Reduce Hospital Visits Research Articles

1700P Perception and attitudes of Italian physicians towards the management of checkpoint inhibitors in oncology during COVID-19 outbreak: Results from a national survey

During the COVID-19 outbreak oncological care has been reorganized to face the emergency. Cancer patients have been reported to be at higher risk of severe events related to SARS-CoV-2. Moreover, there are concerns of a possible interference between immune checkpoint inhibitors (ICIs) and the pathogenesis of the infection. A 22-item questionnaire was shared with Italian physicians managing ICIs, between May 6 and 16, 2020. This survey aimed at exploring the perception about SARS-CoV-2 related risks in cancer patients receiving ICIs, and whether the management of these patients has been modified during COVID-19 outbreak. Respondents were 104, with a median age of 35.5 years, mainly females (58.7%), mainly working in Northern Italy (71%). 47.1% of respondents were afraid that a synergism could exist between ICIs mechanism of action and SARS-CoV-2 pathogenesis, leading to worse outcomes. 97.1% of respondents would not deny an ICI only for the possible occurrence of COVID-19. Measures for reducing hospital visits have been adopted by choosing the ICIs schedule with fewer administrations, adopting the highest labeled dose of each drug (55.8%) and/or choosing, among different ICIs for the same indication, the one with the longer interval between cycles (30.8%). 53.8% of respondents suggested the need to test for SARS-CoV-2 every cancer patient candidate to ICIs. Regarding differential diagnosis between immune-related adverse events (irAEs) and COVID-19 manifestations, 71.2% of respondents declared to manage a patient with onset of dyspnea and cough like a COVID-19 patient until otherwise proven (ie, waiting for the result of SARS-CoV-2 test before doing other diagnostic or therapeutic procedures); however, 96.2% did not reduce the use of steroids to manage irAEs during the pandemic. No major impact of COVID-19 on physicians’ attitudes towards the use of ICIs to manage specific clinical situations in different cancer types (ie, lung, breast, melanoma, urothelial) was observed. These results highlight the uncertainty of physicians dealing with ICIs in cancer patients during COVID-19 outbreak, supporting the need of dedicated studies on this regard.

Telemedicine for Women's Health During COVID-19 Pandemic in India: A Short Commentary and Important Practice Points for Obstetricians and Gynaecologists.

Background/purpose of studyIn view of restrictions on patients because of COVID-19 pandemic, face-to-face consultations are difficult. This short commentary tells us about the feasibility of telemedicine in this scenario in obstetrics and gynaecology.MethodsThe database from our teleconsultation application (Apollo 247 and Askapollo) was analysed to assess feasibility of telemedicine and to design a triage pathway to reduce hospital visits for non-emergency situations and also to identify emergency cases without delay during this lockdown phase. Existing guidelines by Ministry of Health and Family Welfare (MOHFW), Government of India, were accessed.ResultsThis was a single-doctor experience of 375 consultations done over 65 days. We also designed a triage pathway for obstetrics and gynaecology cases, and we discussed general practice for obstetricians and gynaecologists with its utility and limitations.ConclusionTelemedicine has provided us the opportunity to manage women health problems and pregnancy concerns during this pandemic of COVID-19, except a few instances where face-to-face consultation or hospital visit is must. If we implement the triage pathway, we can minimize the risk of exposure for both patients and healthcare teams during COVID-19 pandemic.

Italian survey on managing immune checkpoint inhibitors in oncology during COVID-19 outbreak.

BackgroundDuring COVID‐19 outbreak, oncological care has been reorganized. Patients with cancer have been reported to experience a more severe COVID‐19 syndrome; moreover, there are concerns of a potential interference between immune checkpoint inhibitors (ICIs) and SARS‐CoV‐2 pathogenesis.Materials and methodsBetween 6 and 16 May 2020, a 22‐item survey was sent to Italian physicians involved in administering ICIs. It aimed at exploring the perception about SARS‐CoV‐2‐related risks in cancer patients receiving ICIs, and the attitudes towards their management.ResultsThe 104 respondents had a median age of 35.5 years, 58.7% were females and 71.2% worked in Northern Italy. 47.1% of respondents argued a synergism between ICIs and SARS‐CoV‐2 pathogenesis leading to worse outcomes, but 97.1% would not deny an ICI only for the risk of infection. During COVID‐19 outbreak, to reduce hospital visits, 55.8% and 30.8% opted for the highest labelled dose of each ICI and/or, among different ICIs for the same indication, for the one with the longer interval between cycles, respectively. 53.8% of respondents suggested testing for SARS‐CoV‐2 every cancer patient candidate to ICIs. 71.2% declared to manage patients with onset of dyspnoea and cough as infected by SARS‐CoV‐2 until otherwise proven; however, 96.2% did not reduce the use of steroids to manage immune‐related toxicities. The administration of ICIs in specific situations for different cancer types has not been drastically conditioned.ConclusionsThese results highlight the uncertainties around the perception of a potential interference between ICIs and COVID‐19, supporting the need of focused studies on this topic.

Written Asthma Action Plan in Emergency Department Improves Knowledge and Asthma Control among Adult Acute Asthma Patients

Self-management of asthma using the written asthma action plan (WAAP) is important in ensuring effective management of asthma as it reduces hospital visits. This study evaluates the improvement in knowledge and asthma control using WAAP among adult patients with acute asthma presenting to Emergency Department (ED). This randomized control trial was conducted over a 19-month period in an ED of a university hospital. Adult patients with acute mild to moderate asthma were included in the study. Patients were randomized into intervention and control group. A self-administered knowledge questionnaire was distributed to all patients. Both groups received asthma counselling guided by asthma flyers. The intervention group was further counselled on individualized WAAP. The control group received standard verbal advice upon discharge. Subsequently at 1 month and 3 months a follow up was conducted. Knowledge and asthma control were assessed via a telephone survey. Fifty patients were assigned randomly to intervention (WAAP) and control group. Each group received 25 patients. The knowledge score of the intervention group was significantly more than the control group (16.88+0.44 vs 13.36+3.72; p 19) at 1 month compared to control group (20.64+3.26 vs 17.72+4.17). Both groups achieved good control at 3 months follow up. Self-management with WAAP in ED improves knowledge and asthma control among acute mild to moderate asthma patients.

CD34+ cell therapy significantly reduces adverse cardiac events, health care expenditures, and mortality in patients with refractory angina.

Patients with refractory angina who are suboptimal candidates for further revascularization have improved exercise time, decreased angina frequency, and reduced major adverse cardiac events with intramyocardial delivery of CD34+ cells. However, the effect of CD34+ cell therapy on health care expenditures before and after treatment is unknown. We determined the effect of CD34+ cell therapy on cardiac‐related hospital visits and costs during the 12 months following stem cell injection compared with the 12 months prior to injection. Cardiac‐related hospital admissions and procedures were retrospectively tabulated for patients enrolled at one site in one of three double‐blinded, placebo‐controlled CD34+ trials in the 12 months before and after intramyocardial injections of CD34+ cells vs placebo. Fifty‐six patients were randomized to CD34+ cell therapy (n = 37) vs placebo (n = 19). Patients randomized to cell therapy experienced 1.57 ± 1.39 cardiac‐related hospital visits 12 months before injection, compared with 0.78 ± 1.90 hospital visits 12 months after injection, which was associated with a 62% cost reduction translating to an average savings of $5500 per cell therapy patient. Patients in the placebo group also demonstrated a reduction in cardiac‐related hospital events and costs, although to a lesser degree than the CD34+ group. Through 1 January 2019, 24% of CD34+ subjects died at an average of 6.5 ± 2.4 years after enrollment, whereas 47% of placebo patients died at an average of 3.7 ± 1.9 years after enrollment. In conclusion, CD34+ cell therapy for subjects with refractory angina is associated with improved mortality and a reduction in hospital visits and expenditures for cardiac procedures in the year following treatment.

Clinical pathways for urology patients during the COVID-19 pandemic.

The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose the implementation of nasopharyngeal swabs, we recommend that an accurate triage for COVID-19 symptoms be performed both by telephone at home before hospitalization and at the time of hospitalization. We recommend that during hospital stay patients should be provided with as many instructions as possible to facilitate their return to, and stay at, home. Patients should be discharged under stable good conditions in order to minimize the risk of readmission. It is advisable to reduce or reschedule post-discharge controls and implement an adequate system of communication for telemonitoring discharged patients.

COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons.

BackgroundA mysterious cluster outbreak of pneumonia in Wuhan, China in December 2019 was traced to Severe Acute Respiratory Syndrome Coronavirus 2 and declared a Pandemic by WHO on 11th March 2020. The pandemic has spread rapidly causing widespread devastation globally.PurposeThis review provides a brief understanding of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge as well as best practices for orthopaedic surgeons. These are likely to change as knowledge and evidence is gained.ResultsOrthopaedic surgeons, like other front-line workers, carry the risk of getting infected during their practice, which as such is already substantially affected. Implementation of infection prevention and control as well as other safety measures for health care workers assumes great importance. All patients/visitors and staff visiting the hospital should be screened. Conservative treatment should be the first line of treatment except for those requiring urgent/emergent care. During lockdown all elective surgeries are to be withheld. All attempts should be made to reduce hospital visits and telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned authorities. All patients being admitted to the hospital in and around containment zones should be tested for COVID-19. There are special considerations for anaesthesia with preference for regional anaesthesia. A separate Operation room with specific workflow should be dedicated for COVID-19 positive cases.ConclusionsDespite the magnitude of challenge, the pandemic offers significant lessons for the orthopaedic surgeon who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai.Electronic supplementary materialThe online version of this article (10.1007/s43465-020-00135-1) contains supplementary material, which is available to authorized users.

Caring for patients with cancer in the COVID-19 era.

The current COVID-19 pandemic challenges oncologists to profoundly re-organize oncological care in order to dramatically reduce hospital visits and admissions and therapy-induced immune-related complications without compromising cancer outcomes. Since COVID-19 is a novel disease, guidance by scientific evidence is often unavailable, and impactful decisions are inevitably made on the basis of expert opinions. Here we report how the seven comprehensive cancer centers of Cancer Core Europe have organized their healthcare systems at an unprecedented scale and pace to make their operations 'pandemic proof'. We identify and discuss many commonalities, but also important local differences, and pinpoint critical research priorities to enable evidence-based remodeling of cancer care during the COVID-19 pandemic. Also, we discuss how the current situation offers a unique window of opportunity for assessing the effects of de-escalating anticancer regimens, which may fast-forward the development of more-refined and less-toxic treatments. By sharing our joint experiences, we offer a roadmap for proceeding and aim to mobilize the global research community to generate the data that are critically needed to offer the best possible care to patients.

Clinical Pharmacy Services in Older Inpatients: An Evidence-Based Review.

Hospital admissions in older adults are frequently drug related and avoidable. Clinical pharmacy interventions during hospital stay might reduce drug-related harm and reduce hospital visits. Moreover, several recent positive clinical pharmacy investigations incorporated a transitional care component to further improve medication use after discharge. It is currently unclear what the strength of evidence is and what the exact components should be of such clinical pharmacy interventions in older adults. An evidence-based review was performed to determine the status of the evidence and also to explore whether a clinical pharmacy intervention incorporating transitional care was associated with reduced hospital visits after discharge. Prospective controlled investigations were included if they contained a clinical pharmacy intervention that was initiated before discharge in older inpatients. Relevant quasi-experimental and randomized controlled trials were searched in MEDLINE. First, an evidence-based review was performed, including a description of the study design, characteristics, and outcomes. Major components of successful clinical pharmacy interventions were described and potential implications for clinical practice and research were determined. Second, the Fisher's exact test was used to explore the association between transitional care and reduced hospital visits. Third, based on these findings, a medication review proposal was developed to improve medication use in older adults. Thirty-five studies were included, with 26 randomized controlled trials. Median patient follow-up after discharge was 90days (interquartile range 37-180days) and investigators enrolled a median of 210 (interquartile range 110-498) study participants. On average, patients were aged 77.5years (interquartile range 73-82.2years). Nine randomized controlled trials had sufficient power to detect a reduction in hospital visits after discharge; this was reduced in three randomized controlled trials. Post-discharge follow-up was not associated with reduced post-discharge hospital visits (20 randomized controlled trials: follow-up vs. no follow-up: 6/11 vs. 1/9, p = 0.070). There was a significant reduction in post-discharge hospital visits in patients aged 75years or older (12 randomized controlled trials: follow-up vs. no follow-up: 5/7 vs. 0/5, p = 0.028). A medication review proposal was developed, consisting of six steps. Three powered randomized controlled trials were identified that found a significant association between a pharmacist-led intervention in older adults and a reduction in post-discharge hospital visits. In clinical practice, an intervention consisting of medication reconciliation, review, counseling, and post-discharge follow-up should be provided to such high-risk inpatients. Regarding research priorities, large, multi-center randomized controlled trials should be performed to generate more evidence on the impact of clinical pharmacy interventions on the patient trajectory and economic outcomes.

Management of geriatric cancer patients during the COVID-19 pandemic

Physiological vulnerabilities greatly impact the outcome of coronavirus disease 2019 (COVID-19) infection. The COVID-19 infection results in far more serious illness in patients with compromised physiological reserve (older patients, infants, and pregnant women) and in those with preexisting or poorly controlled comorbidities. The COVID-19 infection can be life-threatening in older patients with cancer, but there are no standard guidelines or individual hospital data regarding methods or policies implemented to guide clinicians. Evolving clinical experience suggests that cancer patients with COVID-19 have more serious complications, such as intensive care admission from severe pneumonia or sepsis and a greater case fatality rate. Cancer history portends the highest risk of serious events. Considering the evidence for a clear association for older age and higher levels of comorbidity with more severe COVID-19 symptoms and adverse outcomes, the concept of risk mitigation is highly relevant to older patients with cancer. Chronological age alone cannot be relied on to ascertain the true biological status of an individual, and a comprehensive geriatric assessment (CGA) provides a multidisciplinary diagnostic process that encompasses several objectively evaluable domains to reliably and objectively assess medical, psychosocial, and functional limitations. With formal assessment tools, previsit questionnaires and appropriate training can reduce this burden on the clinician performing the initial CGA. This would enhance overall capabilities in reliable use of recommendations regarding treatment for comorbidities, geriatric syndromes, supportive care, drug interactions, and toxicities. Routine use of CGA would mitigate most of the risks related to biological vulnerability. Measures to reduce hospital visits such as shorter radiotherapy fractionation and conversion of intravenous to oral systemic regimens can be considered. Proactive discussions regarding end-of-life and hospice care at isolation facilities should be discussed in the management of older patients with cancer and COVID-19 infection. Oncologists should make an extra effort to educate and provide additional guidance to help patients and caretakers making hard decisions regarding withholding anticancer treatment to mitigate the risk of viral infection.

Mobile health application to support CPAP therapy in obstructive sleep apnoea: design, feasibility and perspectives

BackgroundCurrent continuous positive airway pressure (CPAP) devices can be monitored remotely; however, in-person visits are kept for clinical follow-up in order to promote CPAP use and resolve potential side-effects. Mobile health is a promising way to provide remote and easy clinical control for CPAP follow-up and support. We aimed to evaluate the feasibility and acceptance by obstructive sleep apnoea (OSA) patients and healthcare professionals of a newly designed mobile app (Appnea-Q) to promote clinical control through a self-monitoring tool for patients with CPAP supervised by sleep professionals.MethodsAppnea-Q incorporates a simple follow-up questionnaire with automated responses, together with frequent problems and lifestyle recommendations sections. Feasibility, acceptance and usefulness were assessed. First, an internal validation was performed during outpatient CPAP follow-up visits with sleep professionals from various sleep units. Second, an external validation was performed in a subgroup of 15 patients at home.ResultsMost patients (n=75) considered the app useful and were willing to use it and recommend it (72–88%). Up to 64.87% agreed on its capacity to reduce hospital visits. Appnea-Q was rated as acceptable (79.37±19.29) by the system usability score. Sleep professionals (n=30) concurred on its usefulness for OSA patient follow-up, particularly during the first month of CPAP therapy. The external validation showed its feasibility among 11 out of 15 patients and their data were received accordingly on the professionals' web platform.ConclusionsAccording to our validation process, and the viewpoints of the patients and professionals, our new mobile app is a feasible and well-received tool for personal OSA management. Future clinical trials should substantiate its performance and cost-effectiveness in the clinical arena.

Remote Heart Beat Monitoring System

There is an increased prevalence of heart diseases in developing countries and continuous monitoring of heart beats is very much important to reduce hospital visits, health costs and complications. The Internet of Things (IoT) equipped with microcontrollers and sensors can give an easy and cost-effective remote health monitoring. We developed a Heart Beat monitoring module based on an android application. The software involved was the Android Application developed using Android Studio, which is the Integrated Development Environment (IDE). This app retrieved the data from the open IoT platform thingspeak.com. A highly sensitive Pulse Sensor was used to measure the heartbeat of the patient automatically. An Arduino Uno microcontroller interfaced with a Wi-Fi module ESP8266 used to transmit pulse reading over the internet using Wi-Fi. The heartbeat was displayed on the LCD of the patient in run-time. The heartbeat in beats per minute (BPM) was plotted against time (minutes). A mounted pulse sensor to the patient had monitored the heartbeat and transmitted it in the form of voltage signal to the microcontroller, which converted it back into a mathematical value. The Arduino transmitted the data onto the thingspeak.com portal, where it was plotted on a graph and the values were stored for future assessment. The user of the app was given a things peak API and the channel number as an access code, through which physician or nurse can accessed the patient’s data. IoT based heartbeat module as an android application can provide a convenient, cost effective and continuous remote measurements for heart patients to help physicians and nurses update. This app can reduce the burden of hospital visits or admissions for elderly patients.

The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident's Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits.

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents’ healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40–49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.

1384-P: The Guided Transition of Care

Objective: Every year 500,000 youths in the U.S. with chronic disease need transfer to adult providers. Diabetes is a model of chronic illness that transcends age. For those with type 1 diabetes (T1D), 58% report a bad transition experience, the majority change adult providers and there is a 21% drop in clinic visits. Retrospective studies show unstructured transfers result in worse A1c. Despite the need, there is a lack of evidence-based interventions on the organization of care. Meta-analysis established engagement and retention in adult care as appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospital visits. We hypothesized that a physician trained in both adult and pediatric endocrinology would have greater show rates for patients transferred to adult care if he or she first provides care to the patient in the pediatric clinic. In this “guided transition” the doctor continues caring for the patient from pediatric to adult clinic. Methods: We conducted a prospective cohort study of patients with T1D, age 16-26 years, referred to adult T1D clinic and seen by a physician trained in adult and pediatric endocrinology. Patients were grouped based on if their referral originated from another pediatric endocrinologist or if the dual-trained physician previously saw the patient in the pediatric T1D clinic. Transfer to adult care occurred when physician and patient felt it appropriate. The primary outcome was show rate at the first and second adult visits. Results: Of 22 patients, 9 were referred from a different pediatric endocrinologist and 13 underwent guided transition. Both groups had similar initial A1c (p = 0.54). For patients seeing a different pediatric provider, the show rate to the first and second visit was 44% compared to 100% in the guided transition group (p = 0.003). The guided transition group maintained A1c (p = 0.79). Conclusions: The guided transition group was significantly more likely to attend adult clinic than those seeing the provider for the first time. These findings deserve broader replication. Disclosure R. Lal: Consultant; Self; Abbott. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. C. Dosiou: None. T. Aye: None. M. Basina: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007217)

Healthcare service utilization and work-related productivity in reflexology intervention for advanced breast cancer women.

This project's purpose was to determine the effects of a home-based reflexology intervention on symptom-related use of health services and work-related productivity during the 11-week study. A total of 256 patients were randomized to four weekly reflexology sessions (each lasting 30min, delivered by lay caregivers who received two training sessions by a professional reflexologist) or attention control. The Conventional Health Service and Productivity Costs Form was used to collect information on health service utilization and out-of-pocket expenditure of symptom management. The Health and Work Performance Questionnaire was used to measure workplace performance for patients during the study period. We used weighted and unweighted logistic and linear regression analyses. Patients in the reflexology group were less likely to have hospital visits compared to the control group in the weighted unadjusted (odds ratio [OR] = 0.49; 95% confidence interval [CI] = [0.25, 0.97]), unweighted adjusted (OR = 0.35; 95% CI = [0.16, 0.75]), and weighted adjusted (OR = 0.30, 95% CI = [0.13, 0.66]) logistic regressions. Compared to attention control, patients in the reflexology group had lower relative absenteeism in the unweighted adjusted (- 0.32; 95% CI = [- 0.60, - 0.03]) linear regressions and less absolute presenteeism (15.42, 95% CI = [0.87, 29.98]) in the weighted unadjusted analysis. The reflexology intervention delivered by lay caregivers reduced hospital visits and increased workplace productivity in a short-term period, which has potential for cost saving for health care systems and employers. NCT01582971.

Health Benefits of Ozone Warning System in Three Major Cities of South Korea: A Regression Discontinuity Design

Background:Ozone warning system is operating in cities of South Korea. The first stage warning is issued if 1-hour average of ground-level ozone exceeds 120 ppb. Using a case-crossover design combined with a regression discontinuity design (RDD), this study assessed whether the warning system provides health benefitMethods:Since ozone warnings are alerted independently over zones within a city and individuals were assumed to be exposed to ground-level ozone differently (e.g. due to outdoor activities), a fuzzy RDD was applied to estimate the causal effect of the first stage warning on hospital visits and hospitalizations for allergic rhinitis (J30), asthma (J45), pneumonia (J12-18) and chronic lower respiratory disease (J40-44) in three major cities of South Korea (Seoul, Busan, and Daegu) during the period of 2008-2013. Based on a time-stratified case-crossover design, we applied a conditional Poisson regression with over-dispersion. Temperature, relative humidity, holiday and influenza epidemic were adjusted for. Lag effects up to previous 5 days of exposure were considered.Results:A total of 30, 28, and 21 days exceeded 120 ppb of 1-hour maximum of ground-level ozone in Seoul, Busan, Daegu respectively. The first stage warning led to reductions (intent-to-treat effects) in hospital visits and hospitalizations for allergic rhinitis, asthma, pneumonia and chronic lower respiratory diseases. The decrements differed by the health outcomes and the cities, and ranged from 6.0% (95% CI: -0.6 to -11.1) in hospital visit for asthma in Seoul to 23.4% (95% CI: -0.18 to 41.5) in hospitalization for asthma in Busan We also found evidence on some harvesting effects (i.e. increases of hospital visits and hospitalizations following the initial reductions by the warning).Conclusion:Ozone warning system in South Korea reduces hospital visits and hospitalizations for respiratory diseases.

Multifaceted Pharmacist-led Interventions in the Hospital Setting: A Systematic Review.

Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

P191 RISING INCIDENCE OF IRON DEFICIENCY ANEMIA AND ASSOCIATED COST OF CARE IN HOSPITALIZED PATIENTS OF INFLAMMATORY BOWEL DISEASE IN USA: NATIONWIDE ANALYSIS 2002–2014

Extraintestinal complications are common in IBD, and are reported in more than 25% of patients. Anemia is one of the most common manifestations of IBD. One-third of patients with IBD have hemoglobin levels below 12 g/dL. Although ongoing blood loss from chronically inflamed intestinal mucosa and micronutrient deficiency (iron and B12) are the main mechanisms underlying the development of anemia in patients with IBD, chronic inflammation, hemolysis, and medication-induced myelosuppression may also play important roles. We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (Ulcerative Colitis & Crohn’s disease) with or without iron deficiency anemia (IDA) as primary or secondary diagnosis via ICD 9 codes during the period from 2002–2014. All analyses were performed with the use of SAS (version 9.4). From 2002–2014 there were total 23834 discharges of Ulcerative Colitis (UC) patients and 31998 discharges of Crohn’s Disease (CD) patients with IDA, constituting 9.8% & 7.4% discharges respectively. There was a rising trend of IDA in percentage of discharged patients of IBD from 7.4% in 2002 to 9.2% in 2014. Over the years the median length of stay decreased for IBD patients with and without IDA, but still the length of stay was more in IBD patients with IDA vs without IDA. On Multivariate regression analysis Male gender, age above 50, Hispanic race, small hospital, congestive heart failure, malignancy and metastatic disease were significant predictors of IDA in IBD. This analysis demonstrates the burden of IDA in patients of IBD. In a patient population with the predisposition for anemia, like patients with IBD, early diagnosis and management of iron deficiency can promptly reduce hospital visits, improve quality of life, reduce loss of work, and, ultimately, lower health care costs.

Using home blood pressure monitoring in hypertensive pregnancies could reduce hospital visits

Using home blood pressure monitoring in hypertensive pregnancies could reduce hospital visits

P191 RISING INCIDENCE OF IRON DEFICIENCY ANEMIA AND ASSOCIATED COST OF CARE IN HOSPITALIZED PATIENTS OF INFLAMMATORY BOWEL DISEASE IN USA: NATIONWIDE ANALYSIS 2002-2014

Extraintestinal complications are common in IBD, and are reported in more than 25% of patients. Anemia is one of the most common manifestations of IBD. One-third of patients with IBD have hemoglobin levels below 12 g/dL. Although ongoing blood loss from chronically inflamed intestinal mucosa and micronutrient deficiency (iron and B12) are the main mechanisms underlying the development of anemia in patients with IBD, chronic inflammation, hemolysis, and medication-induced myelosuppression may also play important roles. We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (Ulcerative Colitis & Crohn’s disease) with or without iron deficiency anemia (IDA) as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014. All analyses were performed with the use of SAS (version 9.4). From 2002-2014 there were total 23834 discharges of Ulcerative Colitis (UC) patients and 31998 discharges of Crohn’s Disease (CD) patients with IDA, constituting 9.8% & 7.4% discharges respectively. There was a rising trend of IDA in percentage of discharged patients of IBD from 7.4% in 2002 to 9.2% in 2014. Over the years the median length of stay decreased for IBD patients with and without IDA, but still the length of stay was more in IBD patients with IDA vs without IDA. On Multivariate regression analysis Male gender, age above 50, Hispanic race, small hospital, congestive heart failure, malignancy and metastatic disease were significant predictors of IDA in IBD. This analysis demonstrates the burden of IDA in patients of IBD. In a patient population with the predisposition for anemia, like patients with IBD, early diagnosis and management of iron deficiency can promptly reduce hospital visits, improve quality of life, reduce loss of work, and, ultimately, lower health care costs.