Prescription Rates Research Articles

Medical school ranking and provider outpatient Medicare Part D claims for antibiotics among older patients in the USA.

Our study aimed to assess whether there was a relationship between graduating from higher-ranked medical schools and the rate of prescribing antibiotics among Medicare Part D providers in the USA. The study obtained data from the Medicare Part D Prescribers (FY2013-2021) and the Doctor and Clinicians National repositories. A regression model was fitted to assess the relationship between provider medical school ranking and the rate of antibiotic days supplied per 100 beneficiaries at the provider level. A total of 197 540 providers were included. No association was found between the medical school ranking and the rate of antibiotics days supplied per 100 beneficiaries. Instead, the type of provider is associated with the prescription rates. Hospitalists and Emergency Medicine providers had fewer days supplied per 100 beneficiaries than Family Medicine providers. In contrast, students, more experienced providers (>20 years since medical school graduation) and females had more days supplied per 100 beneficiaries. Our study highlights the need for robust outpatient stewardship interventions and incorporating an outcome-based approach to antibiotic stewardship curricula in medical and mid-level provider schools.

Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA).

The effect of the health insurance type on the prognosis of heart failure (HF) patients in Colombia and Latin America is poorly known. We aimed to analyze the characteristics of HF patients that participated in the Colombian Heart Failure Registry (RECOLFACA) as stated by their health insurance type and their relationship with the immediate prognosis of these patients. Patients with HF diagnosis were included in the RECOLFACA registry between 2017-2019. The registry was conducted in 60 centers in Colombia. All-cause mortality was the principal outcome. To evaluate the impact of health insurance on mortality, a Cox proportional hazards regression model was used. The Kaplan-Meier analysis was performed to compare survival probabilities according to insurance type. All statistical analyses were two-tailed and were considered significant with a p value < 0.05. Of the 2,528 participants enrolled in the registry, 99% held details about their health insurance. Of those, 897 patients (35.6%) were covered by public insurance. These patients were significantly younger, with a lower proportion of men, more frequently from rural origin, and lower prevalence of most comorbidities (omitting hypertension, chronic obstructive pulmonary disease (COPD), and Chagas disease) than those with private insurance. Furthermore, patients with public insurance had a worse functional class, as well as a poorer quality of life, and lower frequency of use of implantable devices, while exhibiting similar prescription rates of triple medical therapy for HF. Finally, no differences in short-term mortality were observed between the two groups (HR 1.09; 95% CI 0.79, 1.51). The type of health insurance represents a condition related with relevant differences in the profile of patients with HF in Colombia. Despite this, no significant differences were detected in the short-term prognosis of these patients based on the type of health insurance.

A complex intervention to reduce antibiotic prescribing in rural China: a cluster randomised controlled trial

Excessive use of antibiotics is a widespread problem. We aim to evaluate the efficacy of a multifaceted intervention for reducing antibiotic use in patients with respiratory tract infections (RTIs). In this two-arm cluster randomized controlled trial, we enrolled patients aged 18+ with symptomatic RTIs at 40 township health centers (THCs) selected from 10 counties in Anhui, China. The THCs were randomized using an online tool ('Sealed Envelope') to intervention or usual care (1:1 ratio), stratified by baseline antibiotic prescribing and with random block sizes (4 or 6). The intervention had five components: a half-day clinician training, a WeChat-based peer support group, a decision aid, a poster commitment letter and a patient leaflet. The primary outcome was whether antibiotics were prescribed at the index consultation. Secondary measures included defined daily dose (DDD), illness recovery rate, re-visits to other care-givers or retail pharmacies and incremental cost-effectiveness ratio (ICER). These measures were analyzed using generalized linear mixed modeling controlling for clustering. The study was registered as ISRCTN30652037. Between December 2021 and September 2022, 1053 patients were recruited (intervention, 21THCs, n=552; control, 19THCs, n=501), using consecutive sampling. Antibiotic prescribing rate was 55.25% and 66.67% in the intervention and control arms (Odds ratio 0.52, 95% confidence interval [CI]: 0.27, 0.98; p=0.044). The intervention group also had lower, significant or non-significant, differences for other markers of antibiotic use: DDD (1.57 vs 2.75); prescriptions of two or more types of antibiotics (9.78% vs 11.58%); obtaining antibiotics from retail pharmacies (3.68% vs 5.78) or from other clinics (2.70% vs 4.05%). The intervention resulted in a cost reduction of 9.265 RMB (1.471 USD) per consultation episode and an ICER of-7769.98 RMB or-1233.33 USD/QALYs. The intervention did not encounter any major adverse event. The intervention package was effective and cost-effective in reducing antibiotics prescribing without adverse effects. The trial was supported by National Natural Science Foundation of China (No. 81861138049) and United Kingdom Research Innovation (No. MR/S013717/1).

Black Race is Associated with Decreased Exposure to Advanced Therapies and Worse Outcomes in Individuals with Ulcerative Colitis.

For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes. We used the TriNetX database for two population-based retrospective analyses with Black (n = 22,519) and Asian (n = 8,626) individuals with UC matched for age, sex, and ethnicity. Outcomes included mortality, medication prescriptions, and clinical encounters at 6 months and 10 years. At 6 months and 10 years after diagnosis, Black people had increased mortality (2.7% vs. 1.9% and 8.1% vs. 6.9%, p < 0.0001), were prescribed fewer UC-specific therapies (21.3% vs. 26.4% and 30% vs. 36%, p < 0.0001), had higher rates of emergency department visits (22.3% vs. 13.6% and 41.2% vs. 31.5%, p < 0.0001), and higher hospitalisation rates (30.1% vs. 25.8% and 42.6% vs. 39.9%, p < 0.0001). At 6 months, they had more opioid prescriptions (18.5% vs. 15.7%, p < 0.0001). Asian people had lower mortality at 10 years (5.6% vs. 7.7%, p < 0.0001), higher rates of UC-specific medications at 6 months (28.6% vs. 26.5%, p = 0.002), and more hospitalizations (38.8% vs. 27.7%, p < 0.0001 at 6 months and 50% vs. 42.2%, p < 0.0001 at 10 years). Black individuals with UC are prescribed fewer disease-specific therapies compared to White individuals and have increased hospitalizations and mortality. Black individuals have higher rates of opioid prescriptions. Opioids have been associated with increased complication rates in inflammatory bowel disease. These trends are not seen in Asian individuals. This reveals critical disparities in the care of Black people with UC with opportunity for targeted interventions.

Systematic Approaches to Optimize Opioid Prescribing in Surgical Patients

The opioid crisis has highlighted the urgent need to optimize pain management strategies in surgical settings, prompting a shift towards opioid-sparing therapies. While opioids are crucial for alleviating moderate to severe postoperative pain, their over prescription poses significant risks, including addiction and overdose. This paper examines the feasibility of achieving opioid-free surgical recovery, particularly for minor and minimally invasive procedures, with the goal of extending this practice to more invasive surgeries through enhanced recovery after surgery (ERAS) programs. It also considers the cultural factors that influence patient expectations regarding pain management in countries with lower opioid prescribing rates, such as Japan and Germany, emphasizing the need for tailored approaches in the United States. The study advocates for the exclusion of opioids at every stage of the perioperative experience, promoting opioid-free anesthesia and analgesia. A framework for optimizing opioid prescribing practices in surgical contexts is proposed, highlighting the vital roles of acute pain specialists and pharmacists in developing comprehensive pain management strategies. By incorporating multimodal analgesia techniques, including non-opioid medications and alternative therapies, healthcare providers can effectively mitigate the risks associated with opioids while ensuring adequate pain relief

Incidence and prognosis of first-ever intracerebral hemorrhage on antiplatelet therapy over 10 years in a population-based stroke registry

The use of antiplatelet therapy (APT) is prevalent among the general population, sometimes without clear indications. We provided updated figures on the incidence and prognosis of first-ever intracerebral hemorrhage occurring on APT (APT-ICH) over 10 years in a population-based stroke registry and investigated the rates of inappropriate APT prescription. We included all cases of first-ever ICH not on anticoagulants from January 2011 to December 2020 in the district of L’Aquila (Southern Italy). Indication to APT was adjudicated according to 2021 European Society of Cardiology (ESC) guidelines for cardiovascular prevention. We included 606 first-ever ICHs, of whom 251 (41.4%) were APT-related. One-hundred-forty-two APT-ICHs (56.6%) occurred in patients without clear indications to APT. While the incidence of non-APT-ICH decreased over time, the incidence of APT-ICH was stable. APT-ICH showed higher 30-day and 1-year case-fatality rates versus non-APT-ICH (44.7% versus 25.6%, 50.6% versus 34.4%; p < 0.001). APT intake was independently associated with higher 30-day case-fatality (HR 1.51, 95%CI 1.03–2.14; p = 0.023). Our findings suggest that APT-ICH exhibits sustained incidence over time and elevated mortality. Urgent initiatives are needed to enhance adherence to established guidelines for APT use. This effort has the potential to mitigate the risk of ICH and to reduce the associated mortality.

Inhalation corticosteroids for COVID-19 - a real world data analysis on guideline adherence.

The recommendation to consider prescribing inhalation corticosteroids to a subgroup of vulnerable COVID-19 patients was added to the Dutch medical guideline on November 11, 2021, and was also adopted by other countries during the pandemic. To evaluate the adherence of general practitioners to this guideline, and whether real-world data quality is sufficient to study the effect of revised guidelines on prescribing behaviour. A retrospective cohort study using Dutch primary care data from the Extramural LUMC Academic Network database, containing patient data of 129 general practices in the Leiden - The Hague area. We performed an interrupted time series analysis to measure the effect of the new guideline on the prescription rate of ICS, accounting for general trend and seasonal fluctuations. Between July 1, 2020 to August 1, 2022, 131,482 patients had 164,098 COVID-19 consultations. During this period, 1,709 patients received 2094 ICS prescriptions for COVID-19. After the guideline update, there was an instantaneous decrease in prescription rate (IRR 0.47, 95% CI 0.32-0.69). Prescription rate in the subgroup of vulnerable patients did not change significantly (IRR 0.93, 95% CI 0.66-1.32), while less vulnerable patients were significantly prescribed less (IRR 0.29, 95% CI 0.14-0.59). The revision to COVID-19 guidelines had significant impact on general practitioners' prescription behaviour soon after publication: prescription rate remained constant for vulnerable patients, while less vulnerable patient were significantly prescribed less often. Using electronic health records it is feasible to assess changes in guideline adherence using interrupted time series.

Opioid prescriptions following behavioral health training among primary care providers

BackgroundOverdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.MethodsWe retrieved information from a publicly insured health program in Southern California on 11,975 patients and 180 primary care providers (PCPs) engaged in care between 2017 and 2021. Of the 180 PCPs, 38 received TNT training and 142 did not. We considered a patient as exposed to the provider’s TNT “treatment” if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of opioid prescriptions per patient per quarter-year as the key independent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification.ResultsPost-TNT training, PCPs prescribed fewer than expected opioids. This result remains robust after controlling for several covariates (coef: − 0.209 ; standard error = 0.052, p < 0.001) as well as after clustering patient observations by provider.ConclusionIn a large Southern California healthcare system, the TNT training program preceded a reduction in primary care providers’ prescription rates of opioids. If replicated in larger samples, a low-cost provider training program has the potential to promote more judicious use of opioids for pain management. We encourage more studies to understand the program’s long-term impact on physician behavior and, potentially, on patient outcomes.

Trends and disparities in antiretroviral therapy prescription rates among US Medicare beneficiaries with HIV.

Our objective was to evaluate antiretroviral therapy (ART) prescription rates over time among US Medicare enrolees with HIV and to describe disparities in ART prescription and associated factors. We constructed successive cross-sectional cohorts including adult enrollees with HIV and fee-for-service coverage and Part D enrolment in US Medicare between 2007 and 2019. We calculated the percentage of receipt of any ART prescription (ART%) in a calendar year by sex, age, and original Medicare entitlement and calculated age-sex standardized ART% over time. We used multivariable logistic regression to assess the association between ART prescription and sociodemographic factors and chronic conditions by age strata (<65, ≥65 years) in 2019. ART% increased over time and was highest among people with HIV aged 50-64 years in 2019: 95% in males and 92% in females. Multivariable analysis showed that female sex was associated with less ART%, with odds ratios (ORs) of 0.65 (95% confidence interval [CI] 0.60-0.70) and 0.34 (95% CI 0.30-0.39), than male sex in those aged <65 and ≥65 years, respectively. The youngest and oldest enrollees had lower ART use (e.g., OR 0.43 [95% CI 0.34-0.54] for 18-29 vs. 50-64 years; OR 0.34 [95% CI 0.30-0.39] for ≥80 vs. 65-69 years). The top conditions associated with less ART included dementia and alcohol use disorder. Other factors included no Part D low-income subsidy, non-Hispanic white race, and Midwest residence. ART use increased over time in US Medicare enrollees. Non-Hispanic white, female, and the youngest and oldest enrollees received less ART. Multimorbidity, substance use, and dementia were associated with less ART use. Research to overcome these disparities is needed.

Medical treatment of primary sclerosing cholangitis: What have we learned and where are we going?

It has proven difficult to establish robust evidence for significant clinical benefits of medical treatment in primary sclerosing cholangitis (PSC). For ursodeoxycholic acid, clinical practice guidelines only offer vague recommendations, leading to a situation of variable prescription rates depending on local reimbursement policies and physician preference. The difficulty in drug development in PSC is partly related to poor understanding of critical disease processes with failure to identify relevant mechanisms of action of putative drugs. The variable disease course, both intra-individually and between individuals, and lack of robust definitions of what success looks like for clinical trials in PSC have also contributed to the negative outcomes of trials performed. In this review article we will discuss these uncertainties and challenges, building on key previous and ongoing clinical trials. Despite the lack of consensus for an ideal phase II and phase III study design, several trials for diverse compounds are currently ongoing, indicating a shift from therapeutic nihilism towards hope for people with PSC. While waiting for robust efficacy data for drugs currently being tested, the current lack of effective interventions should not motivate prescription of compounds to people with PSC based on low-quality evidence.

Effects of shared decision-making on the prognosis of peritoneal dialysis patients

Background: Chronic kidney disease (CKD) patients face critical decisions in choosing kidney replacement therapy such as hemodialysis (HD) or peritoneal dialysis (PD), which significantly affect their quality of life and health outcomes. Recent studies highlight the importance of shared decision-making (SDM) in helping patients understand their treatment options and make informed choices. SDM not only improves patient satisfaction and autonomy but also emphasizes the need for comprehensive pre-dialysis education to support optimal treatment selection. Methods: Among patients with chronic kidney failure from 8 hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, HD conversion, emergency room visits, hospitalization days, and outpatient visits. Results: A significant difference was observed in hospitalization days (P = .0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to HD, survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate. Conclusions: This study emphasizes the benefits of SDM in reducing hospitalization days for PD patients, suggesting its potential role as a guide in future decisions regarding PD. PD provides a particularly beneficial home-based treatment alternative for patients facing challenges with hospital visits, supported by advanced technologies. Overseas, various countries are implementing policies and incentives to promote home dialysis, demonstrating the potential for SDM to enhance patient satisfaction and outcomes in dialysis care globally.

Prospective Drug Utilization Evaluation Analysis in Outpatient Departments with Ear, Nose, and Throat Outpatients: Incorporating Benchmarks and World Health Organization Indicators.

Drug utilization studies are tools for determining the effectiveness of drug use. The aim of the study was to evaluate drug usage patterns in ear, nose, and throat (ENT) outpatient settings by incorporating established benchmarks and World Health Organization (WHO) indicators. A cross-sectional study on drug utilization evaluation (DUE) was conducted on 800 patients from the ENT outpatient department. We gathered data on currently prescribed medications and identified any discrepancies with a thorough analysis. Continuing educational activities such as "dear doctor" letters and personal consultations were used to rectify any irrational prescribing patterns among physicians. The WHO/International Network for Rational Use of Drugs core drug use indicators, specifically prescribing and patient care indicators, and established benchmarks were applied to encourage rational prescribing. The three most common diagnoses were pharyngitis (51.49%), allergic rhinitis (25.11%), and acute suppurative otitis media (21.17%). Montelukast, in combination with levocetirizine (13.77%) and amoxicillin in combination with clavulanic acid (8.81%), was the most frequently prescribed medication. The average number of drugs per prescription was 4.2% (±1.1), with low usage of generic names (33.0%) and suboptimal reliance on the essential drugs list (76.7%). Furthermore, patient care indicators demonstrated room for improvement, particularly concerning consultation times (6 minutes), dispensing times (30 seconds), and drug labeling practices (0% labeled). The DUE improved the prescribing rate of first-line drugs for five diseases and few aspects of prescribing and patient care indicators. There is an overuse of prescribed drugs, a need for more utilization of generic names, and less than optimal use of the essential drugs list. Additionally, shortcomings in patient care were observed, including issues in consultation, drug dispensing times, and labeling. However, DUE effectively improved WHO patient care metrics and the prescription of first-line drugs warranting its implementation.

Prevalence and Persistence of Prescription Opioid Use Following Hospital Discharge After Childbirth: An Australian Population-Based Cohort Study

(Anesth Analg. 2024;138(5):970–979. doi: 10.1213/ANE.0000000000006582) Childbirth accounts for nearly 300,000 hospitalizations a year in Australia and is associated with acute pain. Pain treatment has shown that nonopioid analgesics are effective for mild to moderate pain, and opioids are effective for severe pain; the prescription rate of opioids in Australia is considered high, ranked eighth internationally in 2016. Opioid use has many general risks, but in addition to these the risk of persistent use after being exposed to opioids postpartum are elevated. In the United States, this risk has been shown to be up to 2.5 times higher for those prescribed opioids within a week of a vaginal delivery, along with a 1.5-fold risk of developing opioid use disorder and a 2-fold risk of an opioid overdose. This study was designed to evaluate the prevalence of dispensing of opioid medications following childbirth in Australia, as well as the extent to which individuals experienced persistent opioid use.

Antibiotic Prescribing Decisions for Upper Respiratory Tract Infections Among Primary Healthcare Physicians in China: A Mixed-Methods Approach Based on the Theory of Planned Behavior

Objectives: In China, primary healthcare (PHC) facilities have high antibiotic prescribing rates for upper respiratory tract infections (URTIs), which are primarily viral and self-limited. This study aimed to identify the main factors influencing PHC physicians’ antibiotic decisions for URITs based on the theory of planned behavior. Methods: A convergent mixed-methods study was conducted at 30 PHC facilities across Shaanxi Province, China. A total of 108 PHC physicians completed a five-point Likert Scale questionnaire focused on behavioral components of antibiotic prescribing, including attitudes, subjective norms, perceived behavioral control, belief in past experiences, and prescribing intentions. Twenty-two physicians participated in semi-structured interviews. Results: Respondents had a good awareness of AMR (Mean = 4.49) and a weak belief regarding the benefit of antibiotics (Mean = 2.34). The mean score for subjective norms was 3.36, and respondents had good control over their prescribing behavior (Mean = 4.00). A reliance on past prescribing experiences was observed (Mean = 3.34), and physicians’ antibiotic prescribing intention was 3.40 on average. Multiple linear regression revealed that physicians showing a more favorable attitude towards antibiotics (p = 0.042) and relying more on their past experiences (p = 0.039) had a higher antibiotic prescribing intention. Qualitative interviews indicated that most physicians would consider prescribing antibiotics when facing diagnostic uncertainty. Low utilization of diagnostic tests, limited effectiveness of training programs, inadequate knowledge of guidelines, and lack of feedback on antibiotic prescriptions all contributed to antibiotic overprescribing. Conclusions: PHC physicians in China demonstrated strong intentions to prescribe antibiotics for URTIs when facing diagnostic uncertainty. Beliefs about antibiotics and previous prescribing behavior were significantly linked to prescribing intentions. Multifaceted interventions that focus on facilitating diagnostic tests, improving the quality of training, effectively implementing clinical guidelines, and providing practical feedback on antibiotic prescriptions may help reduce antibiotic overprescribing in China’s PHC facilities.

Early Adoption of Sodium-Glucose Cotransporter-2 Inhibitor in Patients Hospitalized With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

ImportanceSodium-glucose cotransporter-2 inhibitors (SGLT2is) are the first therapy shown to improve clinical outcomes for patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) greater than 40%. Nationwide adoption of SGLT2is in the US since publication of the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction (EMPEROR-Preserved) in August 2021 is unknown.ObjectiveTo examine trends and hospital-level variation in SGLT2i adoption.Design, Setting, and ParticipantsThis cohort study included patients with LVEF greater than 40% who were hospitalized for decompensated HF at 1 of 557 sites in the US between July 1, 2021, and September 30, 2023, from the Get With The Guidelines–Heart Failure registry.Main Outcomes and MeasuresPatient-level trends and site-level variation in prescription rates of SGLT2i at hospital discharge. Site-level variation was quantified using the median odds ratio, which describes the average odds that a patient being treated at one vs another randomly selected hospital would receive SGLT2i therapy at discharge.ResultsOf 158 849 patients (median [IQR] age, 76 [66-85] years; 89 816 females [56.5%]), 22 126 eligible patients (13.9%) with HF and an LVEF greater than 40% were prescribed an SGLT2i at hospital discharge. Quarterly prescription rates increased from 4.2% in July to September 2021 to 23.5% in July to September 2023 (P for trend &amp;amp;lt; .001). SGLT2i prescription was more likely among patients with HF with mildly reduced LVEF (41%-49%) than in those with preserved LVEF (≥50%; 5127 of 27 712 patients [18.5%] vs 16 999 of 131 137 patients [13.0%]; absolute standardized difference, 16.7%). After adjustment for patient characteristics, there was a high variance between hospitals in the rate of SGLT2i prescription (median odds ratio, 2.12; 95% CI, 2.02-2.25). Among 518 hospitals with 10 or more eligible discharges, 11 hospitals (2.1%) discharged 50% or more of their patients with an SGLT2i prescription, while 232 (44.8%) discharged fewer than 10% of eligible patients with an SGLT2i prescription.Conclusion and RelevanceFor patients with HF and an LVEF greater than 40%, discharge prescription of SGLT2is increased from 4.2% to 23.5% during the first 2 years after the EMPEROR-Preserved trial demonstrating treatment benefits; however, these rates varied across US hospitals.

Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery

Study Design: Retrospective cohort study of national database. Objective: This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery. Summary of Background Data: Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery. Methods: Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months. Results: In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P&lt;0.0001), 6 months (OR 1.36, P&lt;0.0001), 12 months (OR 1.36, P&lt;0.0001), and 24 months (OR 1.33, P&lt;0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P&lt;0.0001). Adjacent segment disease (OR 1.54, P&lt;0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P&lt;0.0001 at 24 mo) were also significantly higher in the ADP group. Conclusions: Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications. Level of Evidence: III

Antimicrobial stewardship implementation in primary and secondary tier hospitals in India: interim findings from a need assessment study using mixed method design

Anti-microbial stewardship program (AMSP) is practiced only in tertiary hospitals in India, though, the lower tier hospitals remain the first point of contact in patient care. This study was conducted in lower tier hospitals to calculate antibiotic and multiple antibiotic prescription rate (APR, MPR) for common infections and finding existing strength of health system for optimizing antibiotic prescription. We conducted a cross sectional convergent parallel mix-method study in eight lower tier hospitals of three districts of West Bengal, India. Six hundred OPD prescriptions of UTI, ARI, AUFI, ADD were evaluated. Qualitative data collected through in-depth interviews of medical officers/officers in administrative positions, infection control nurses were analyzed using content analysis method. APR was 63.8% in primary tier hospitals and 60.8% in secondary tier hospitals. The MPR was higher in secondary tier hospital (23.8%). Presence of infection control committee, designated nursing staff, initiation of prescription audit, increased monitoring were identified as few facilitators for future implementation of AMSP in lower tier hospitals. The routine infection control activities of lower tier hospitals are currently delinked from AMR containment measures and thus, customized AMSP needs to be established in these hospitals catering two third of the population of India.

Antimicrobial prescribing practices and factors associated with antimicrobial prescribing in hospitalized COVID-19 patients in Oyo state: A retrospective study.

Proportion of hospitalized COVID-19 patients receiving antimicrobial drug is significantly high despite evidence of low level of actual bacterial co-infection, potentially contributing to poor health outcome and global antimicrobial resistance. A retrospective study was performed on antimicrobial agents prescribed to adult patients with confirmed COVID-19 admitted across three isolation facilities between 1 March 2020 and 30 April 2021 in Ibadan, Oyo state, Nigeria. From individual records, we evaluated patient demographics, COVID-19 risk factors, diagnostic testing, disease severity and antimicrobial utilization. The primary aim was to determine the prevalence of antimicrobial prescription as well as factors associated with antimicrobial prescribing in hospitalized patients with COVID-19 in Oyo state. In total, 271 patients were included in this study. The median age of the population was 51 years (IQR; 32-62 years). The mean duration of hospital admission was 13 days (IQR: 10-14 days). Majority of participants were symptomatic (81.5%). All participants had a COVID-19 PCR test performed and none had bacterial culture performed. All patients received antimicrobial therapy across the entire cohort. The mean DOT per LOT across cohorts was 1.2 for mild cases, 1.4 for moderate cases and 1.3 for severe cases. Factors associated with the number of antimicrobials per prescription were being single (P = 0.02), being below 60 years of age (P = 0.04), mild COVID-19 symptoms (P < 0.001) and diabetes comorbidity (P = 0.03). Given the high rate of antimicrobial prescription and absence of bacteriological culture analysis in these patients, there is risk of development and spread of antimicrobial resistant. Continuous review of antimicrobial prescription is critical in the management of hospitalized COVID-19 patients.

Appropriate Allergic Rhinitis Medications Can Reduce Systemic Steroid Requirement and Prevent Rhinosinusitis.

Background: Allergic rhinitis (AR) is quite common and sometimes it requires systemic steroids and can be accompanied by coronavirus disease-2019 (COVID-19), rhinosinusitis, or asthma. We aimed to determine the comparative effect of different types of AR medications on clinical prognosis in real-world settings. Methods: We used national claims data provided by the National Health Insurance Service in the Republic of Korea. We enrolled 275,895 adult patients who were first diagnosed with AR and started AR medications between 1 January 2018 and 31 December 2018. We classified them into five groups according to the type of AR medication prescribed and analyzed their 3-year follow-up data. Results: The prescription rate of systemic steroids was low in the INCS group (19%), whereas it was 35-40% in other groups. INCS users needed less systemic steroids than other AR medication users (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.452-0.560; p-value < 0.001). The incidence of rhinosinusitis was approximately 11% in the other AR medication group and 6-8% in the other groups. AH (HR, 0.745; 95% CI, 0.616-0.903; p = 0.003), AH-LTRA (HR, 0.667; 95% CI, 0.551-0.808; p < 0.001), and INCS (HR, 0.746, 95% CI, 0.615-0.904; p = 0.003) significantly prevent rhinosinusitis, compared with other AR medication. However, other prognosis factors were not significantly correlated with the type of AR medications. Conclusions: INCS can reduce systemic steroid requirements and AH, AH-LTRA, and INCS prevent rhinosinusitis compared with other AR medications. As choosing an appropriate AR medication can determine the clinical outcomes, clinicians should be careful in prescribing proper AR medications.

BS SO09 - Use of ursodeoxycholic acid in preventing gallstone formation after bariatric surgery – introduction of a new clinical pathway

Abstract Background Rapid weight loss is a risk factor for symptomatic gallstone formation. Managing gallstone disease such as choledocholithiasis can be more challenging after Bariatric Surgery (BS) due to altered anatomy. Ursodeoxycholic acid (UDCA) is a low-cost and low-risk method of reducing the risk of symptomatic gallstone disease and cholecystectomy by almost a third in patients who have had BS. However, it is not yet included in national guidelines for bariatric surgery. We audited prescription rates of UDCA in patients who underwent BS with a view to introducing it into our standard post BS care bundle. Method Data was collected from 30 consecutive patients who underwent a sleeve gastrectomy or Gastric bypass in November and December 2023. The results informed our practice and a UDCA prescribing pathway was developed using evidence from randomized trials. The pathway was circulated to all members of the bariatric service on 17/1/2024 and discussed at the departmental meeting. The audit loop was closed by collecting data from a further 30 consecutive patients. Demographic data, type of operation, BMI, history of gallstone disease, prescribing data and reasons for non-compliance were collected. The compliance rate to the UCDA pathway was expected to be 100%. Results Data was collected from 60 patients (85% female; median BMI 49; median age 45). No patient who could have benefited received UDCA prior to the intervention. After the intervention, 15/30 (50%) of patients were correctly prescribed UDCA. Therefore, correct prescription of UDCA did not meet target compliance rates. No patient was incorrectly prescribed UCDA. Reasons for non-compliance include human error, concern about the size of the tablet, inadequate knowledge about how to administer (e.g. crushing in liquid) and misconceptions of oral intake after BS. Conclusion UCDA can reduce incidence of symptomatic gallstones following BS, yet use of UDCA in bariatric centres in the UK is thought to be low. We discovered that more time should be dedicated to educating the team about administration methods and how it interacts with the current postoperative diet plan. A UCDA pathway and education of bariatric teams can improve compliance with appropriate UDCA prescribing. Further intervention is required and planned in our centre such as utilising e-prescribing as a prompt to include UDCA in the discharge prescription and considering the use of the drug's liquid form in the short term.