Use Of Supportive Medications Research Articles

Disparities in the utilization of supportive care medications among older adults with metastatic pancreatic ductal adenocarcinoma.

51 Background: Inequities in cancer care delivery can profoundly affect access to high-quality treatments and patient outcomes. Supportive care medication use is important for preserving quality of life in older adults with metastatic pancreatic ductal adenocarcinoma (PDAC). Whether there are differences in supportive care medication use by race and sex is unknown. Our objectives were to assess the racial/ethnic and biological sex inequities in use of treatments for pain, depression, and pancreatic insufficiency-related treatments (PERT) among older adults with PDAC. Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked database, to identify Medicare beneficiaries aged 65 and older diagnosed with metastatic PDAC from January 2008 to December 2019. We included those continuously enrolled in Medicare prescription drug benefits in the 6 months before and month of diagnosis. Any use of opioid pain medications, antidepressants, and PERT was identified from diagnosis to the end of the study period (at death, disenrollment, or 12 months). Multivariable regression was used to compare supportive care medications use by racial/ethnic and biological sex groups. Results: There were 29,509 individuals in our sample, with12.9% Black patients, 3.9% Hispanic patients, and 83.2% White patients. The mean age was 76.5 (SD: 7.4) years. Mean follow-up time was 135.4 (SD:117.7) days overall, with the shortest follow-up among Black patients 124 (SD:111.1) days and longest for White patients 137.5 (SD: 118.8) days. Antidepressants were used by 23.8%, opioids by 60.3%, and PERT by 12.4% overall. Within race groups there were limited differences in medication use by sex. However, we observed differences in supportive care treatment use by race and ethnicity. Specifically, relative to White individuals, those who identified as Black were 20% less likely (adjusted risk ratio [aRR]: 0.8, 95% CI:0.74-0.85) to receive antidepressants, 14% less likely to receive opioids (aRR: 0.86, 95% CI:0.84-0.89), and 41% less likely to receive PERT (aRR: 0.59, 95% CI:0.53-0.65). Similar patterns were observed for patients of Hispanic ethnicity, with those individuals being 12% less likely (adjusted risk ratio[aRR]: 0.88, 95% CI:0.89-0.98) to receive antidepressants, 9% less likely to receive opioids (aRR: 0.91, 95% CI:0.87-0.96), and 42% less likely to receive PERT (aRR: 0.58, 95% CI:0.47-0.70). Conclusions: Our preliminary data showed differences in the uptake of supportive care drugs among Black and Hispanic patients relative to White patients. Specifically, these individuals were less likely to start opioid pain medications, antidepressants, and pancreatic enzyme replacement therapy compared to their White counterparts. These findings highlight potential gaps in treatment use that may better support patients facing life-limiting illnesses.

Canadian Expert Recommendations on Safety Overview and Toxicity Management Strategies for Sacituzumab Govitecan Based on Use in Metastatic Triple-Negative Breast Cancer.

Sacituzumab Govitecan (SG) is an antibody-drug conjugate (ADC) comprised of an anti-Trop-2 IgG1 molecule conjugated to SN-38, the active metabolite of irinotecan, via a pH-sensitive hydrolysable linker. As a result of recent Canadian funding for SG in advanced hormone receptor (HR)-positive breast cancer and triple-negative breast cancer (TNBC), experience with using SG and managing adverse events (AEs) has grown. This review presents a summary of evidence and adverse event recommendations derived from Canadian experience, with SG use in metastatic TNBC for extrapolation and guidance in all indicated settings. SG is dosed at 10 mg/kg on day 1 and day 8 of a 21-day cycle. Compared to treatment of physicians' choice (TPC) the phase III ASCENT and TROPiCS-02 studies demonstrated favorable survival data in unresectable locally advanced or metastatic TNBC and HR-positive HER2 negative metastatic breast cancer, respectively. The most common AEs were neutropenia, diarrhea, nausea, fatigue, alopecia, and anemia. This review outlines AE management recommendations for SG based on clinical trial protocols and Canadian guidelines, incorporating treatment delay, dose reductions, and the use of prophylactic and supportive medications.

Clinical phenotype of pulmonary vascular disease requiring treatment in extremely preterm infants

BackgroundPulmonary vascular disease (PVD) and pulmonary hypertension (PH) is a significant disorder affecting prognosis of extremely preterm infants. However, there is still a lack of a consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of newborn (PPHN), early PH, and late PH. To investigate PH in extremely preterm infants, this study compared the baseline characteristics, short-term outcomes, and treatment duration, categorized by the timing of requiring PH treatment.MethodsThis study retrospectively analyzed extremely preterm infants admitted to a single tertiary center. Between 2018 and 2022, infants with clinical or echocardiographic diagnosis of PH who required treatment were divided into three groups based on the timing of treatment initiation: initial 3 days (extremely early-period), from day 4 to day 27 (early-period), and after day 28 (late-period). The study compared the outcomes, including mortality rates, bronchopulmonary dysplasia (BPD) severity, PH treatment duration, and oxygen therapy duration, among the three groups.ResultsAmong the 157 infants, 67 (42.7%) were treated for PH during their stay. Of these, 39 (57.3%) were treatment in extremely early, 21 (31.3%) in early, and seven (11.4%) in late periods. No significant differences were observed in maternal factors, neonatal factors, or morbidity between the three groups. However, infants who received extremely early-period treatment had a higher mortality rate, but shorter duration of noninvasive respiratory support, oxygen therapy, and PH medication use. On the other hand, the late-period treatment group received longer durations of respiratory support and treatment.ConclusionsThis study revealed differences in mortality rates, respiratory outcomes, and treatment duration between the three groups, suggesting varying pathophysiologies over time in extremely preterm infants.

Medication Management Difficulty, Medication Nonadherence, and Risk of Hospitalization Among Cognitively Impaired Older Americans: A Nationally Representative Study.

Effective disease management in older adults relies on medication adherence to prevent adverse outcomes like hospitalization, particularly among those with cognitive impairment. In this study, we examined the impact of cognitive impairment on medication management, adherence, and hospitalization risk across levels of cognitive function. Analyzing data from 28,558 community-dwelling older adults, we found that those with dementia had the most difficulty managing medications (13.12%), followed by cognitive impairment without dementia (5.80%), and intact cognition (1.96%). Only persons with dementia showed a significant association between medication management difficulty and hospitalization risk (Odds Ratio [OR] = 1.71; 95% Confidence Intervals: 1.08, 2.70; p = .02). Cost-related medication nonadherence was associated with hospitalization risk solely among those with intact cognition (OR = 1.25; 95% CI: 1.07, 1.45; p = .004). Dementia was associated with higher odds of medication management difficulty and subsequently hospitalization risk, underscoring the need for resources to support medication use for this population.

The future is now: Implementation of standard of care, preemptive pharmacogenomic testing in patients with gastrointestinal cancers.

1546 Background: Preemptive germline pharmacogenomic (PGx) testing provides insight into the safety of high-risk chemotherapy and effective use of supportive care medications in gastrointestinal (GI) cancers. Advances in clinical practice guidelines and clinician support have accelerated the appetite for PGx testing, particularly for drugs with severe adverse reactions. The objective of this study was to assess operational outcomes associated with end-to-end electronic health record (EHR) integration of standard of care, preemptive multigene PGx testing in patients with GI cancers. Methods: Patients in two UCHealth GI oncology clinics were tested for five PGx genes related to 5-fluorouracil (5-FU, DPYD), irinotecan ( UGT1A1), and supportive care therapies ( CYP2C19, CYP2D6, CYP2C9). The PGx test order was embedded in all GI oncology treatment plans. Patient samples were genotyped, and PGx results were returned as discrete data to the EHR. Automated clinical decision support (CDS) tools provided PGx-guided recommendations at the point of prescribing. We leveraged the EPIS process framework and evaluated operational outcomes such as number of patients tested, lab turnaround time, patients with actionable phenotypes, and number of CDS alerts and clinical actions. Results: The analysis included 89 patients who received results for DPYD/UGT1A1 and 83 patients who received results for supportive care genes. Among samples tested, DPYD/UGT1A1 and supportive care gene results were returned to the EHR in an average of 4.7 ± 2 days (range 1-8) and 17.3 ± 3 days (range 9-24), respectively. The number of patients with abnormal phenotypes, defined as poor metabolizers for UGT1A1 and any non-normal phenotypes for the other genes, were UGT1A1, n=10 (11.2%); DPYD, n=4 (4.5%); CYP2C19, n=43 (51.8%); CYP2D6, n=31 (41.3%; 8 uninterpretable results); and CYP2C9, n=19 (22.9%). This equated to 14/89 (15.7%) and 68/83 (81.9%) patients having an abnormal result for DPYD/UGT1A1 and at least one supportive care gene, respectively. CDS alerts fired for 32 drug-gene interactions for 25 distinct patients. Of the alerts, 7 (21.9%) were for 5-FU or irinotecan, which showed for 7/89 patients (7.9%); 25 (78.1%) were for supportive care medications, which showed for 23/83 patients (27.7%). There were 9 clinical actions taken in response to the PGx alerts, 7 (77.8%) for 5-FU or irinotecan and 2 (22.2%) for supportive care drugs. Appropriate clinical actions were taken for 100% of patients with 5-FU or irinotecan drug-gene interactions. Conclusions: End-to-end EHR integration of PGx testing and prescribing guidance facilitated clinician adoption of preemptive, standard of care multigene PGx testing, with test results driving important medication changes. Future studies will evaluate the impact of PGx testing on clinical outcomes and cost effectiveness metrics in this population.

Abstract PO5-12-11: Characterizing Symptom Alerts in Different Breast Cancer Regimens: A Remote Symptom Monitoring Study

Abstract Introduction: Remote symptom monitoring is becoming more common in the management of patients on active cancer treatments. The patterns of symptoms and subsequent alerts for specific types of treatment administered as part of standard of care remains unknown. This study aims to characterize the frequencies and types of symptom alerts among breast cancer patients receiving neoadjuvant and adjuvant therapy. Methods: This secondary analysis used data from a hybrid type 2 randomized controlled trial testing the implementation of remote symptom monitoring. For our analysis, we included women with breast cancer receiving (neo)adjuvant therapy. Enrolled patients received remote symptom monitoring surveys within 30 days of treatment initiation at the University of Alabama at Birmingham from 06/2021 to 05/2023. Self-reported symptoms were recorded via weekly electronic surveys for six months. The weekly survey used the PRO-CTCAE measurement tool and patients report frequency, intensity, and interference of the following symptoms: constipation, decreased appetite, diarrhea, cough, insomnia, nausea/vomiting, neuropathy, pain, urinary problems. Symptom alert severity is categorized as either moderate or severe. Self-reported race and treatment regimen (within the first 60 days) were abstracted from the electronic medical record. Regimens were grouped into three categories 1) trastuzumab-containing, 2) any regimen with pembrolizumab, 3) chemotherapy without trastuzumab or pembrolizumab. Descriptive statistics were calculated using frequencies and percentages for categorical variables and medians and interquartile ranges (IQR) for categorical variables. Results: A total of 108 women with breast cancer were included in our analysis. Overall, 54% were of White race, 36.1% were of Black or African American race, and 1.85% were of Asian race. The median age was 54 years (IQR 41-65). Fifty-one percent were prescribed a chemotherapy regimen, 33% trastuzumab-based regimen, and 15% pembrolizumab-based regimen. Symptom alerts were addressed supportively or escalated with nursing and treating oncologist via direct communication with patients. A total of 1438 symptom alerts were triggered with 55% of surveys generating an alert. The most reported symptom alert was pain, accounting for 30% of all alerts. Additionally, of all symptom alerts, 70% were moderate and 30% severe, with similar distributions across regimens. Patients receiving pembrolizumab regimen most often reported moderate pain compared to the other two regimens (35% vs 22% vs 23%). However, severe pain was most often reported by those receiving chemotherapy at 46%, trastuzumab-based regimen at 40%, and pembrolizumab-based regimen at 31%. Furthermore, patients on trastuzumab-based regimens reported severe diarrhea most frequently (11%) compared to 3% & 2% for the other two regimens. Discussion: Symptoms experienced during receipt of (neo)adjuvant breast cancer treatment are common, with the majority being moderate in nature. Differences in symptom profiles were observed across different treatment modalities, consistent with known side effect profiles. The higher prevalence of pain in patients receiving chemotherapy alone may be attributed to the use of growth factors in these regimens. Further exploration is warranted to investigate the use of supportive medications in managing these symptoms. Further evaluations are underway to evaluate how symptom alerts could potentially increase treatment adherence and decrease hospitalizations. Citation Format: Katia Khoury, Nicole Caston, Megan Patterson, Nancy Holmes, Jena Seward, Erica Stringer-Reasor, Nusrat Jahan, Gabrielle Rocque. Characterizing Symptom Alerts in Different Breast Cancer Regimens: A Remote Symptom Monitoring Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-11.

Vincristine-induced adverse events related to body weight in dogs treated for lymphoma.

Traditional dosing of chemotherapy drugs based on body surface area may overdose small dogs, leading to an increased frequency of adverse events (AEs). Evaluate the frequency of hematologic and gastrointestinal AEs in dogs with newly diagnosed lymphoma treated with vincristine weighing ≤15 kg in comparison to dogs weighing >15 kg. We hypothesized that dogs weighing ≤15 kg would experience a higher frequency of AEs. One hundred and thirty-eight dogs with newly diagnosed lymphoma were treated with vincristine. A multicenter retrospective study reviewing hematologic data and medical record information. Complete blood counts were performed no more than 24 hours before vincristine administration and then between 4 and 8 days post-administration. Data were evaluated using logistic regression or ordinal logistic regression. Thirty-eight dogs weighing ≤15 kg and 100 dogs weighing >15 kg were included. The median vincristine dose for both groups was 0.6 mg/m2. Seventeen (12.3%) instances of neutropenia occurred with no significant difference in overall frequency or grade between groups. Thirty initially asymptomatic substage A dogs (29.4%) experienced gastrointestinal AEs. Because of the widespread use of gastrointestinal supportive care medications, statistical comparison between groups could not be performed. Seven instances of hospitalization occurred (5.0%) and the risk of hospitalization did not differ significantly between groups (P = .37). Vincristine dosed at ≤0.6 mg/m2 does not increase the risk of hematologic AEs in dogs weighing ≤15 kg.

Abstract 4816: Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients

Abstract Background: Beyond its well-known lethality, pancreatic cancer (PC) is associated with a wide variety of physical and psychological complications. These complications collectively lead to an increase in symptom burden experienced by patients with PC, as compared to other cancer types, leading to lower health-related quality of life (HRQoL) and worsened clinical outcomes. Reducing symptom burden is often achieved through the use of supportive care medications (SCM). Racial disparities have been described in the use of pain and psychiatric medications but limited research has explored potential disparities in access to and utilization of other SCM among diverse racial and ethnic groups. The goal of this study was to illustrate the presence of racial/ethnic disparities in the treatment patterns of supportive care medications in end-of-life care of PC patients Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database from 2005 to 2017. Participants were identified using ICD9 and ICD10 diagnostic codes. Patients diagnosed with PC and have died in 2005-2007 with more than 1 year of Medicare enrollment before death were included. Logistic regression models to assess the association between use of supportive care medications and race, adjusting for covariates (sex, race, age, marital status, education, income, residence, CCI, year of diagnosis of PC, cancer stage). Results: After the application of the inclusion/exclusion criteria, 74,309 patients were included in the final analysis (White: 72.53%, Black 11.01%, Hispanic 9.60%, Asian/Pacific Islander 6.58%) Racial and ethnic disparities in the use of multiple SCM drug classes were identified. The results are summarized in Table 1. Conclusion: Disparities in the use of SCM were found in patients with PC. Minorities had significantly less use of sleep aids and headache aids, and increased use of cognitive aids and appetite stimulants. AAs also had lower uses of anti-emetics. AA Hispanic Asian SCM Drug Class aOR 95% CI aOR 95% CI aOR 95% CI Anti-emetics 0.77 (0.73, 0.81) 0.98 (0.93, 1.03) 1.01 (0.95, 1.08) Appetite stimulants 1.06 (1.01, 1.11) 1.01 (0.96, 1.06) 1.28 (1.20, 1.36) Cognitive aids 1.38 (1.25, 1.53) 1.04 (0.93, 1.17) 1.11 (0.97, 1.26) Headache aids 0.68 (0.63, 0.74) 0.81 (0.74, 0.87) 0.85 (0.77, 0.93) Sleep aids 0.71 (0.67, 0.75) 0.87 (0.82, 0.92) 0.87 (0.81, 0.93) Citation Format: Olga M. Trejos Kweyete, Yi Guo, Sherise C. Rogers, Lisa Scarton, David L. DeRemer, Chardae L. Whitner, Diana J. Wilkie, John M. Allen. Racial disparities in adjunctive supportive care medication use in pancreatic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4816.

Racial and Ethnic Differences in Psychosocial Care Use Among Adults With Metastatic Breast Cancer: A Retrospective Analysis Across Six New York City Health Systems.

A metastatic breast cancer (mBC) diagnosis can affect physical and emotional well-being. However, racial and ethnic differences in receipt of outpatient psychosocial care and supportive care medications in adults with mBC are not well described. Adults with mBC were identified in the INSIGHT-Clinical Research Network, a database inclusive of >12 million patients receiving care across six New York City health systems. Outpatient psychosocial care was operationalized using Common Procedure Terminology codes for outpatient psychotherapy or counseling. Psychosocial/supportive care medications were defined using Rx Concept Unique Identifier codes. Associations between race/ethnicity and outpatient care and medication use were evaluated using logistic regression. Among 5,429 adults in the analytic cohort, mean age was 61 years and <1% were male; 53.6% were non-Hispanic White (NHW), 21.4% non-Hispanic Black (NHB), 15.9% Hispanic, 6.1% Asian/Native Hawaiian/Pacific Islander (A/NH/PI), and 3% other or unknown. Overall, 4.1% had ≥one outpatient psychosocial care visit and 63.4% were prescribed ≥one medication. Adjusted for age, compared with NHW, Hispanic patients were more likely (odds ratio [OR], 2.14 [95% CI, 1.55 to 2.92]) and A/NH/PI patients less likely (OR, 0.35 [95% CI, 0.12 to 0.78]) to have an outpatient visit. NHB (OR, 0.59 [95% CI, 0.51 to 0.68]) and Asian (OR, 0.36 [95% CI, 0.29 to 0.46]) patients were less likely to be prescribed medications. Despite the prevalence of depression, anxiety, and distress among patients with mBC, we observed low utilization of psychosocial outpatient care. Supportive medication use was more prevalent, although differences observed by race/ethnicity suggest that unmet needs exist.

Abstract B026: Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers

Abstract Background: Pancreatic (PC) and colorectal cancer (CRC) are both cancers of the digestive system, with similar symptom profiles. Neurologic and psychiatric symptoms are commonly seen in multiple types of cancer including PC and CRC. Supportive care medications (SCM) are central to symptom management and improving health-related Quality of Life (HRQoL). Examples of SCM used to manage these symptoms include opioid analgesics, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Racial disparities in clinical outcomes including HRQoL have been reported in PC and CRC, respectively. While racial disparities have been separately described in the use of SCM for PC and CRC, no comparisons of SCM use based on cancer type in racial and ethnic minorities has been performed. The purpose of our study was to explore differences in SCM use among racial and ethnic minorities with PC and CRC, respectively. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a PC or CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or were not a member of racial or ethnic group were excluded from the analysis. We assessed five SCM classes, including opioids, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Prescription claims were specific to patients diagnosed with PC or CRC, and compared by cancer type. Our objective was to characterize the relationship between cancer type and receipt of SCM in racial and ethnic minorities. Results: After assessment of our inclusion/exclusion criteria, 45,502 patients were included in the analysis (PC- 44.9%; CRC- 55.1%). Racial demographics were as follows: Black/African American: 51.5%, Hispanic- 23.6%, Asian- 23.5%, American Indian/Alaska Native: 1.3%. When comparing cancer types, patients with PC were more likely to receive multiple classes of SCM including opioids (Odds Ratio [OR] 2.17, 95%CI: 2.09-2.25), non-opioid analgesics (OR 1.29, 95%CI: 1.22-1.37), antidepressants (OR 1.19, 95%CI: 1.14-1.24), and anxiolytics (OR 1.45, 95%CI:1.37- 1.54). PC patients were less likely to receive antipsychotics (OR 0.77, 95%CI: 0.72- 0.83). Differences were similar when disaggregated by specific race and ethnicity. Conclusion: Among racial and ethnic minorities, patients with PC were more likely to be prescribed multiple classes of SCM used to treat neurologic and psychiatric symptoms, including opioids, non-opioid analgesics, antidepressants, and anxiolytics. The observed results suggests a heavier overall symptom burden for PC in this population. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Chardaé Whitner, Diana J. Wilkie. Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B026.

Potential benefits of combining two long-acting injectable antipsychotic: a retrospective study.

The aim of this study was to evaluate the efficacy and tolerability of the combination of two long-acting injectable antipsychotics (LAIA) in psychiatric disorders, especially in schizophrenia. Eighty-three patients treated with dual LAIA were included in the study by retrospective screening from the hospital registration system. The present study was designed as an observational, retrospective, naturalistic mirror-image study. The number of hospitalizations before and after switching to dual LAIA was compared in patients who received oral antipsychotics and single LAIA during the study period. In addition, it was analyzed which was the preferred dual antipsychotic combination. Of the patients, 44.6% had schizophrenia, 41.0% had schizoaffective disorder, and 14.4% had other psychiatric disorders. The number of patients receiving oral treatment prior to dual LAIA use was 80 (96.4%). Data on dual LAIA regimens showed that 31.3% were receiving paliperidone and aripiprazole, 24.1% were receiving paliperidone and flupenthixol, 18.1% were receiving paliperidone and zuclopenthixol, and 26.5% were receiving the other combinations. After dual LAIA treatment, there was a significant decrease in the number of hospitalizations compared to before (from 5.95 to 0.99, p<0.001). In addition, while the number of patients who did not require hospitalization in the pre-treatment period was 10.8%, it reached 48.1% in the post-treatment period (p<0.001). No significant adverse effect related to the use of dual LAIA was observed in any patient during the treatment period. The use of dual LAIA instead of oral antipsychotics or single LAIA in chronic psychotic patients with poor social support and irregular medication use is thought to reduce hospitalization and related treatment costs and regularize medication use.

Exploring medication safety structures and processes in nursing homes: a cross-sectional study

BackgroundMedication safety is important to limit adverse events for nursing home residents. Several factors, such as interprofessional collaboration with pharmacists and medication reviews, have been shown in the literature to influence medication safety processes.AimThis study had three main objectives: (1) To assess how facility- and unit-level organization and infrastructure are related to medication use processes; (2) To determine the extent of medication safety-relevant processes; and (3) To explore pharmacies’ and pharmacists’ involvement in nursing homes’ medication-related processes.MethodCross-sectional multicenter survey data (2018–2019) from a convenience sample of 118 Swiss nursing homes were used. Data were collected on facility and unit characteristics, pharmacy services, as well as medication safety-related structures and processes. Descriptive statistics were used.ResultsMost of the participating nursing homes (93.2%) had electronic resident health record systems that supported medication safety in various ways (e.g., medication lists, interaction checks). Electronic data exchanges with outside partners such as pharmacies or physicians were available for fewer than half (10.2–46.3%, depending on the partner). Pharmacists collaborating with nursing homes were mainly involved in logistical support. Medication reviews were reportedly conducted regularly in two-thirds of facilities.ConclusionA high proportion of Swiss nursing homes have implemented diverse processes and structures that support medication use and safety for residents; however, their collaboration with pharmacists remains relatively limited.

Implementing a text message-based intervention to support type 2 diabetes medication adherence in primary care: a qualitative study with general practice staff

BackgroundThe Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project has developed, and is evaluating, a mobile phone-based intervention delivering brief messages targeting identified behaviour change techniques promoting medication use to people with type 2 diabetes in general practice. The present study aimed to inform refinement and future implementation of the SuMMiT-D intervention by investigating general practice staff perceptions of how a text message-based intervention to support medication adherence should be implemented within current and future diabetes care.MethodsSeven focus groups and five interviews were conducted with 46 general practice staff (including GPs, nurses, healthcare assistants, receptionists and linked pharmacists) with a potential role in the implementation of a text message-based intervention for people with type 2 diabetes. Interviews and focus groups were audio-recorded, transcribed and analysed using an inductive thematic analysis approach.ResultsFive themes were developed. One theme ‘The potential of technology as a patient ally’ described a need for diabetes support and the potential of technology to support medication use. Two themes outlined challenges to implementation, ‘Limited resources and assigning responsibility’ and ‘Treating the patient; more than diabetes medication adherence’. The final two themes described recommendations to support implementation, ‘Selling the intervention: what do general practice staff need to see?’ and ‘Fitting the mould; complementing current service delivery’.ConclusionsStaff see the potential for a text message-based support intervention to address unmet needs and to enhance care for people with diabetes. Digital interventions, such as SuMMiT-D, need to be compatible with existing systems, demonstrate measurable benefits, be incentivised and be quick and easy for staff to engage with. Interventions also need to be perceived to address general practice priorities, such as taking a holistic approach to care and having multi-cultural reach and relevance. Findings from this study are being combined with parallel work with people with type 2 diabetes to ensure stakeholder views inform further refinement and implementation of the SuMMiT-D intervention.

Impact of the oncology care model (OCM) on Medicare payments, utilization, and care delivery: Update through year 5.

1512 Background: OCM was a voluntary episode-based alternative payment model designed to improve the value of care for fee-for-service Medicare beneficiaries receiving systemic therapy for cancer. Participating practices received monthly enhanced oncology services (MEOS) care coordination payments and could receive additional payments (or penalties) if they met quality and total episode spending goals during 6-month episodes. Methods: We used a difference-in-differences approach to evaluate OCM impacts on Medicare payments, utilization, and quality measures during 6-month episodes before (July ‘14-January ’16) and after (July ‘16-June ‘21) OCM’s start. Patient-episodes were attributed to OCM-participating practices (n = 202) or propensity-matched comparison practices (n = 534). Statistical significance was defined as p≤0.10 to avoid missing program impacts. Results: Total episode payments (TEP) for 6-month OCM episodes increased from 29,120 in the baseline period to 35,467 in the OCM period (+21.8%). In reference to comparison episodes, OCM led to a 499 relative reduction in TEP (90%CI -771, -227, -1.7% relative to baseline.) OCM had no significant impact on TEP for low-risk breast, prostate, and bladder cancers, and OCM led to a relative decrease of 755 (CI -1140, -371) for all other higher risk cancers. Reductions in TEP were largest for high-risk breast cancer, lymphoma, lung cancer and colorectal cancer. The overall OCM impact on TEP was attributable to relative reductions in both Part A payments (-152, [CI -257, -47]) and Part B payments (-276, [CI -459, -92]). There was no OCM impact on Part D payments. While OCM had no impact on Part B chemotherapy payments, OCM reduced Part B non-chemotherapy drug payments by 251 (CI -330, -173; -9.3%). Utilization analyses showed no impact of OCM on ED visits or hospitalizations, but OCM reduced the likelihood of ICU admission by 0.6 percentage points (PP; CI -1.0, -0.1, -5.4%). OCM had no impact on initial chemotherapy regimen selection, but OCM led to greater use of biosimilar cancer therapies and value sensitive changes in the use of antiemetics, bone supportive medications, and WBC growth factors (including greater use of biosimilar WBC growth factors; all p &lt; 0.10). OCM reduced hospitalizations in the last 30 days of life by 0.8 PP (CI -1.6, -0.1; -1.5%) with no impact on use of chemotherapy or hospice at the end of life. Despite OCM-related TEP reductions, OCM resulted in net losses to Medicare after accounting for MEOS and performance-based payments. Conclusions: OCM led to reductions in TEP with similar or improved quality. Reductions in TEP were greatest for common, high-cost cancer types and were driven primarily by changes in use of supportive care medications. The Medicare Enhancing Oncology Model will build on the experience of OCM to further the goal of improving the quality and value of cancer care for Medicare beneficiaries.

0401 Factors Associated with Insomnia in Male University Students

Abstract Introduction University students can experience high levels of stress, and this can impact sleep quality and increase insomnia symptomology. Little research has investigated insomnia in male university students. This study examined factors associated with insomnia in male students to address concerns and direct resources. Methods Male students aged 18-35 at Memorial University completed an online survey. The Insomnia Severity Index (ISI) was used as the dependent variable to measure insomnia. Participants self-reported demographic and academic variables and also completed the Morning Evening Questionnaire (MEQ), Mindful Attention Awareness Scale (MAAS), Medical Outcomes Study Social Support Survey (MOS-SSS), Kessler Psychological Distress Scale (K10), and indicated sleep medication and stimulant use. Univariate and multivariate linear regressions were used to examine the relationship between insomnia and demographic factors, chronotype, social support, mindfulness, psychological distress, and sleep medication and stimulant use. Results The majority of participants (n=564; Mage = 23) were white (77.8%), undergraduates (76.3%), and enrolled full-time (90.7%). The mean insomnia severity score was 7.7 (SD = 5.42). Overall, 46% scored in the no insomnia range, 36% scored in the subthreshold insomnia range, 16% scoring in the clinical insomnia (moderate severity) range, and 2% scored in the clinical insomnia (severe) range. At the univariate level, sleep medication use (β = -.275, p &amp;lt; .001), stimulant use (β = -.158, p &amp;lt; .001), chronotype (β = -.344, p &amp;lt; .001), social support (β = -.244, p &amp;lt; .001), mindfulness (β = -.409, p &amp;lt; .001), and distress (β = .577, p &amp;lt; .001), were significantly associated with insomnia symptom severity. In the multivariate model (Adjusted R2 = .40, p &amp;lt; .001), only evening chronotype (β = -.195, p &amp;lt; .001), greater distress (β = .429, p &amp;lt; .001), and sleep medication use (β = -.139, p &amp;lt; .001) remained significantly related to insomnia. Conclusion This study identified factors associated with insomnia in male university students. Addressing insomnia, particularly in those with evening chronotype and those who use sleeping medication, may improve psychological distress and the overall well-being of male university students. Support (if any) Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).

Factors Affecting Initiation and Retention of Medication-Assisted Recovery (MAR) within a Pilot Pharmacist-Involved Practice Model at a Federally Qualified Healthcare Center (FQHC) during the COVID-19 Pandemic.

During the COVID-19 pandemic, opioid-related overdose deaths increased. Although Medication-Assisted Treatment or Recovery (MAT or MAR) is available, initiation and retention rates vary. The goal of this study was to evaluate clinical, demographic, and Social Determinant of Health factors affecting MAR initiation, on-time initiation of medications, and successful retention in the program. The secondary goal was to evaluate the impact of a novel interprofessional practice model incorporating pharmacists. A retrospective analysis was conducted using electronic health record data from a pilot MAR Program initiated within a California Federally Qualified Healthcare Center. From September 2019 to August 2020, 48 patients enrolled into the program. On-time initiation of medications occurred in 68% of patients and average program retention was 96.4 ± 95.8 days. Patients currently using opioids (p = 0.005) and those receiving supportive medications (p = 0.049) had lower odds of on-time MAR initiation. There were no statistically significant factors associated with successful retention in the program. The number of visits with members of the interprofessional team did not significantly affect on-time initiation or successful retention. Current opioid use and receipt of supportive medications were associated with lower on-time medication initiation. Further studies are warranted to explore additional factors which may affect initiation and retention.

Abstract 1932: Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer

Abstract Background: Colorectal cancer (CRC) is the 4th most common cancer type in the US. Following CRC treatment, about 37% of CRC survivors experience symptoms associated with anxiety and depression. Additionally, psychosocial distress is especially prevalent among CRC survivors with a stoma, and those reporting CRC-induced sexual dysfunction. Pharmacotherapy is one of the mainstay treatment options for psychological distress among patients with CRC. Research has shown that racial disparities are present with the use of supportive care medications in other cancer types. However, this has not been explored with the use of psychotropic medication for patients with CRC. The purpose of this research is to evaluate the presence of racial disparities in psychotropic medication use among patients with CRC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a CRC diagnosis and an active outpatient prescription claims for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Patients who were on psychotropic medications before CRC diagnosis, or unspecified race or ethnicity were excluded from the analysis. Psychotropic medications consisted of anxiolytics, antidepressants, and antipsychotic medications. Results: 136,014 participants were included in the analysis. The racial and ethnic breakdown comprised of 81.56% White, 11.22% African American (AA), 2.66% Hispanic, 4.27% Asian/Pacific Islander (API), and 0.25% Native American (NA). Results are presented as unadjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to White patients, AA (OR 0.53; 95% CI 0.50-0.56), API (OR 0.50; 95% CI 0.46-0.54), Hispanic (OR 0.64; 95% CI 0.58-0.71), and NA (OR 0.59; 95% CI 0.43-0.81) patients had lower utilization of anxiolytic medications. Regarding antidepressant use, AA (OR 0.55; 95% CI 0.53-0.57), API (OR 0.46; 95% CI 0.43-0.49), Hispanic (OR 0.73; 95% CI 0.68-0.79), and NA (OR 0.78; 95% CI 0.63-0.96) had lower utilization compared to White patients. Differences in antipsychotic medication use was observed with Asian/Pacific Islanders (OR 0.71; 95% CI 0.64-0.78) and Native Americans (OR 0.49; 95% CI 0.31-0.76) compared to White patients. No other racial differences in antipsychotic medications were identified. Conclusion: The study showed that racial and ethnic disparities are present with the use of psychotropic medications among patients with CRC. Racial and ethnic minority patients had lower use for most of the drug classes evaluated. Further research is warranted to assess the potential barriers and facilitators of psychotropic medication use among patients belonging to historically minoritized racial and ethnic groups. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1932.

Ethnic Variations in Patient Outcomes in a Memory Clinic Setting Between 2013 and 2021.

The incidence of dementia in Black and Asian populations in the UK is set to rise. There is concern surrounding differences in services provided for different ethnic groups. This study aimed to examine ethnic variations in survival, services accessed, and medication use across White, Black, and Asian groups in routine memory clinic setting. We retrospectively examined referrals to a memory service between 2013 and 2021. A random sample of 104 White, 99 Asian, and 74 Black patients were analyzed for differences in support services, voluntary services, medication use, and survival rate. There were statistically significant differences in survival of the Asian compared to the White group (Hazard ratio (HR = 2.17,95% confidence interval (CI) 1.23-3.85, p = 0.008)) following adjustment for age, gender, diagnosis, cognitive impairment, severity, access to support and voluntary services, and use of cholinesterase inhibitors, N-methyl-D-aspartate antagonists, and antipsychotics. The Asian group showed a statistically significantly reduction in access to support services compared to the White group (HR = 0.05, 95% CI 0.01-0.37, p = 0.003). In contrast, the survival rate was similar between the White and Black dementia patients. We found significantly reduced survival and reduced access to support services in Asian compared to White patients with dementia. Further research is needed to investigate the generalizability of our results, and determine the cause, and consequent remedies of these associations in ethnic minority groups.

Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study

Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. HCD was used to map the intervention "journey" and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process.

1139: FOUR-FACTOR PROTHROMBIN COMPLEX CONCENTRATE FOR REFRACTORY BLEEDING IN TRAUMA AND CARDIAC SURGERY

Introduction: Four-Factor Prothrombin Complex Concentrate (4F-PCC) is a concentrated product containing factors II, VII, IX, X, proteins C and S, that is FDA approved for reversal of vitamin K antagonists in adults with acute major bleeding or need for urgent surgery. The utilization of factor products for off-label indications has been increasing secondary to continued national blood shortages and ease of administration, with the hope of reducing blood product utilization. Methods: This single-center retrospective study at an academic level I trauma center analyzed the use of 4F-PCC for refractory bleeding between June 2018 and March 2022 in adult trauma and cardiovascular surgery patients. The primary objective was to determine blood product utilization in patients during a time period of six hours pre and post 4F-PCC administration. Secondary outcomes included thrombotic events, mortality, and use of supportive hemostatic medications. Results: Thirty-five patients received 4F-PCC for significant exsanguination refractory to massive transfusion: cardiac (n=32, 91%) and trauma surgery (n=3, 9%). The median age was 62 years (IQR 50-69) and the majority were male (n=21, 60%). The median dose administered was 2128 units (IQR 1668-2750) or 25 units/kg of factor IX (IQR 20.7-29). Units of blood products given pre and post 4F-PCC administration were: packed red blood cells (PRBC) [5.4 (IQR 3.2-8.9), 2.1 (IQR 1.8-4.1) p< 0.01], fresh frozen plasma (FFP) [4.4 (IQR 2.5-8.0), 3.4 (IQR 1.3-4.7) p=0.03], platelets [1.9 (IQR 1.1-2.2), 1.2 (IQR 1.0-2.2) p=0.20] and cryoprecipitate [1.3 (IQR 0.8-2.4), 0.9 (IQR 0.8-1.8) p=0.83]. Five patients experienced thrombotic events and the mortality was 29%. Three patients received concomitant phytonadione and seven received desmopressin. Conclusions: There was a significant reduction in PRBC and FFP units transfused after 4F-PCC administration in patients for refractory bleeding for trauma and cardiac surgery patients. Further investigation is warranted to determine if the reduction in product administration results in differences in clinical outcomes and if this finding is replicated in other surgical populations.