Physicians In UK Research Articles

Delivering an enhanced pleural procedural skill teaching programme for UK physicians in a tertiary UK hospital

Delivering an enhanced pleural procedural skill teaching programme for UK physicians in a tertiary UK hospital

Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians.

Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each from cardiology, respiratory and internal medicine, plus 25 haematologists. Most (89%) participants had local guidelines for PE management, and 65% reported a PE follow-up clinic, of which 69% were joint clinics. Almost half (47%) had a protocol for the investigation of CTEPD. According to participants, 129 (74%) routinely consider a diagnosis of CTEPD and 97 (55%) routinely investigate for CTEPD, with 76% of those 97 participants investigating in patients who are symptomatic at 3 months and 22% investigating in all patients. This survey demonstrated variability in the follow-up of PE and the awareness of CTEPD and its investigation. The findings support the conduct of a national audit to understand the barriers to the timely detection of CTEPD.

Differences in management approaches for lupus nephritis within the UK.

Outcomes of therapy for LN are often suboptimal. Guidelines offer varied options for treatment of LN and treatment strategies may differ between clinicians and regions. We aimed to assess variations in the usual practice of UK physicians who treat LN. We conducted an online survey of simulated LN cases for UK rheumatologists and nephrologists to identify treatment preferences for class IV and class V LN. Of 77 respondents, 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. A total of 37 (48.0%) reported having a joint clinic between nephrologists and rheumatologists, 54 (70.0%) reported having a multidisciplinary team meeting for LN and 26 (33.7%) reported having a specialized lupus nurse. Of the respondents, 58 (75%) reported arranging a renal biopsy before starting the treatment. A total of 20 (69%) of the nephrologists, but only 13 (27%) rheumatologists, reported having a formal departmental protocol for treating patients with LN (P < 0.001). The first-choice treatment of class IV LN in pre-menopausal patients was MMF [41 (53.2%)], followed by CYC [15 (19.6%)], rituximab [RTX; 12 (12.5%)] or a combination of immunosuppressive drugs [9 (11.7%)] with differences between nephrologists' and rheumatologists' choices (P = 0.026). For class V LN, MMF was the preferred initial treatment, irrespective of whether proteinuria was in the nephrotic range or not. RTX was the preferred second-line therapy for non-responders. There was variation in the use of protocols, specialist clinic service provision, biopsies and primary and secondary treatment choices for LN reported by nephrologists and rheumatologists in the UK.

The impact of COVID-19 on patient involvement in treatment decisions in the US and EU4+UK.

e18758 Background: The COVID-19 pandemic has impacted many facets of the healthcare landscape. This study aims to assess the effect of COVID-19 on the evolution of patient involvement in cancer treatment decisions at different time points throughout the pandemic. Methods: The Ipsos COVID-19 Evolution study was run online from April to June 2022 with a total of 353 oncologists responding in the US and EU4+UK (US: 100, EU4+UK: 253). Each physician completed a demographic form and a questionnaire. The demographic form gathered information regarding specialty, practice type and volume of patients treated with anti-cancer drugs in an average month. The questionnaire collected information from physicians on patient workload, diagnosis/tumor characterization, patient management, patient treatment, personal attitude and events, and expectation in the next 6 months. Physicians were required to provide this information by referencing the different time points with regards to the pandemic including pre-pandemic, 1st peak, Delta/Omicron spread, current state and in the next 6 months. Results: Sampled physicians in the US reported an average of 50% of their managed patients involved in treatment decisions pre-pandemic, while the EU4+UK physicians reported an average of 45% of patients. This increased to 56% and 53% in US and EU4+UK, respectively, at the time of this study and was expected to increase further to 57% and 56%, respectively, in 6 months’ time. While most of the physicians reported an increase in the proportion of patients involved, physicians in the UK reported a drop at the 1st peak and Delta/Omicron spread compared to pre-pandemic (-1% and -3% respectively). Physicians in Germany reported the highest increase in the volume of patients being involved at the 1st peak of COVID-19 that quickly dropped during the Delta/Omicron spread (+18% and +6%, respectively). Physicians in Italy reported a much bigger change in the current state and predicted this to grow further in the next 6 months (+27% and +32%, respectively). Besides the recorded growth in the volume of patients involved in treatment decisions, the level of involvement has also increased from pre-pandemic. The average involvement score was 4.8 and 4.7 out of 7 in US and EU4+UK respectively pre-pandemic and grew to 5.2 and 5.0 at the 1st peak. This further increased to 5.6 and 5.8 at the time of this study. Conclusions: Results from this study highlighted participating physicians reported their patients to be more involved in their cancer treatment decisions compared to pre-pandemic levels and predicted more patients to become increasingly involved in the coming months. Further investigation into the continued impact of the pandemic on patient involvement and the benefits of patient participation would provide further insight into optimal ways to provide better treatment experiences through inclusivity. Further investigation using comparator cohort is warranted.

OA20 Differences in management approaches for lupus nephritis within the UK

Abstract Background/Aims Outcomes of current therapy for lupus nephritis (LN) are suboptimal. Guidelines offer varied options for treatment of LN at onset, for refractory disease or relapse. Recent randomised trials have demonstrated the efficacy of newer agents and combination therapies, although these are not all permitted within NICE or NHS England funding. Therefore, treatment strategy may vary between clinicians or regions. We aimed to describe variations in usual practice of UK physicians who treat LN. Methods We conducted an online survey of simulated LN case scenarios for rheumatologists and nephrologists within the UK to identify treatment preferences for proliferative (class IV) and membranous (class V) LN. Results Of 77 respondents who completed the survey 48 (62.3%) were rheumatologists and 29 (37.7%) were nephrologists. 69% of the nephrologists but only 27% of rheumatologists reported having a formal departmental protocol for treating patients with LN (p &amp;lt; 0.001). The first-choice treatment of class IV LN in pre-menopausal female patients differed significantly between nephrologists and rheumatologists (p = 0.026) (see Table 1). For patients who failed to improve on first-line therapy there was no significant difference between nephrologists' and rheumatologists' second-choice therapy (p = 0.50) (see Table 1). However, 55% of nephrologists chose to change to second-choice treatment 3-6 months from the start of first treatment and 34.5% would change after 6-12 months but 81.3% of rheumatologists chose to change after 3-6 months and 10.4% would change in less than 3 months (p = 0.016). For class V LN, MMF was the preferred initial treatment irrespective of whether proteinuria was in nephrotic range or not. For nephrotic range class V LN not responding to first-choice treatment there were significant differences between nephrologists' and rheumatologists' choices for second-line therapy (p = 0.041) (see Table 1). Conclusion There is variation in treatment choices for LN between physicians with different choices reported by nephrologists and rheumatologists. These results suggest that: (i) care may not be well coordinated between rheumatologists and nephrologists; (ii) clearer guidelines are required to ensure use of the best therapies; (iii) access to the most effective therapies needs to be improved. Disclosure S.T. Ibrahim: None. B. Rhodes: None. B. Griffiths: None. C. Gordon: None. C.J. Edwards: None. D. Jayne: None. E.M. Vital: None. L. Lightstone: None. M.R. Ehrenstein: None. P. Hewins: None. Z. Mclaren: None. J.A. Reynolds: None.

Over a third of palliative medicine physicians meet burnout criteria: Results from a survey study during the COVID-19 pandemic

Background: Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown. Aim: To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors. Design: Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life. Setting/participants: Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings. Results: There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31–40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002–0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62–0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75–49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); p < 0.001). Conclusions: Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics.

Investigating monotherapy and combination therapy trends in newly diagnosed patients with pulmonary arterial hypertension among EU3 &amp; UK physicians over the COVID-19 pandemic

Abstract Background Pulmonary Arterial Hypertension (PAH) is a form of pulmonary hypertension, where the narrowing of arteries in the lungs restricts blood flow and so increases pressure in the vessels. Studies have demonstrated that initial combination therapies are optimal for PAH management. However, prescription of monotherapy treatment is still prevalent as a first line therapy. Purpose The purpose of this research was to investigate prescribing trends of physicians for first line patients with PAH in the UK, Germany, Italy and Spain. We investigated the proportions of newly diagnosed patients and the prescription trends for monotherapy and combination therapy prior to and during the COVID-19 pandemic. Methods A multi-country, multi-centre online medical chart review study of patients with PAH was conducted between April – June of 2019, 2020 and 2021 respectively. Recruited from a large access panel, 178 treating cardiologists, pulmonologists &amp; rheumatologists in the UK (n=16), Germany (n=55), Italy (n=55) and Spain (n=52) were screened for duration of practice in their speciality and caseload (≥5 PAH patients in the last 3 months), and provided data on 694 PAH patients (UK = 71, Germany = 206, Italy = 208, Spain = 209). Reported patient data pertained to medical chart information reflecting the prior year, i.e., Q2 2021 data reflected the 2020 period (advent of the COVID-19 pandemic). Results In this dataset, there has been a consistent decrease in the proportion of newly diagnosed (i.e. diagnosed within 12 months of being reported) patients reported from 2019 to 2020 and 2021. In 2019, 49% of the reported patients were diagnosed within the last 12 months. However, the newly diagnosed patient population dropped to 37% in 2020 and continued to drop to 27% in 2021. Despite this, there has been an increase in reported first line patients within the newly diagnosed segment from 74% in 2019, to 75% in 2020, then at 87% in 2021. This increase can be seen to coincide with the ongoing COVID-19 pandemic. In 2019, 58% of reported newly diagnosed patients were recorded as receiving monotherapy. This did drop to 33% in 2020; however, in 2021 monotherapy uptake increased to 47%. Of note, the usage of the endothelin receptor antagonist (ERA) drug class increased from 67% in 2019 to 83% in 2020 but dropped to 69% in 2021. Conclusions This data set suggests a decreasing trend in newly diagnosed patients and a gradual shift in treatment type to first line monotherapy prescription, which coincided with the height of the COVID-19 pandemic. More newly diagnosed patients (those diagnosed within 12 months of being reported) are receiving monotherapy treatment at the expense of combination therapy, and this has also coincided with the pandemic. Further investigation using comparator cohort is warranted to assess whether the challenges physicians faced during the pandemic has had a causal effect on the prescribing habits for PAH therapies. Funding Acknowledgement Type of funding sources: None.

IMPACT OF NON-VITAMIN K ORAL ANTI-COAGULANTS ON WARFARIN UTILISATION AND NHS BUDGET IN UK

Introduction: Vitamin K anticoagulants were the mainstay prophylaxis of stroke in patients with atrial fibrillation and thromboembolic diseases. Non-vitamin K oral anticoagulants were approved for use in UK. To evaluate the impact of the introduction and change in guidelines on the utilisation of newer agents on the prescribing oral anticoagulants in UK. Methods: A segmented regression of interrupted time series analysis of the primary care data of oral anticoagulants from England, Scotland, Northern Ireland, and Wales between 2001 and 2021. Results: The overall utilisation of oral anticoagulants increased from 85.8, 9, 2.8, and 7.3 million defined daily doses in 2001 to 430, 36, 14.1, and 26.5 million defined daily doses in 2021 in England, Scotland, Northern Ireland, and Wales respectively. In 2021, the market domination changed from warfarin to apixaban. Segmented regression analysis showed that with the change in the National Institute for Health and Care Excellence clinical guidance in 2014, the utilisation of vitamin K anticoagulants decreased significantly by 2.39e+07, 1675341, 604863 and 2065009 defined daily doses annually in England, Scotland, Northern Ireland, and Wales, respectively. The overall expenditure on oral anticoagulants increased from £16, £1.6, £0.5, and £1.3 million in 2001 to £751, £60, £25, and £44.5 million in 2021 in England, Scotland, Northern Ireland, and Wales respectively. Conclusion: Prescribing oral anticoagulants changed in response to the change in clinical guidance. This suggests that the UK physicians followed evidence-based practice and changed to nonvitamin K oral anticoagulants primarily when recommended by the National Institute for Health and Care Excellence.

Physicians' Conceptions of the Dying Patient: Scoping Review and Qualitative Content Analysis of the United Kingdom Medical Literature.

Most people in high income countries experience dying while receiving healthcare, yet dying has no clear beginning, and contexts influence how dying is conceptualised. This study investigates how UK physicians conceptualise the dying patient. We employed Scoping Study Methodology to obtain medical literature from 2006-2021, and Qualitative Content Analysis to analyse stated and implied meanings of language used, informed by social-materialism. Our findings indicate physicians do not conceive a dichotomous distinction between dying and not dying, but construct conceptions of the dying patient in subjective ways linked to their practice. We argue that the focus of future research should be on exploring practice-based challenges in the workplace to understanding patient dying. Furthermore, pre-Covid-19 literature related dying to chronic illness, but analysis of literature published since the pandemic generated conceptions of dying from acute illness. Researchers should note the ongoing effects of Covid-19 on societal and medical awareness of dying.

Surveillance of Unruptured Intracranial Aneurysms: Cost-Effectiveness Analysis for 3 Countries.

No consensus exists on adequate surveillance of conservatively managed unruptured intracranial aneurysms (UIAs). We aimed to determine optimal MRI surveillance strategies for the growth of UIAs using cost-effectiveness analysis. A secondary aim was to develop a clinical tool for personalizing UIA surveillance. We designed a microsimulation model from a health care perspective simulating 100,000 55-year-old women to estimate costs and quality-adjusted life years (QALYs) over a lifetime horizon in the United States, the United Kingdom, and the Netherlands, using literature-derived model parameters. Country-specific costs and willingness-to-pay thresholds ($100,000/QALY for the United States, £30,000/QALY for the United Kingdom, and €80,000/QALY for the Netherlands) were used. Lifetime costs and QALYs were annually discounted at 3% for the United States, 3.5% for the United Kingdom, or 4% (costs) and 1.5% (QALYs) for the Netherlands. Strategies were no follow-up surveillance, follow-up with MRI in the first and fifth year after UIA discovery, every 5 years, every 2 years, or annually, or immediate intervention (i.e., clipping or coiling). Using the microsimulation model, we developed a tool for personalizing UIA surveillance for men and women, with different ages and varying aneurysm characteristics. Uncertainty in the input parameters was modeled with probabilistic sensitivity analysis. Among 55-year-old women, 2,222 individuals in the United States, 1,910 in the United Kingdom, and 2,040 in the Netherlands needed to undergo an annual MRI scan to prevent 1 case of subarachnoid hemorrhage per year. No surveillance MRI was most cost-effective in the United States (in 47% of the simulations) and United Kingdom (in 54% of simulations), whereas annual MRI was most cost-effective in the Netherlands (in 53% of simulations). In the United States and United Kingdom, annual surveillance or surveillance in the first and fifth year after discovery was cost-effective in patients <60 years and at increased risk of aneurysm growth. The optimal, personalized, surveillance strategies were summarized in a look-up table for use in clinical practice. Generally, the US and UK physicians should refrain from assigning patients, particularly older patients and those with few risk factors for aneurysm growth or rupture, to frequent MRI surveillance. In the Netherlands, annual follow-up is generally most cost-effective.

Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians.

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is widely accepted as a more accurate method for measurement of blood pressure (BP) compared to a single office-based measurement of BP. However, it is unclear how physicians interpret ABPM and make management decisions. This study's goal is to investigate variation in ABPM interpretation among paediatric nephrologists (Canada and UK) and paediatric cardiologists (Canada only) via an online survey. The survey content included baseline demographics, questions on the use and indications for ABPM, interpretation of results, and subsequent management decisions in various clinical scenarios. The survey was sent to 196 Canadian physicians, with 69 (35.2%) total responses. Thirty-five UK clinicians also completed the survey. Most respondents were >44 years old, were in practice for at least 11 years, and were university-based. There were substantial differences among clinicians in ABPM interpretation for isolated systolic, diastolic, and night-time hypertension. For example, only 53.1% of physicians would initiate or modify treatment in those with diastolic HTN in CKD. Further, even for the same abnormal ABPM parameter, the decision to start or alter treatment was influenced by the underlying medical condition. There is significant variation in clinical practice among physicians for interpretation and management of hypertension when using ABPM. Differences in guidelines among various jurisdictions, as well as knowledge gaps in the research on which guidelines are based, create ambiguity regarding ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasoning behind the variation in physicians' interpretation may help to standardise practice.

Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey

ObjectivesTo explore intercountry and intracountry differences in physician opinions about continuous use of sedatives (CUS), and factors associated with their approval of CUS.SettingsSecondary analysis of a questionnaire study.ParticipantsPalliative care physicians...

Drexit: Understanding why junior doctors leave their training programs to train overseas: An observational study of UK physicians.

IntroductionDrexit (“Doctor‐Exit”) is the exponentially growing trend for junior doctors in the UK to walk away from their jobs in the National Health Service (NHS). Our objective was to identify the reasons why junior doctors in the UK leave their NHS training programs to train overseas.Materials and MethodsA simultaneous and convergent mixed‐methods study was performed to analyze both an online survey and semi‐structured interviews from junior doctors who had left the NHS. Social media, online professional media, and networks of junior doctors were used to recruit doctors. All were UK medical school graduates who had left the NHS within the last 15 years (2003‐2018).Results96.1% (149/155) of respondents reported not being offered an exit interview on leaving the NHS. 94.8% (147/155) of respondents did not regret quitting the NHS. Participants were more satisfied with their pay and work life balance in their overseas posts when compared to training in the NHS (P < 0.05). Burnout was variably defined and was prominent in doctors who left 53.8% (113/210) but was reversed when they practiced medicine overseas in 89.2% (74/83) of cases. Qualitative data identified four key themes which were categorized into push factors, which were lack of interest in retention and bleak outlook; and pull factors, which were financial vs social capital and things are different overseas.ConclusionListening to the frontline junior doctors' voices lend insights into a better understanding of the push and pull factors that appear to be exacerbating the exodus of junior doctors from the NHS. Our results indicate that exit interviews should be performed routinely. There needs to be a shift to focus on the training of doctors rather than service provision, with efforts to support, appreciate, and value junior doctors. Further exploration is needed to identify what is happening in training programs overseas to improve retention within the NHS. Furthermore, identifying issues perceived by junior doctors in the UK in the context of workforce planning may be applicable to healthcare systems across the globe.

Real-world trends in EU4 and the UK in frontline (1L) maintenance (MT) for nonsquamous (NSQ) advanced non-small cell lung cancer (aNSCLC) without actionable mutations after introduction of immune checkpoint inhibitors.

296 Background: Immune checkpoint (PD-1, PD-L1) inhibitors are important in the treatment (Tx) of aNSCLC, as reflected in European Society for Medical Oncology (ESMO) guidelines. Pembrolizumab (pembro) combined with pemetrexed and platinum-based chemotherapy is a standard induction option in 1L Tx of NSQ aNSCLC. Decisions about 1L maintenance consider response and toxicity after induction, performance status, and patient preference. This study documents recent real-world 1L MT patient characteristics and Tx in EU4 (France, Germany, Italy, Spain) and UK. Methods: This retrospective analysis used patient chart review completed by treating physicians in EU4 and UK between 1 Jan 2018 and 31 Dec 2020 in the IQVIA Oncology Dynamics (OD) database. Adults (≥21 years) with confirmed NSQ aNSCLC (stage IIIB/C or IV) without actionable oncogenic driver mutations and with Eastern Cooperative Oncology Group (ECOG) status of 0 or 1 were included. 1L MT and Tx characteristics and trends over time were evaluated overall and by country. Results: In total, 1,814 NSQ aNSCLC patients receiving 1L MT Tx met the inclusion criteria; 29% of patients entered the analysis in 2018, 40% in 2019, and 31% in 2020. Most patients were male (61%), in the 46–65 age group (51%), current/ex-smokers (87%), and treated in the UK (29%) or Germany (24%); 94% were metastatic (stage IV), 10% presented with CNS/brain metastases, and 77% had ECOG score of 1. Overall, 91% were tested for PD-L1; of these, 47% had tumor proportion score (TPS) of ≥1% to 49%, 22% had TPS of ≥50%, and 21% tested negative. Baseline demographic and clinical characteristics were generally similar among countries. The top two Tx in 1L MT were pemetrexed (40%; range: 12% in Germany to 66% in Italy) and pembro (28%; range: 14% in Spain to 49% in Germany) monotherapies. Overall use of pemetrexed-based Tx in 1L MT decreased from 68% in 2018 Q1 to 56% in 2020 Q4, while pembro-based Tx increased from 18% in 2018 Q1 to 73% in 2020 Q4 in 1L MT. Conclusions: Despite ESMO guidelines, this real-world data suggests notable differences between European countries in 1L MT Tx for NSQ aNSCLC, with trends over time likely reflecting introduction and adoption of pembro regardless of PD-L1 status. Awareness of country and time-variability in clinical practice are critical for implementing clinical trials and updating clinical practice guidelines to maximize Tx benefits with improved tolerability.[Table: see text]

Supporting the vital role of boundary-spanning physician researchers in the advancement of medical innovation

A wide range of stakeholders recognise that physicians play a vital role in medical innovation and, in particular, the importance of boundary-spanning engagement between physicians and industry in clinical research. While UK physicians are keen to take part in research, this article draws on a range of literature to identify apparent and anticipated challenges that discourage or prevent cross-sector engagement by physician researchers. To encourage greater interaction and exploration of associated support mechanisms, we present a full spectrum of engagement modes, funding opportunities and illustrative initiatives, showing how different stakeholders (from government institutions, charities, professional bodies and industry) can contribute to improving the engagement of physicians in boundary spanning research. We emphasise the importance of mutual understanding, trust and commonly shared practices, as well as adequate resources, to encourage these vital interactions.

PND37 Cost-Effectiveness of BoNT-A Products for Treatment of Pediatric Spasticity in the United Kingdom

For children with impaired motor function, pain, or other functional difficulties attributable to focal spasticity, the UK National Institute for Health and Clinical Excellence guidelines recommend treatment with botulinum neurotoxin type A (BoNT-A). Two BoNT-A products are licensed for pediatric use in the United Kingdom: abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A), but these treatments differ in terms of doses, costs, and injection frequencies. The objective of this analysis was to evaluate the average expenditure per response obtained with aboBoNT-A or onaBoNT-A for managing pediatric spasticity of the upper (ULS) and lower (LLS) limbs. Cost-effectiveness analyses were conducted for BoNT-A treatment of ULS and LLS in the UK. Effectiveness was defined as response to therapy and was based on data from systematic literature reviews and meta-analyses of randomized controlled trials. BoNT-A dose was based on product label and the average weight of a pediatric (6-year-old) patient in the UK. Injection interval was based on clinical trial data, adjusted to consider differences in use observed in real-world studies of BoNT-A use in adult spasticity. Resource use for responders and non-responders was based on a survey of UK physicians treating pediatric LLS. Unit costs were informed by UK fee schedules. AboBoNT-A resulted in lower annual costs compared with onaBoNT-A for the management of ULS (£487 saved) and LLS (£429 saved). Results were driven by differences in injection intervals and a higher treatment response rate for people receiving aboBoNT-A compared with onaBoNT-A. Total cost per responder was lower for people receiving aboBoNT-A compared with onaBoNT-A (ULS: £37,880 vs. £50,100; LLS: £46,459 vs. £66,037). Results were robust to sensitivity analyses. AboBoNT-A may be a cost-effective choice for treatment of spasticity in children. These findings could help deliver more effective and efficient healthcare in the UK.

Comparison of treatments and outcomes of children with juvenile dermatomyositis followed at two European tertiary care referral centers

To compare the treatment approaches and disease outcomes of children with JDM followed in two European tertiary care peadiatric rheumatology centres. The medical notes of patients with JDM seen at Istituto Giannina Gaslini (IGG) of Genoa, Italy or Great Ormond Street Hospital (GOSH) of London, UK between January 2000 and December 2015 within 6 months after disease onset and followed for at least 6 months were reviewed. Demographic, clinical and therapeutic data were collected. At each visit, the caring physician was asked to rate the disease state subjectively. A total of 127 patients were included, 88 at GOSH and 39 at IGG. At 24 months, the median values of muscle strength and disease activity were at the normal end of the scale and around three quarters of patients were said to have inactive disease. Also, at 2 years, 38.6% and 36% of British and Italian patients, respectively, had damage. Cyclophosphamide, azathioprine, infliximab, rituximab and mycophenolate mofetil were used more frequently by UK physicians, whereas ciclosporin, intravenous immunoglobulin and hydroxychloroquine were prescribed by Italian physicians. This study shows a significant difference in the choice of medications between pediatric rheumatologists practising in the two centres. Despite this, a high proportion of patients had inactive disease at 2 years and there was a low frequency of damage: modern treatments have improved outcomes.

Differences in the evaluation of skin prick testing results for food allergy diagnosis between US and UK physicians

Differences in the evaluation of skin prick testing results for food allergy diagnosis between US and UK physicians

PMU104 UTILISING MOBILE TECHNOLOGY TO UNDERSTAND PHYSICIAN PRESCRIBING BEHAVIOURS CLOSE TO REAL TIME WITHIN PLAQUE PSORIASIS (PSO) AND ACTINIC KERATOSIS (AK)

Prescribing decisions can be difficult to understand in a ‘real’, uninterrupted way via traditional research methods. Direct questioning can lead to ‘stock’ answers; such as asking physicians to recall and explain prescribing behaviours where post-rationalisation can prevent an accurate read of drivers and barriers. To understand what drives plaque psoriasis and Actinic Keratosis (AK) physician prescribing and to identify the barriers between real and reported prescribing behaviours, LEO Pharma conducted a two-step, 8-week market research project involving close to ‘real-time’ decision capture methodology. Thirty-five primary and 16 secondary care UK physicians were surveyed using mobile App technology and telephone depth interviews (TDI) to ascertain what happens in the clinical context from first presentation of the patient through to prescribing of the treatment by the physician. This report presents the findings of physician prescribing behaviour in patients with mild-moderate plaque psoriasis obtained from 30 TDIs and 213 primary care recorded videos. Four key drivers were identified from this research: most physicians have their own, unique default treatment pathway based on habit and familiarity, variation exists in how severity is defined and measured, patient distress influences how physicians measure severity and how aggressively they treat and finally, the patient voice is a powerful influencer with patient preferences and experience often determining the treatment prescribed. In conclusion, there is no standardised plaque psoriasis treatment pathway, but one which is individual to both the physician and the patient. Severity drives where new patients enter the pathway. Enabling the patient to express their level of distress could encourage physicians to treat more aggressively.

P178 Maintenance treatment for ANCA-associated vasculitis in real world practice in the UK: reality of vasculitis remission and relapse and burden of disease

Abstract Background AAV is a relapsing remitting condition and patients are at risk of organ damage from active AAV and therapy especially glucocorticoids (GC). The maintenance phase of AAV is critical for good long-term outcomes. This retrospective study examined maintenance definition, therapy and outcomes in patients in routine clinical practice. Methods 300 AAV patients managed by 100 UK physicians (40% rheumatologists) who completed induction therapy for organ or life threatening AAV and initiated maintenance between 2014-16 were studied. Data were collected at time maintenance was determined to begin by the physician and at 6, 12, 18 and 36 months. Results 56% had granulomatosis with polyangiitis; mean age 55.4 years 54% male. 61% had incident AAV and 39% relapsed. Physicians defined time of start of maintenance from treatment start with mean of 4.5 months, on basis of fixed time point 47%, starting new maintenance drug 27%, reaching full remission 16% and no specific criteria 9%. At this time 45% were in full remission vs 49% in partial and 6% refractory. Various maintenance regimes were used, 11% received rituximab (84% 6 monthly and 16% 12 monthly) at varying planned doses 61% 1g, 19% 500 mg and 16% 375 mg/m2, 4% not recorded. Remission rates varied and many patients experienced adverse events (AE) and infections, prolonged GC use was common. At most recent review patients had been followed for a mean of 49.2 months - 6% had died, 30% relapsed at least once, and 10% required renal replacement therapy. 62% had no vasculitis activity and were ANCA negative with 14% still experiencing active disease. 35% still received GCs - 19% &amp;gt; 5mg/ day. There was negative impact on functional status with 13% reducing working hours, 13% restricted social life, 4% leaving employment, 3% registered as disabled and 2% leaving full time education. Conclusion Maintenance therapy is variably defined at 4-5 months from start of remission induction therapy. Achieving full remission and preventing relapse are still problems and many patients require GC therapy to maintain remission. Infectious complications are a problem and there is significant negative impact on patient functional status. Disclosures D. Worthington Corporate appointments; Employee of Vifor Pharma. P. Rutherford Corporate appointments; Employee of Vifor Pharma. Shareholder/stock ownership; Vifor Pharma.