Total Prescriptions Research Articles

Total Parenteral Nutrition Management Based on Intravenous Drug Compounding Service

Total parenteral nutrition treatment is complex and has serious and detrimental complications, including catheter-related blood stream infections, fluid and electrolyte imbalance, hyperglycemia and hypercalcemia. This research examines how Intravenous Drug Compounding Service (IDCS) figures in total parenteral nutrition prescriptions reviewed by pharmacists, strengthens hospital clinical care and improves patients’ health. For this study, a total of 56164 nutritional prescriptions or medical orders from a hospital in Guangdong from 2016 to 2020 were randomly selected. According to whether IDCS was administered, the patients were divided into two experimental groups: the intervention group and the control group. The types and numbers of irrational prescriptions in the two groups were analyzed and compared, and further analysis of the role of IDCS in improving the level of nutritional prescriptions was performed. The results showed that the rate of irrational prescriptions in the intervention group from 2016 to 2020 was significantly lower than that in the control group, and the difference was statistically significant (P<0.01). The total irrational prescription rate in the intervention group was 32.53‱ on average, which was significantly lower than the 156‱ in the control group. The difference was statistically significant (P<0.01). After the administration of IDCS, the incidence rates of both total prescription errors and formulation errors were significantly lower than the incidence rate of irrational prescriptions without pharmacists’ intervention. The study confirms the importance and necessity of IDCS, so that patients can receive more efficient nutrition and health management services.

Recent trends in pirfenidone and nintedanib use for idiopathic pulmonary fibrosis in Australia.

Objectives Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease presenting in people aged ≥50 years. There is currently no cure for IPF, but two medications (pirfenidone and nintedanib) have been shown to slow the functional decline of the lungs. In 2017, these two medications were listed on the Pharmaceutical Benefits Scheme (PBS) for subsidisation in Australia. This study evaluated local trends in the use of these two medications. Methods Prescription data for this analysis were obtained from the PBS Item Reports for the period May 2017-May 2020. Population data were extracted from the Australian Bureau of Statistics data cubes. A descriptive approach was used to conduct and report the analysis to illustrate trends in the use of these two medications and associated costs. Results There were 44 010 prescriptions processed for the treatment for IPF in the 3-year period. Nintedanib use was higher than pirfenidone use, accounting for 54% of prescriptions. New South Wales accounted for 35% of the total prescriptions but, when standardised against population size, the Australian Capital Territory accounted for the highest proportion of prescriptions (24%). Prescriptions for nintedanib and pirfenidone were associated with a total cost of A$131 377 951 over the period 2017-20. Conclusion This study provides initial information on prescription rates, practices and expenditure for pirfenidone and nintedanib. In addition, we provide some insight into possible pharmacological and epidemiological trends based on jurisdictional differences. Together, the results from this study provide a platform for future research given the dearth of information on IPF in Australia. What is known about the topic? Data regarding trends in the utilisation of antifibrotics for the treatment of IPF in Australia are currently limited. What does this paper add? This study demonstrated that nintedanib use was slightly higher than pirfenidone use, and that there were variations in jurisdictional prescribing practices. The highest number of prescriptions and costs were attributable to New South Wales but, when standardised against population size, the Australian Capital Territory had the highest number of prescriptions and costs. What are the implications for practitioners? This study provides some insights into the use of pirfenidone and nintedanib, as well as pharmacoepidemiological trends, in Australia, which is useful for economic evaluation and modelling future health expenditure.

Prescription Pattern Monitoring and Off-label Use of Medicines in the Pediatric Department at Tertiary Care Teaching Hospital

Background Off-label use means the use, concerning dosage, indication, route of administration, or age, of pharmaceutical products which are beyond the terms of the product license. For regulatory bodies and physicians, the global challenge is to achieve optimum pediatric drug therapy. Objective This prospective observational work was carried out in the paediatric department to evaluate the prescribing pattern of medicines and to identify the use of off-label drugs. Method A cross-sectional study was carried in 200 paediatric patients of ages between 0 and 12 years at the paediatric outpatient department of Universal College of Medical Sciences, Bhairahawa. Data were collected by reviewing the prescription paper and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed by using the World Health Organization (WHO) Prescription Indicators and off-label use was assessed using the WHO Children Formulary 2010. Result Among 413 total prescriptions, only 5.56% of drugs were found to be prescribed by generic name, 16.7% of prescriptions were found to be antibiotic and 57.62% of prescribed drugs were from essential drug list. Out of 413 prescribed drugs, 16.46% of drugs were found to be off-label. The maximum extent of off-label prescribing was 51.47% in the child, followed by infants (42.6%) and neonates (5.8%). Fexofenadine; antihistaminic (23.56%), Amoxicillin+clavulanic acid; antibiotic (22.06%) had higher off-label use. Off-label dose (71.8%) was the most common cause of off-label prescribing. Conclusion Off-label prescribing among pediatric patients is common.More eminence data on the safety and efficacy of off-label medicines must be generated to rationalize paediatric pharmacotherapy.

222. Comparison of Outpatient Antibiotic Prescriptions in a High Prescribing State, 2016–2018

BackgroundAbout 80% of antibiotic prescriptions are written in outpatient settings. Outpatient antibiotic use (AU) is highest in the Southern United States. Tennessee consistently has one of the highest AU rates in the country. Previous analyses found that 1,195 prescriptions were filled in Tennessee per 1,000 total population in 2016. Moreover, 50% of all outpatient antibiotic prescriptions were written by 9.3% of prescribers. We sought to assess Tennessee outpatient antibiotic prescribing trends, comparing 2016 with 2018 data.MethodsThe Tennessee IQVIA outpatient antibiotic prescription dataset from January 1 to December 31, 2018 was analyzed and compared to 2016 results. Orally administered antibacterial agents were included. Patients < 20 years old were classified as pediatric. County level population data were obtained from the Tennessee Department of Health. Antibiotic prescription rates were calculated as antibiotics prescribed per 1,000 population in the specified age group. Analysis was performed using SAS 9.4.ResultsThe statewide AU rate decreased from 1,195 in 2016 to 1,074 in 2018 per 1,000 population. Consistent with the previous analysis, female patients (1,288), those over 65 years (1,459), and those < 2 years (1,372) had the highest rates of AU in 2018. Lower rates were observed in all age groups in 2018 except for the 3–9 years group. While narrow penicillins and macrolides remain the most frequently prescribed antibiotics, amoxicillin-clavulanate and ciprofloxacin fell out of the top five antibiotics used in adults, and amoxicillin-clavulanate fell out of the top five antibiotics used in pediatrics. Similar to 2016, 9.2% (3,098) of the providers contributed to 50% of the total prescriptions in 2016, and 2,090 of the 2,994 (69.8%) 2016 highest prescribing providers were also among the highest prescribers in 2018.ConclusionDespite a decline in outpatient antibiotic prescription volume, Tennessee remains one of the nation’s highest prescribing states. While a decline in broad spectrum antibiotic prescriptions may indicate a shift to more appropriate usage, these data do not include indication, excluding appropriate use assessment. Identifying and focusing antibiotic stewardship interventions for consistently high prescribers remains a priority for Tennessee.Disclosures All Authors: No reported disclosures

High protein prescription in methylmalonic and propionic acidemia patients and its negative association with long-term outcome

Methylmalonic acidemia (MMA) and propionic acidemia (PA) are inborn errors of metabolism. While survival of MMA and PA patients has improved in recent decades, long-term outcome is still unsatisfactory. A protein restricted diet is the mainstay for treatment. Additional amino acid mixtures (AAM) can be prescribed if natural protein is insufficient. It is unknown if dietary treatment can have an impact on outcome. We performed a nationwide retrospective cohort study and evaluated both longitudinal dietary treatment and clinical course of Dutch MMA and PA patients. Protein prescription was compared to the recommended daily allowances (RDA); the safe level of protein intake as provided by the World Health Organization. The association of longitudinal dietary treatment with long-term outcome was evaluated. The cohort included 76 patients with a median retrospective follow-up period of 15 years (min-max: 0-48 years) and a total of 1063 patient years on a protein restricted diet. Natural protein prescription exceeded the RDA in 37% (470/1287) of all prescriptions and due to AAM prescription, the total protein prescription exceeded RDA in 84% (1070/1277). Higher protein prescriptions were associated with adverse outcomes in severely affected patients. In PA early onset patients a higher natural protein prescription was associated with more frequent AMD. In MMA vitamin B12 unresponsive patients, both a higher total protein prescription and AAM protein prescription were associated with more mitochondrial complications. A higher AAM protein prescription was associated with an increased frequency of cognitive impairment in the entire. Protein intake in excess of recommendations is frequent and is associated with poor outcome.

Status of Diabetic Neuropathy in Korea: A National Health Insurance Service-National Sample Cohort Analysis (2006 to 2015).

This report presents the status of diabetic neuropathy (DN) in Korea as determined using a National Health Insurance Service-National Sample Cohort (NHIS-NSC). Annual prevalences of DN were estimated by age and gender using descriptive statistics. Pharmacological treatments for DN were also analyzed. The annual prevalence of DN increased from 24.9% in 2006 to 26.6% in 2007, and thereafter, gradually subsided to 20.8% in 2015. In most cases, pharmacological treatments involved a single drug, which accounted for 91.6% of total prescriptions in 2015. The most commonly used drugs (in decreasing order) were thioctic acid, an anti-convulsive agent, or a tricyclic antidepressant. In conclusion, the prevalence of DN decreased over the 10-year study period. Thioctic acid monotherapy was usually prescribed for DN. To reduce the socio-economic burden of DN, more attention should be paid to the diagnosis of this condition and to the appropriate management of patients.

Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults

Nimodipine is a highly prescribed drug for the treatment of cognitive impairment and dementia in Argentina. There is little evidence to support the use of nimodipine for cognitive impairment and dementia. To test the effectiveness of a behavioral intervention based on social norm feedback to reduce prescription of nimodipine for cognitive impairment in Argentina. This pragmatic parallel-group randomized clinical trial included 2 arms with a 1:1 allocation ratio. General practitioner physicians in the national health care system for older adults in Argentina (INSSJP-PAMI) with history of high nimodipine prescription rate were enrolled. The study was conducted from May 2019 to October 2019, and data were analyzed from November 2019 to February 2020. The treatment group received 2 emails with evidence-based information about nimodipine plus the individual's level of nimodipine prescription compared with their peers. The control group received 2 emails with general information about the risks of overprescription in older adults. The primary outcome was the cumulative number of nimodipine prescriptions per 1000 prescriptions of all drugs made by the targeted physicians during the 6 months of the study. Secondary outcomes included annual monetary savings attributable to the intervention and physicians' qualitative perceptions of the acceptability of the procedure. Of 1811 physicians enrolled, 906 physicians (354 [39.1%] women; mean [SD] age, 57.10 [10.73] years) were randomized to treatment and 905 participants (331 [36.6%] women; mean [SD] age, 56.49 [10.47] years) to the control group. Physicians in the treatment group wrote a mean of 93.25 (95% CI, 89.27 to 97.24) prescriptions of nimodipine, compared with 98.99 (95% CI, 95.00 to 102.98) prescriptions among practitioners in the control group during the half-year of the intervention (mean difference, -5.73 [95% CI, -11.38 to -0.10] prescriptions; P = .046), which meant a 5.79% reduction. Regression analysis revealed a significant association of the group condition with number of prescriptions per 1000 total prescriptions when controlling for baseline prescriptions (B = -0.312 [95% CI, -0.465 to -0.160]; P < .001). The observed difference corresponds to a 4.48% reduction in nimodipine prescriptions per 1000 prescriptions of all drugs made by physicians in the treated group compared with the control group. Physicians who effectively opened the email in the treatment group (427 physicians [47.1%]) prescribed the drug 11.3% less compared with the control group (426 physicians) (mean difference, -10.78 [95% CI, -18.53 to -3.03] prescriptions; P = .006). Expenditures were 7.18% lower in the treatment group, resulting in an estimated annual net cost benefit of US $234 893.35 (95% CI, $225 565.35 to $237 112.30). In this randomized clinical trial, the social norm email feedback program showed an effect on curbing the nonrecommended prescription of nimodipine. It was highly cost-effective and well accepted by participants. ISRCTN.org identifier: ISRCTN17823729.

Irrational use of Antibiotics and Associated Health Risks in District Charsadda, Pakistan

Antibiotics are drugs used for the treatment most of the bacterial infections. The rapid and irrational use of antibiotics presents a high risk of developing health complications and also leads to antibiotic resistance. The current study is designed to know about the ratio of irrational use of antibiotics and associated risks with it. Antibiotics remain an integral part of the prescriptions at DHQ Hospital Charsadda. Our study was based mainly on antibiotic prescriptions. A total of 500 prescriptions were examined in which 62% of the prescriptions were examined thoroughly and found rational whereas 38% were irrational. 26.98% of these irrational prescriptions were due to inaccurate doses. Additionally, 25.39% of them were prescribed for incorrect durations, indicating basic misconceptions in the prescriptions. Among the total irrational prescriptions, the frequency of antibiotics-drug interactions, drug-food interactions, and contraindications were 18.51%, 14.5%, and 14.81% respectively. Irrational use of antibiotics is a serious health threat and its consequences lead to the development of antibiotic resistance in different bacterial species. There is a need for intervention of studies in different hospitals of Pakistan to avoid irrational use and encourage rational use of antibiotics.

Practice- and individual-level antibiotic prescribing associated with antibiotic treatment non-response in respiratory tract infections: a national retrospective observational study.

Antibiotic overuse results in adverse clinical outcomes. This study quantified the independent contributions of practice- and individual patient-level antibiotic prescribing to antibiotic treatment non-response in respiratory tract infections (RTIs) in primary care. RTI episodes with antibiotic prescribed in 2018 were extracted from an Australian national general practice database. Practices were classified into tertiles by total antibiotic prescriptions per patient and ratios of broad- to narrow-spectrum antibiotic prescriptions. The association between practice- and individual patient-level antibiotic prescribing in the previous year and antibiotic treatment non-response (defined as prescription of a different antibiotic) ≤30 days after the initial RTI episode was quantified using generalized estimating equations. Of 84 597 RTI episodes with antibiotics prescribed in 558 practices, 5570 (6.6%) episodes of treatment non-response were identified. Patients with high individual-level antibiotic prescribing (≥4 prescriptions/year) had an increased risk of treatment non-response (versus no prescriptions/year: OR = 1.64, 95% CI = 1.52-1.77). At the practice level, there was no significant association between total antibiotic prescriptions per patient and treatment non-response (high versus low: OR = 0.99, 95% CI = 0.92-1.06). RTI episodes in practices with high broad- to narrow-spectrum antibiotic ratios had an increased risk of treatment non-response (versus low-ratio practices: OR = 1.14, 95% CI = 1.05-1.23); this association was only observed among patients with <4 antibiotic prescriptions/year. The general practice-level broad- to narrow-spectrum antibiotic ratio was a predictor of RTI antibiotic treatment non-response in patients with lower individual-level antibiotic use. The measure of practice-level antibiotic prescribing could potentially guide the improvement of antibiotic treatment.

Pilot Study, Antihypertensive Prescription Analysis of Hypertensive Patients at Community Pharmacy Outlet; Sri Lankan Perspectives

Prescribing pattern of antihypertensive medicines is much concerned in the context of treating this disease hypertension. The main objective was to determine prescribing patterns of antihypertensive medicines. Hundred prescriptions were collected from one community pharmacy outlet for three days. Prescriptions of hypertensive patients were analysed by using Microsoft Excel. Out of hundred prescriptions, 57% accounted for female and 43% for male. According to the results, antihypertensive drugs were widely prescribed for patients (54%) above 60 years, as expected following 45% of patients within 20-60 years age category. But, only one patient below 20 years of age (1%) was prescribed with anti-hypertensives. Out of all the prescribed anti-hypertensives, 59% accounted for Angiotensin Receptor Blockers (ARBs) &amp; Angiotensin Converting Enzyme Inhibitors (ACEIs) followed by Calcium Channel Blockers (CCB) (16%), Diuretics (13%), β-Blockers (5%) and others (Alpha blockers, Potassium channel blockers, α &amp; β blockers &amp; Alpha-2 adrenergic receptor agonists) (7%) respectively. Losartan was the highly prescribed ACEI and ARBs (85%) followed by HCT (Diuretic) (75%) Diltiazem and Nifedipine (CCB) (36% equally) and Bisoprolol (β-Blocker) (57%) as highly prescribed anti-hypertensives under each category. Study concluded that, ACEIs and ARBs were the highly prescribed drug category following the drug Losartan. 1% from the total prescriptions were accounted for prescribing Nifedipine (CCB) only for the age below 20. But there were antihypertensive drug combinations prescribed for the 20-60 and above 60 age categories rather than prescribing a single antihypertensive. Further recommended to analyse the types of anti-hypertensive combinations among each age category.

Economic impact of comorbid diabetes and associated racial disparities in managing Medicare beneficiaries with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)

ABSTRACT Clinical management of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is progressing to include chronic/metabolic complications, which may impose a significant economic burden on beneficiaries and Medicare. We assessed the national economic impact of comorbid Type-II Diabetes Mellitus (T2DM) on HIV/AIDS patients and potential raical disparities. This study was a cross-sectional study of Medicare database 2013–2017. Analytical sample included HIV/AIDS positive beneficiaries continuously enrolled in Part A/B. Total medical costs, prescription costs, inpatient costs, outpatient costs, out-of-pocket (OOP) costs, and Medicare costs were assessed from Medicare claims. Generalized linear models with log-link and gamma distribution were used to examine the impact of T2DM on different costs. A total of 2,509 eligible HIV/AIDS positive beneficiaries were identified of which 19.9% (n=498) had T2DM. After adjusting for covariates, T2DM beneficiaries had higher inpatient costs: 63.34% (95% CI: 42.73%−86.94%), outpatient costs: 50.26% (95% CI: 30.70%−72.75%), Medicare costs: 27.95% (95% CI: 13.81%−43.84%), OOP costs: 59.15% (95% CI: 40.02%−80.92%), and total medical costs: 27.83% (95% CI: 14.27%−43.00%) than non-T2DM beneficiaries. Incremental costs were higher among African Americans than Caucasians. Comorbid T2DM mposes a significant economic burden on HIV/AIDS patients and Medicare, which is higheramong African Americans.

Randomised placebo-controlled multicentre effectiveness trial of adjunct betamethasone therapy in hospitalised children with community-acquired pneumonia: a trial protocol for the KIDS-STEP trial

IntroductionCommunity-acquired pneumonia (CAP) causes around 10 hospitalisations per 1000 child-years, each associated with an average 13 non-routine days experienced and more than 4 parent workdays lost. In adults, steroid treatment...

PNS268 Prediction of TOTAL and Ambulatory Prescription Cost Based on Health State Using a Machine Learning Approach

The aim of this study is to utilize machine learning based algorithms to provide an estimation of both the total and the ambulatory prescription costs per patient related to their health state. An available database was used. This contained information from the IT systems of the Valencia region on the assigned population of a health department. The variables include socio-demographic data (age and sex), Clinical Risk Group’s classification as the health state stratification, and the cost per patient of 2013. A double part algorithm is purposed to correctly address the problem. The first stage aims to predict if the patient will cause any cost to the Health Service. A logistic regression was calculated, achieving over 90% of accuracy with over 95% specificity. The second part of the algorithm acts only on the patients marked as expenders in the first half, and focus on the numerical prediction of the cost. In this step an artificial neural network was trained, with significantly different results, higher for the ambulatory prescription costs (64% R2). The combined result of the hole system ends up over 70% R2 for the prescription cost, and close to 90% for the total costs. The identification of the expending patients was correctly achieved, been able to find them with a high confidence level. For the numerical predictions, the results may seem insufficient, but considering the system as a whole the global predictive value is higher than the offered in previous studies utilizing a statistical approach. This study proves that machine learning and artificial intelligence tools could improve the predictive models used in health management.

Fatores associados à baixa adesão ao tratamento farmacológico de pacientes atendidos por um Centro Integrado de Saúde

Introdução: O problema com a adesão a farmacoterapia é influenciada por diversos fatores que afetam significativamente os pacientes, tornando assim um desafio a ser solucionado e que continua por anos como um dos maiores problemas de saúde, para este estudo os dados foram coletados nos atendimentos realizados pelos alunos do curso de farmácia no Centro Integrado de Saúde da Universidade Anhembi Morumbi. Objetivo: Expor os principais motivos que levaram os pacientes atendidos pelo Centro Integrado de Saúde a não continuar com a farmacoterapia. Métodos: Os dados foram coletados em consulta médica, com o formulário estruturado partir do método Dáder. Cada caso foi estudado e classificado conforme o Problema Relacionado ao Medicamento (PRM) e se necessário aplicada a intervenção farmacêutica. Desta forma, construiu-se um perfil para análise, com base em problemas que levaram a não adesão, prescritor, sexo, faixa etária e escolaridade. Resultados: O maior problema em relação à adesão está relacionado a aquisição, seguido por reações adversas a medicamentos. Do total de prescrições feitas, 72% se referem a prescrições feitas por neurologistas e reumatologistas. 71% dos pacientes são do sexo feminino, demonstraram maiores abandonos a adesão farmacoterapêutica, e 60% dos pacientes com faixa etária acima de 50 anos, são os que mais abandonam o tratamento farmacoterápico, devido o uso de polifarmacia, esquecendo de tomar os medicamentos. Conclusão: O problema com adesão ao tratamento medicamentoso é prevalente na sociedade e um grande desafio a se enfrentar, devido a influência de fatores de diversas esferas, tornando o assunto difícil de se compreender, desta forma é necessário mais estudo e analises profundas para conseguir chegar a um denominador em comum para, então, desenvolver um plano de ação, porém concluímos que os mais relevantes problemas estão relacionados com a difícil aquisição do medicamento, sendo este o problema que possui interferência direta na farmacoterapia.

PIN147 Geography Variations in Antibiotic Use RATE: Evidence from 8,026 Primary Clinics in Taiwan

This study aims to explore whether the utilization rate of antibiotics in primary clinics is affected by medical department and geographical location. We also analyzed the correlation between medical-level factors, county-level factors, and antibiotic use rates. This study used a retrospective study design. We collected antibiotics utilization data (in the third quarter of 2017) from a total of 8,026 Western medicine primary clinics across Taiwan from the Taiwan National Health Insurance Medical Quality Information Open Network. The number of clinics, clinics and hospitals in each administrative area are also collected. We also collected data on the population of various administrative regions in Taiwan to calculate the degree of urbanization and aging population in each administrative region. This study used the 2-way analysis of variance (ANOVA) method to analyze whether there is a significant difference in antibiotic usage among different medical departments and different administrative regions. We also used Hierarchical Linear Modeling to analyze the correlation between medical-level factors, county-level factors and antibiotic use rate. This study found that the antibiotic use rate was significantly different between different medical departments and different administrative regions, and the interaction between the medical department and the administrative region and the antibiotic usage rate was significantly correlated. There was a significant positive correlation between the total amount of prescriptions in the clinic and the rate of antibiotic use. Regarding the administrative region where the clinic is located, the degree of urbanization and antibiotic utilization rate showed a significant positive correlation, while other factors were not significantly related to the antibiotic use rate. Antibiotic use rate has significant differences in geography. The higher the total prescription amount of the clinic, the higher the degree of urbanization in the administrative area where the clinic is located, and the higher the antibiotic use rate.

Investigating the utilization of beam-specific apertures for the intensity-modulated proton therapy (IMPT) head and neck cancer plans

Intensity-modulated proton therapy (IMPT) planning for the head and neck (HN) cancer often requires the use of the range shifter, which can increase the lateral penumbrae of the pencil proton beam in the patient, thus leading to an increase in unnecessary dose to the organs at risks (OARs) in proximity to the target volumes. The primary goal of the current study was to investigate the dosimetric benefits of utilizing beam-specific apertures for the IMPT HN cancer plans. The current retrospective study included computed tomography datasets of 10 unilateral HN cancer patients. The clinical target volume (CTV) was divided into low-risk CTV1 and high-risk CTV2. Total dose prescriptions to the CTV1 and CTV2 were 54 Gy(RBE) and 70 Gy(RBE), respectively, with a fractional dose of 2 Gy(RBE). All treatment plans were robustly optimized (patient setup uncertainty = 3 mm; range uncertainty = 3.5%) on the CTVs. For each patient, 2 sets of plans were generated: (1) without beam-specific aperture (WOBSA), and (2) with beam-specific aperture (WBSA). Specifically, both the WOBSA and WBSA of the given patient used identical beam angles, air gap, optimization structures, optimization constraints, and optimization settings. Target coverage and homogeneity index were comparable in both the WOBSA and WBSA plans with no statistical significance (p > 0.05). On average, the mean dose in WBSA plans was reduced by 12.1%, 2.9%, 3.0%, 3.8%, and 5.2% for the larynx, oral cavity, parotids, superior pharyngeal constrictor muscle, and inferior pharyngeal constrictor muscle, respectively. The dosimetric results of the OARs were found to be statistically significant (p < 0.05). The use of the beam-specific apertures did not deteriorate the coverage and homogeneity in the target volume and allowed for a reduction in mean dose to the OARs with an average difference up to 12.1%.

The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon.

We examined the impact on geographic distribution of medications to treat opioid use disorder (MOUD) in Oregon after the Comprehensive Addiction and Recovery Act (CARA) was implemented in February 2017 to include nurse practitioner (NP) prescribers. We conducted interrupted time series analysis with linear regression on prescriptions dispensed for buprenorphine used for MOUD in the Oregon Prescription Drug Monitoring Database written by physician (MD/DO) and NP prescribers January 1, 2016, to December 31, 2018. We analyzed total prescriptions by prescriber type and pharmacy ZIP Code using STATA 16.1. From January 1, 2016, to December 31, 2018, 420,765 eligible prescriptions were written by waivered MD/DO and/or NP prescribers. Prior to CARA, buprenorphine use was increasing steadily at 140 prescriptions per month (95% CI: 78-201; P < .01). Following CARA, dispensing increased by 88 prescriptions per month (95% CI: 23-152; P = .01). The absolute number increased in rural areas immediately after CARA implementation (368 prescriptions; 95% CI: 124-613; P < .01). NP contribution to total buprenorphine prescribing increased significantly in both urban and rural areas (0.44% per month [95% CI: 0.30%-0.57%; P < .01] and 0.74% per month [95% CI: 0.62%-0.85%; P < .01]). The contribution of NPs had a particularly large impact for very rural (frontier) areas, where NPs provided 36% of all buprenorphine prescriptions by the end of 2018. Changes in federal law regarding MOUD had a positive impact on both supply and geographic distribution in Oregon, particularly in frontier areas comprising 10 of 36 counties (27%).

Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?

The Korean National Health Insurance system imposes a 30% coinsurance for outpatient medical care and prescription drugs; however, at the age of 65, the coinsurance model changes to a copayment model that offers lower fees for the elderly. Thus, this study aimed to investigate the influence of the copayment model for outpatient visits and prescription drugs on healthcare utilization among the Korean elderly. We compared total outpatient visits, total prescriptions, and out-of-pocket expenses between a case group with copayment reduction (65 years or older) and a control group without any reduction (64 years or younger). We obtained secondary data collected from seven waves of the Korea Health Panel Survey (2010–2016). Outpatient visits increased exclusively in the case group among those with lower income. After adjusting for covariates, the results of the difference-in-differences analysis showed that, compared to the control group, there was a significant increase in outpatient visits among individuals with lower income in the case group. Our study shows that cost sharing changes affect Korean patients with different income levels in different ways.

Opioid Prescribing Patterns Among Generalists, Radiation Oncologists, and All Oncologists for Medicare Part D Beneficiaries from 2013-2017

In response to the opioid crisis, recent policies aiming to reduce opioid prescribing, misuse, & abuse have generated concern that patients with cancer pain may unintentionally experience reduced access to necessary opioid therapy. It is unknown how opioid prescribing patterns have changed between generalists, radiation oncologists, and all oncologists during this era. We conducted a longitudinal repeated cross-sectional study estimating adjusted annual national trends in opioid prescribing among generalists, radiation oncologists, and all oncologists using the Medicare Part D Prescriber Public Use Files 2013-2017. Poisson models estimated annual adjusted predicted mean rates of opioid prescribing-per-1,000 total prescriptions & long-acting opioid prescribing per-1,000 opioid prescriptions. Poisson models estimated adjusted incidence rate ratios (aIRRs) to quantify annual changes in prescribing rates. From 2013-2017 the annual adjusted predicted mean rate of opioid prescriptions per 1,000 total prescriptions decreased from 54.0 to 41.8 among generalists (aIRR = 0.78; p<0.01), from 190.9 to 154.3 among radiation oncologists (aIRR = 0.75, p<0.01) and from 133.1 to 108.5 among all oncologists (aIRR = 0.83; p<0.01). The rate of long-acting opioid fills per 1,000 opioid prescriptions changed from 96.0 to 86.5 (aIRR = 0.87; p<0.01), from 164.3 to 168.4 (aIRR = 1.07, p = 0.23) and 231.9 to 222.7 (aIRR = 0.95; p<0.01) for generalists, radiation oncologists, & all oncologists, respectively (Table). oncologists (-25%), and all oncologists (-17%) from 2013-2017. Overall opioid prescriptions declined more for radiation oncologists than generalists or other oncologists, suggesting that radiation oncologists are responding to the opioid epidemic by decreasing prescriptions for their patients. The rate of long acting opioid prescriptions (as a percentage of overall opioid prescriptions) increased among radiation oncologists. Opioid policy & advocacy have been effective in reducing the extent of opioid prescribing in the Medicare population but how much of the decrease in prescribing by oncologists is ‘appropriate’ versus ‘inappropriate’ deserves further investigation.Tabled 1Abstract 2869; TableAll opioidsGeneralistsRadiation OncologistsAll OncologistsaIRR (95%CI)PaIRR (95%CI)PaIRR (95%CI)P2013RefRefRef20140.98 (0.97-0.99)<.010.98 (0.95-1.02)0.410.97 (0.95-0.98)<.0120150.92 (0.91-0.92)<.010.88 (0.84-0.91)<.010.93 (0.91-0.94)<.0120160.85 (0.85-0.86)<.010.83 (0.79-0.86)<.010.88 (0.87-0.90)<.0120170.78 (0.77-0.78)<.010.75 (0.72-0.78)<.010.83 (0.82-0.85)<.01 Open table in a new tab

Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None