access of marginalized groups of population to the preventive health care is still at very low level.&#x0D; Conclusion: The system of preventive health care measures in Slovakia is relatively well-defined in legislation and supports the provision of preventive care. However, it is not enforced. There are no serious sanctions in case of neglecting patient´s obligations and people are not motivated to undergo preventive examinations. Only sanctions that in some cases work are financial. The detailed research of access of people from socially disadvantaged environment to the preventive care is desirable.

Jehovah's Witness Patients: Interventions for Successful Stem Cell Transplantation Without Blood Product Transfusions for Hematologic Malignancies.

Jehovah's Witnesses are members of a religion that prohibits them from accepting blood product transfusions. This refusal makes them a particularly compelling population in the context of hematologic malignancies and stem cell transplantation, because blood product transfusions are a mainstay of supportive treatment. This article presents preventive and supportive measures allowing Jehovah's Witness patients the opportunity to receive a stem cell transplantation without blood product transfusions. A literature review was done that included evidence focusing on optimizing hematopoiesis, blood loss prevention, alterations in chemotherapy regimens, and implications for nursing practice. With proper preventive and supportive care measures, Jehovah's Witness patients can receive stem cell transplantations for hematologic malignancies without blood product transfusions.

Vaccine-preventable diseases: Uncommon disease primer for the front-line provider.

This practice point provides quick information for front-line health care providers on vaccine-preventable diseases which, given the success of immunization programs in Canada, are now uncommon or rarely seen. These infections can still occur in children and youth from Canada and elsewhere, and their clinical identification has important public health implications. Knowledge of signs and symptoms, immunizing travellers and newcomers to Canada, awareness of outbreaks in-community and elsewhere, and early consultation with an expert in infectious diseases and public health authorities in suspected cases, are key preventive care measures.

Self-reported receipt of preventive practices and its associated factors among adults with diabetes in the United States.

Previous studies indicated that a high proportion of adults with diabetes do not receive recommended preventive care in the United States. Nevertheless, a comprehensive evaluation of the factors associated with the receipt of most recommended preventive care measures collectively is lacking. Therefore, this study describes the utilization of multiple preventive care measures collectively. Moreover, this paper aims to identify factors associated with receiving the recommended preventive care. A cross-sectional study design was implemented using data from multiple panels (2009–2015) of the Medical Expenditure Panel Survey. The sample included adults aged 21 years or older with diabetes (n = 8415). The outcome for this study was either receiving five selected preventive care measures (HbA1c tests, cholesterol tests, foot examinations, dilated eye examinations, and influenza vaccines) collectively or not. Multivariable logistic regressions were performed among all adults with diabetes, those with multimorbidity, chronic kidney disease (CKD) or eye complications. Adults with diabetes were poorly adherent to receiving the five preventive care measures collectively (15.6%). Among all adults with diabetes, factors associated with receiving all the selected preventive practices included age, education, health insurance, prescription drug coverage, duration of diabetes, number of chronic conditions and smoking status. Similar results were observed among adults with multimorbidity. Among adults with CKD, those with private insurance and drug prescription coverage were more likely to receive the recommended practices. The findings suggest low adherence to receiving all five recommended practices. It is crucial to increase the awareness about the need for all the recommended practices among adults with diabetes.

ORGANIZATION OF UNDERGRADUATE TRAINING OF DOCTORS FOR THE WORK WITH THE POPULATION ON PROMOTING A HEALTHY LIFESTYLE AND A COMMITMENT TO MEASURES OF MEDICAL PREVENTION

The research includes the assessment of the lifestyle factors of the major players of the educational process (students and teachers) in the modern medical school, the analysis of sources of knowledge on a healthy lifestyle and preventive measures, the awareness of a healthy lifestyle; the development and testing of new educational programs for training students and teachers, developing tactics on improving medical education to meet practical needs of the network of health care facilities and institutions of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor). Medical and sociological studies of lifestyle factors of students showed 62.9% of respondents to have insufficient sleep duration. Lack of exercise is the second most frequent factor(51.7%). 31.1% of students noted disturbances of the dietary pattern. 20.0% of the surveyed students were cigarette smokers. 12.7% of students regularly gambled mostly with the use a computer. 2.8% of respondents admitted that they regularly used drugs and 1.7 % of respondents drank alcohol every day. The data obtained show the lifestyle of a substantial proportion of the future doctors to be failed to be considered healthy. Analysis of the sources of students’ knowledge on a healthy lifestyle shows 59.9% of them to gain knowledge in the process of becoming a doctor, 42.7% - from specialized professional literature. However, a substantial proportion of the students receive the information about the preventive health care measures from the nonprofessional sources. For the improvement of the educational process and preservation of health of major players we consider a comprehensive interdisciplinary program that includes specialized courses for the first and fifth year students, advanced training sessions for teachers and the consolidated program on preventive health care and health promotion in all disciplines of undergraduate training to be necessary.

Risks of Living Kidney Donation: Current State of Knowledge on Outcomes Important to Donors.

In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.

Pharmacogenetics: Ethics and Public Policy

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Adherence to Preventative Health Care Measures in Inflammatory Bowel Disease Patients Is Low

Introduction: Prior studies have shown that preventative health issues are neglected in patients with inflammatory bowel disease. In 2017, the American College of Gastroenterology (ACG) published comprehensive 14-point guidelines regarding preventive care measures (PCMs) in IBD. The adherence to these guidelines has not been assessed. We aimed to evaluate adherence to PCMs outlined by ACG in IBD patients at our center. Methods: We conducted retrospective quality improvement study including IBD patients who had received care at our gastroenterology outpatient clinics between September, 2017 to October, 2017. Baseline patient characteristics and data regarding adherence to preventative health care measures was noted. Results: A total of 94 patients were included. Mean age was 47.6 years and 34% were males. 49% of the patients had Crohn's disease (CD), while 51% had ulcerative colitis. 58.5% of the patients were on long-term steroids, while 45.7% and 44.6% of the patients were on immunomodulators and biologics respectively. Majority of the patients (88%) had a PCP, and 56.6% of the female patients were established with a gynecologist. Adherence with appropriate PCMs as indicated was: Influenza 58.5%, pneumococcal: 56.3%, herpes zoster 19.5%, varicella zoster 11.6%, meningococcal 100%, Tetanus, Diphtheria and Pertussis (Tdap) 55.3%, HAV: 58.5%, HBV 80.5%, HPV 80%, depression screening: 55.3%, melanoma screening: 30.8%. In women on immunosuppressive therapy, 51.6% underwent annual cervical cancer screening, and 33.3% of patients on immunomodulators had non-melanoma skin cancer screening. Bone mineral density testing was performed 67.2% of patients in whom it was indicated, and smoking cessation was advised to 76.9% of CD patients who used tobacco. Conclusion: Despite comprehensive guidelines, PCMs in IBD patients continue to be neglected. There continues to be debate whether preventative care in IBD is best addressed by PCP or gastroenterologists. Although our sample size is small, our results demonstrate significant room for improvement. There is a trend towards better preventive care in patients with IBD who have a PCP in addition to a gastroenterologist. Our next steps include: feedback to our physicians regarding adherence to PCMs, development of electronic health record reminders, and placing flyers in patient rooms. We plan to collect post-intervention data to assess if our interventions lead to improvement in preventive health care delivery to IBD patients.619_A Figure 1. Adherence to preventive care measures in patients with IBD619_B Figure 2. Comparison between gastroenterology fellow and faculty in regards to adherence to preventive care measures in IBD

Validation of a risk stratification tool for a Hospital Outreach Medication Review (HOMR) program.

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources. To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review. A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively. 235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25). Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Intervention for diabetes patients in Indonesia: A mixed methods study

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.