US Health Care Professionals Research Articles

Adaptive learning to address gaps in metastatic breast cancer treatment with CDK 4/6 inhibitors.

92 Background: To address identified gaps in knowledge and confidence of US-based healthcare professionals (HCPs) when using cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i) to treat metastatic breast cancer (mBC), an adaptive learning program (ALP) was deployed to review guideline recommendations and evidence from randomized clinical trials (RCTs) and real-world data (RWD). Methods: The ALP consisted of reading materials (guideline excerpts, RCTs, RWD, cases) with a virtual tutor that taught. The ALP continued to review necessary content until responders were both correct and confident (conscious competence). Impact on learning was interpreted as greater for learning objectives with the lowest accuracy score (% of correct responses) and higher distance to 100% conscious competency at baseline. Immediately post-ALP, satisfaction, perceived impact on knowledge, confidence and intent to change practice were assessed quantitatively and qualitatively. ANOVA compared continuous measures by profession. Results: Participants (n=261) were physicians (MD, 17%), advanced practice practitioners (APP, 20%), registered nurses (RN, 49%), pharmacists (11%), and other (3%). Mean completion time was 44 minutes and learners’ proficiency shifted +64% towards conscious competency. The learning objectives most impacted by the education are shown (Table). Learners most satisfied with the ALP (47% with 9-10 on a 10-point satisfaction scale) appreciated the challenge and reported positive impact on their knowledge and confidence, resulting in intent to change their patient-communication, clinical decisions and interprofessional collaboration when using CDK4/6i. Conclusions: This ALP initiative addressed the educational gaps of US HCPs regarding CDK4/6i in HR+/HER2- mBC by challenging participants to re-consider their knowledge and confidence until conscious competency was demonstrated. Engaged learners found the activity impactful and reported intent to change practice. Future studies should seek to address attrition challenges and assess long term impacts of such programs. Top five learning objectives with lowest-ranking accuracy, by profession. Learning Objectives (LOs) Most Impacted Initial Scores by Profession Final Score ALL MD APP RN PharmD Other Identify appropriate CDK4/6i treatment options for a premenopausal woman with newly diagnosed HR+/HER2- mBC 54 57 53 53 62 52 100 Match RWD sources with their characteristics 56 55 60 55 61 41 100 Interpret results from the landmark CDK4/6i RCTs 58 62 61 53 64 56 100 Interpret RWE related to the use of CDK4/6i in patients who are underrepresented in RCTs* 62 62 63 58 74 65 100 Identify the latest updates from CDK4/6i RCTs 62 60 63 61 62 82 100 Average accuracy score for all 24 LOs 71 72 73 69 74 64 100 *Significantly different between professions (p<0.05; one-way ANOVA).

Impact of visit characteristics on intention to recommend HPV vaccine: An experiment with US health care professionals

ObjectivePresumptive recommendations that assume parents want to vaccinate can increase human papillomavirus (HPV) vaccine uptake. We sought to examine how visit characteristics affect health care professionals' (HCPs) intention to use this evidence-based recommendation style. MethodsIn 2022, we conducted an online experiment with 2527 HCPs who had a role in adolescent vaccination in the United States. Participants read 1 of 8 randomly assigned vignettes about a well-child visit. Using a 2 × 2 × 2 between-subjects factorial design, the vignettes varied the following visit characteristics: patient age (9 vs. 12-year-old), prior parental vaccine refusal (yes vs. no), and time pressure on the HCP (low vs. high). HCPs reported on their intention to use a presumptive HPV vaccine recommendation, as well as on related attitudes, subjective norms, and self-efficacy. Analyses used 3-way analysis of variance and parallel mediation. ResultsParticipants were pediatricians (26%), family/general medicine physicians (22%), advanced practitioners (24%), and nursing staff (28%). Overall, about two-thirds of HCPs (64%) intended to use a presumptive recommendation. Intentions were higher for older children (b = 0.23) and parents without prior vaccine refusal (b = 0.39, both p < 0.001). Time pressure had no main effect or interactions. HCPs' attitudes and self-efficacy partially mediated effects of patient age and prior vaccine refusal (range of b = 0.04–0.28, all p < 0.05). ConclusionTo better support visits with younger children and parents who have refused vaccines, HCPs may need more training for making presumptive recommendations for HPV vaccine. Reinforcing positive attitudes and self-efficacy can help HCPs adopt this evidence-based recommendation style.

Abstract 13187: TikTok and Cardiovascular Health: An Analysis of TikTok as a Potential Outlet to Increase Cardiovascular Health Literacy

Introduction: Multidisciplinary approaches promoting continued patient education may improve patient adherence and reduce hospitalizations. The recent emergence of short video applications provides a new avenue for health-related education. Current and future patients can benefit from utilizing this new media resource to expand cardiovascular health literacy and promote positive outcomes. Methods: TikTok was queried in #cardiology, #cardiologylife, #interventionalcardiology, #pediatriccardiology, #cardiologynurse between 11/15/22-11/18/22. Inclusion criteria were English videos focused on information, inspiration, or wellness from US healthcare professionals between 2021-2022. Posts that met inclusion criteria (N=218) were statistically analyzed. A linear model was created to estimate a value for views. Results: The year 2022 had the highest values of 324,077 views, 14,901 likes, and 1170 downloads, as opposed to 2021 with 305,377 views, 6918 likes, and 508 downloads. Of the 218 videos, 127 (58.3%) involved information, 45 (20.6%) involved inspiration, and 46 (21.1%) involved wellness. The difference in mean views between 2021 and 2022 was 38,937 (p=0.23), suggesting a potential upward trend. The difference in mean likes and downloads between 2021 and 2022 was 2909 (p=0.009) and 276 (p=0.013) respectively. Linear modeling revealed a strong relationship between likes/downloads and views, but could not predict the number of views on a video. While we cannot confidently state that the mean number of views is increasing, we have determined that likes and downloads are certainly increasing with expanding engagement. Conclusions: The results of this study highlight the use of social media, specifically TikTok, as an inexpensive and passive way to improve health literacy. The increasing average number of views from 2021 to 2022 illustrates the upward trend among users and how TikTok can be used in a multidisciplinary approach to patient care and patient education. Further research is required to determine the role TikTok may play in patient care and how it may be utilized to inform the care of specific patient populations; however, the opportunities it may provide are promising.

Assessment of FDA-Approved Drugs Not Recommended for Use or Reimbursement in Other Countries, 2017-2020

Drug expenditures in the US are higher than in any other country and are projected to continue increasing, so US health systems may benefit from evaluating international regulatory and reimbursement decision-making of new drugs. To evaluate regulatory decisions and health technology assessments (HTAs) in Australia, Canada, and the UK regarding new drugs approved by the US Food and Drug Administration (FDA) in 2017 through 2020, as well as to estimate the US cost per patient per year for drugs receiving negative recommendations. In this cross-sectional study, recommendations issued by agencies in Australia, Canada, and the UK were collected for new drugs approved by the FDA in 2017 through 2020. All data were current as of May 31, 2022. Authorizations and HTAs in selected countries. All FDA-approved drugs were matched by active ingredient to decision summary reports published by drug regulators and HTA agencies in Australia, Canada, and the UK. Regulatory approval concordance and reasons for negative recommendations were assessed using descriptive statistics. For drugs not recommended by an international agency, the annual US drug cost per patient was estimated from FDA labeling and wholesale acquisition costs. The FDA approved 206 new drugs in 2017 through 2020, of which 162 (78.6%) were granted marketing authorization by at least 1 other regulatory agency at a median (IQR) delay of 12.1 (17.7) months following US approval. Conversely, 5 FDA-approved drugs were refused marketing authorization by an international regulatory agency due to unfavorable benefit-to-risk assessments. An additional 42 FDA-approved drugs received negative reimbursement recommendations from HTA agencies in Australia, Canada, or the UK due to uncertainty of clinical benefits or unacceptably high prices. The median (IQR) US cost of the 47 drugs refused authorization or not recommended for reimbursement by an international agency was $115 281 ($166 690) per patient per year. Twenty drugs were for oncology indications, and 36 were approved by the FDA through expedited regulatory pathways or the Orphan Drug Act. This cross-sectional study assessed reasons for which drugs recently approved by the FDA were refused marketing authorization or not recommended for public reimbursement in other countries. Drugs with limited international market presence may require close examination by US health care professionals and health systems.

Abstract WMP13: Implementation Issues Arising From Less-intense Monitoring In Routine Care: Process Evaluation Of The Optimial Post Rtpa-iv Monitoring In Acute Ischemic Stroke (OPTIMISTmain) Study

Background and Aims: OPTIMISTmain is an international, multicenter, stepped-wedge cluster randomized trial to determine effectiveness and safety of less-intensive versus standard monitoring in thrombolysis-treated patients with mild-moderate acute ischemic stroke. A process evaluation was undertaken to determine feasibility, acceptability, and impact of the intervention on care processes, experience and staffing. Methods: A sample of stroke care nursing managers and unit staff from 7 US sites were invited to participate in semi-structured interviews at an early stage of the study. Implementer clinician surveys were undertaken pre- and post-intervention to define integration of the intervention. Qualitative data were independently analyzed by 2 coders; survey data reported from descriptive analysis. Results: 19 nurses were interviewed from the units with 1:2 to 1:6 nurse-to-patient ratios. Less-intensive monitoring was well accepted: less time constraints and improved workload, and perceived to be cost efficient from improved use of neuro-intensive care beds. Some nurses had initial safety concerns over missing deteriorating patients. Less-intensive monitoring led to patients being less irritable and more cooperative from having more rest. There was greater flexibility in the allocation of nursing staff from workforce shortages arising due to the COVID pandemic. Similar results were evident in the survey (13 hospitals, 34 respondents): 80% of respondents agreed that less-intensive monitoring benefited work; 74% believed it should be widely adopted at a national level. Nurses reported time being freed up to provide more patient education (56%), continence/daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (24%, e.g. communication, family support). Conclusions: Less-intensive monitoring after thrombolysis for acute ischemic stroke patients appears feasible and acceptable among US healthcare professionals.

Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers’ attitudes and practices

ABSTRACT This study aimed to evaluate the attitudes and practices of US healthcare professionals (HCPs) regarding the Advisory Committee on Immunization Practices (ACIP) vaccination recommendations on HepA and HepB for adult patients at risk of contracting these infections or experiencing complications of hepatitis disease. This cross-sectional, web-based survey of 400 US HCPs, which included nurse practitioners and family medicine, internal medicine, infectious disease, emergency department, and gastroenterology physicians, assessed HCPs’ attitudes and practices regarding the ACIP recommendations for adult patients at risk for hepatitis disease. HCP participants were identified via a survey research panel. A recruitment quota of 400 HCPs was set, including 50 NPs, 100 FMs, 100 IMs, 50 GIs, 50 EDs, and 50 IDs. The most frequently reported reasons for not recommending either HepA or HepB vaccines were “I think the risk of HepA infection is low in this patient population” and “I am uncertain about what the guidelines say about vaccinating this population.” The most reported factors considered when determining eligibility for either vaccine were medical history and the patient’s willingness/motivation to be vaccinated. Most reported it was extremely or moderately important to prevent hepatitis disease by vaccinating adult patients at risk, and most also reported recommending a HepA vaccine or HepB vaccine to patients at risk. Although most HCPs reported recommending HepA and HepB vaccines to patients at risk, these findings contrast with the low reported vaccination rates among these populations, and improved awareness of the ACIP recommendations among HCPs is needed.

Management of short-bowel syndrome: A survey of unmet educational needs among healthcare providers.

Management of short-bowel syndrome with intestinal failure (SBS-IF) is complex and requires a multidisciplinary approach. Because of the rarity of SBS-IF, healthcare professionals (HCPs) often lack clinical experience with the disease and may benefit from education regarding SBS-IF and its management. This study identified unmet educational needs related to the management of patients with SBS-IF. This was a prospective, web-based survey (December 2019-January 2020) in which a series of clinical questions were posed to US HCPs after presenting three standardized SBS-IF cases to assess current practice patterns. HCPs were then asked a series of questions to identify potential knowledge gaps and unmet educational needs relating to SBS-IF management. Overall, 558 HCPs completed the survey, with 12%-38% having a formal SBS-IF multidisciplinary team currently available to make treatment decisions within their institution. Clinicians involved in care included gastroenterologists (93%), registered dietitians (79%), gastroenterology nurse practitioners and physician assistants (37%), registered nurses (43%), social workers (45%), and psychologists/psychiatrists (27%). There was underuse of published guidelines and limited understanding of the course of intestinal adaptation. Responses to the clinical scenarios highlighted disparities in SBS-IF care delivery, including diagnosis, management goals, medications prescribed, and nutrition practices. Future SBS-IF educational interventions for HCPs should aim to improve awareness and understanding of the disease, facilitate timely diagnosis, and standardize management practices to ensure patients receive optimal interdisciplinary care as widely as possible.

The impact of live education on the competence and performance of oncology practitioners who care for patients with ovarian cancer.

e23010 Background: About a third of ovarian cancer patients in the US have limited access to a gynecologic oncologist (GO) due to geographic disparities. A survey by The Society of Gynecologic Oncology (SGO) found that the majority of GOs found it was vital to coordinate local access to care, from diagnosis to survivorship, for patients living in areas of disparity. This allows rural/underserved patients broader access to novel therapies, as they increasingly become standard of care. It is critical for not only GOs to be current on the latest ovarian cancer data, but all clinicians who care for these patients. Methods: CEC Oncology developed two educational initiatives focused on PARP inhibitor therapy in ovarian cancer, which was targeted to all US healthcare professionals caring for ovarian cancer patients. Evaluations were collected from attendees attending an SGO Symposium and Ground Round (GR) series to assess impact on practice, increased competency, and intent to make a change in practice. Learning, knowledge, and competence was objectively assessed by analyzing pre-test, post-test, and follow-up survey data (sent 4-6 weeks post-activity). Chi-square analysis was conducted with a priori significance set at 0.05. Results: A total of 830 clinicians were educated, with SGO attendees primarily practicing in academic settings and GR attendees mostly from community practices. SGO attendees were asked case questions at baseline, immediately after the activity, and 4-6 weeks after the activity. Knowledge increased from pre- to post-test regarding current genetic testing recommendations (23% increase; P= .004) and appropriate selection of PARP inhibitor therapy (25% increase; P= .017). Knowledge was sustained at follow-up analysis. At follow-up, 90% of SGO and 84% of GR attendees made a change as a result of attending the activities. More attendees were able to incorporate germline multigene testing into practice, than originally intended; increase of 29% for SGO and 7% for GR audiences. All attendees experienced the barrier lack of patient education about the importance of genetic testing/counseling more than anticipated; increase of 7% for SGO and 13% for GR audiences. At follow-up, there was a 9% increase in GR attendees listing staying current with trial data and practice guidelines as a barrier. Conclusions: There were some notable differences seen in competence/performance among attendees of the two ovarian cancer educational initiatives. Differences may be attributed to practice setting (SGO primarily academic; GR primarily community.) Overall, GR attendees were more likely to face barriers, suggesting that community-based clinicians have fewer resources and experience more barriers to implementing best practices. Thus, it is vital to offer education for clinicians in community-based practices, particularly in areas that are considered ‘geographically disparate’.

Physician Understanding and Willingness to Prescribe Biosimilars: Findings from a US National Survey.

Biosimilars have the potential to increase patient access and significantly reduce healthcare costs in the US. However, uptake in the US has been slower than anticipated, limiting the benefits of biosimilar competition. Understanding the factors that affect uptake is critically important to realize the benefits of biosimilars. A US national survey study was conducted electronically from December 11, 2019 to January 8, 2020. The survey was administered to 507 US healthcare professionals practicing in dermatology, gastroenterology, hematology, oncology, nephrology, or rheumatology. The survey evaluated prescriber attitudes toward biosimilars in general, as well as prescriber decision making, using a series of hypothetical scenarios with fictional biological products. Fewer than half had a baseline understanding of key elements of biosimilarity, even among respondents who had previously prescribed a biosimilar. Regardless of previous experience, all respondents benefited from receiving additional information about biosimilarity, indicating the potential benefits of educational efforts for prescribers across all specialties and levels of experience. Prescriber choice was driven primarily by formulary status; however, respondents identified a variety of factors that would influence their willingness to prescribe a biosimilar, including financial savings to the patient, pharmacovigilance, patient experience, and education on the FDA approval process. Over one-third of participants indicated a preference for reference products and nearly half indicated a hesitancy to try biosimilars until they have been on the market longer. Naming conventions for biosimilars did not affect prescribers' willingness to prescribe biosimilars. Gaps in prescriber knowledge and hesitancy toward biosimilars remain significant challenges for biosimilar uptake. While formulary status of a biosimilar product strongly influences prescriber choice, additional prescriber education on biosimilarity is needed.

Understanding prescription behavior across healthcare professionals in treating knee osteoarthritis before and during the 2020 COVID-19 pandemic

Purpose: The main goal in treating knee osteoarthritis (OA) is providing symptom relief, with a continued focus on easing joint pain and enabling mobility, in order for patients to go about daily activity. With the COVID-19 pandemic having impacted healthcare systems and regimes globally, the aim of this study is to understand how treatment management of knee OA patients and prescribing behavior across US healthcare professionals (HCPs) was affected, and how they adapt towards a potential ‘new norm’ in treating this condition.

Assessment of Risk Factors for Suicide Among US Health Care Professionals

Burnout among health care professionals has been increasingly associated with suicide risk. An examination of possible risk factors may help in the prevention of suicide among health care professionals. To assess suicide risk factors for 3 categories of health care professionals (surgeons, nonsurgeon physicians, and dentists) compared with non-health care professionals. Data from the National Violent Death Reporting System were reviewed to identify all individuals who died by suicide in the United States between January 1, 2003, and December 31, 2016. Individuals were divided into health care professionals and non-health care professionals (general population), with the health care professionals further categorized into surgeons, nonsurgeon physicians, and dentists. The covariates of suicide decedents included demographic characteristics (age, sex, race, and marital status), medical history (mental illness, substance use, and physical health), and documented factors associated with the suicide death (job, intimate partner, financial, legal, and other problems). Data were analyzed from October 2 to December 17, 2019. In this analysis, the outcome variable was occupation, with health care professionals overall and by category compared with the general population. Multiple logistic regression analyses with backward stepwise selection were performed. A total of 170 030 individuals who died by suicide between 2003 and 2016 were identified. Of those, 767 individuals (0.5%) were health care professionals (mean [SD] age, 59.6 [15.6] years; 675 men [88.0%]; 688 white [89.7%]), with the remainder of the sample (95.5%) comprising the general population (mean [SD] age, 46.8 [31.5] years; 77.7% men; 87.8% white). A total of 485 health care professionals (63.2%) were nonsurgeon physicians, 179 professionals (23.3%) were dentists, and 103 professionals (13.4%) were surgeons. Compared with the general population, risk factors for suicide among health care professionals included having Asian or Pacific Islander ancestry (odds ratio [OR], 2.80; 95% CI, 1.96-3.99; P < .001), job problems (OR, 1.79; 95% CI, 1.49-2.17; P < .001), civil legal problems (OR, 1.61; 95% CI, 1.15-2.26; P = .006), and physical health problems (OR, 1.40; 95% CI, 1.19-1.64; P < .001) and currently receiving treatment for mental illness (OR, 1.45; 95% CI, 1.24-1.69; P < .001). Compared with the general population, health care professionals had a lower risk of suicide if they had black ancestry (OR, 0.55; 95% CI, 0.36-0.84; P < .001) or were female (OR, 0.44; 95% CI, 0.35-0.55; P < .001) or unmarried (OR, 0.36; 95% CI, 0.31-0.42; P < .001). Health care professionals who died by suicide were also less likely to have problems with intimate partners (OR, 0.71; 95% CI, 0.60-0.86; P < .001) or alcohol use (OR, 0.58; 95% CI, 0.45-0.73; P < .001) compared with the general population. Surgeons had a higher risk of suicide compared with the general population if they were older, male, married, had Asian or Pacific Islander ancestry, were currently receiving treatment for mental illness, or had problems with their job or alcohol use. Compared with their nonsurgeon physician colleagues, surgeons had a higher risk of suicide if they were male, older, married, or currently receiving treatment for mental illness. This study highlights risk factors for suicide among health care professionals, with additional analyses of surgeon-specific risk factors. The results may be useful in improving the detection of burnout and the development of suicide prevention interventions among health care professionals.

Religious Service Attendance and Deaths Related to Drugs, Alcohol, and Suicide Among US Health Care Professionals

The increase in deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) has been identified as a public health crisis. The antecedents associated with these deaths have, however, seldom been investigated empirically. To prospectively examine the association between religious service attendance and deaths from despair. This population-based cohort study used data extracted from self-reported questionnaires and medical records of 66 492 female registered nurses who participated in the Nurses' Health Study II (NHSII) from 2001 through 2017 and 43 141 male health care professionals (eg, dentist, pharmacist, optometrist, osteopath, podiatrist, and veterinarian) who participated in the Health Professionals Follow-up Study (HPFS) from 1988 through 2014. Data on causes of death were obtained from death certificates and medical records. Data analysis was conducted from September 2, 2018, to July 14, 2019. Religious service attendance was self-reported at study baseline in response to the question, "How often do you go to religious meetings or services?" Deaths from despair, defined specifically as deaths from suicide, unintentional poisoning by alcohol or drug overdose, and chronic liver diseases and cirrhosis. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of deaths from despair by religious service attendance at study baseline, with adjustment for baseline sociodemographic characteristics, lifestyle factors, psychological distress, medical history, and other aspects of social integration. Among the 66 492 female participants in NHSII (mean [SD] age, 46.33 [4.66] years), 75 incident deaths from despair were identified (during 1 039 465 person-years of follow-up). Among the 43 141 male participants in HPFS (mean [SD] age, 55.12 [9.53] years), there were 306 incident deaths from despair (during 973 736 person-years of follow-up). In the fully adjusted models, compared with those who never attended religious services, participants who attended services at least once per week had a 68% lower hazard (HR, 0.32; 95% CI, 0.16-0.62) of death from despair in NHSII and a 33% lower hazard (HR, 0.67; 95% CI, 0.48-0.94) of death from despair in HPFS. The findings suggest that religious service attendance is associated with a lower risk of death from despair among health care professionals. These results may be important in understanding trends in deaths from despair in the general population.

Patient Perspectives on the Cultural Competence of US Health Care Professionals

This survey study uses data from the 2017 National Health Interview Survey to examine patients’ perspectives on the cultural competence of US health care professionals.

Cultural Sensitivity and Global Pharmacy Engagement in Asia: India, Indonesia, Malaysia, Philippines, and Vietnam

Schools and colleges of pharmacy in the United States increasingly interact with those in Asian countries for various purposes such as education and research. For both those visiting and those hosting, it is important to understand and respect the culture of the other's country to enrich these interactions. This paper, the second of two manuscripts on Asian countries, focuses on India, Indonesia, Malaysia, Philippines, and Vietnam. For each country, the following information is provided: general introduction, health care system, pharmacy practice, and pharmacy education, stereotypes and misconceptions, recommendations for US-based health care professionals, faculty members, and students who visit these Asian countries, and recommendations for them to host visitors from these Asian countries. The aim of this paper is to assist US health care professionals, faculty members, and students in initiating and promoting a culturally sensitive engagement.

MON-022 Enhancing Patient Care: Co-Creation and Validation of a New and Improved Delivery System for Lanreotide Depot/Autogel and Its Evaluation by US Healthcare Professionals

Lanreotide autogel/depot, a somatostatin analogue used to treat patients with acromegaly and gastroenteropancreatic neuroendocrine tumours (GEP-NETs), is currently supplied as a sterile, ready-to-use, single-dose prefilled syringe and is administered subcutaneously. To further enhance patient care, we performed several studies to i) gain insights into patient, caregiver and healthcare professional (HCP) use of the current delivery system (DS) and ii) evaluate use of a new improved DS developed from this patient-centred approach. From June 2015 to September 2016, 4 formative studies were conducted in Europe and the US in participants representing patients with acromegaly (n=33) or GEP-NETs (n=21), caregivers (n=3), nurses (n=73), and other relevant HCPs (n=2). These studies provided feedback on the current DS; identified challenges/areas for improvement; evaluated a prototype new DS; and identified critical tasks. A human factor (HF) validation study was then performed in the US and Germany (May/June 2017) to determine whether the new DS could be used safely and effectively in its intended setting. Inclusion criteria included: patients with acromegaly, or non-diagnosed participants with enlarged hands and fingers/dexterity issues and willingness to self-inject (acromegaly representatives); a caregiver of/patient with a GEP-NET, or non-diagnosed participants willing to inject self/someone else (GEP-NET representatives/caregivers). Critical tasks were assessed by asking participants to perform two injections with the new DS into their chosen site on a mannequin. Results of the HF validation study are reported. Formative study-led improvements to the new DS included: ergonomics (larger flanges to improve handling; robust over-cap to improve needle shield removal); robustness of injection process (plunger support); intuitiveness of use (tray to protect the DS and prevent accidental plunger depression; recessed areas to improve handling); needle exposure (white opaque over-cap, improved retractable needle system after injection). The HF validation study comprised US participants (N=35) (including HCPs who did [n=16] or did not [n=19] receive training prior to testing) and German participants (N=33) (including acromegaly representatives [n=15] and GEP-NET representatives/caregivers [n=18]; all received training before testing). Among HCPs, 13 task errors were noted in untrained participants and 3 in trained participants. Among German participants, 18 task errors were noted in acromegaly representatives and 16 in GEP-NET representatives/caregivers. No task errors were specific to the new DS. A new delivery system for lanreotide depot/autogel was developed in conjunction with patients, caregivers and HCPs. It is hoped that the ergonomic, robust and intuitive delivery system will further improve patient care. Sponsored by Ipsen

389. Anti-TNF treatments for women with chronic inflammatory diseases: Comparing attitudes and perceptions of physicians in Europe and the US

Introduction Chronic inflammatory disease (CID) activity in Women of Childbearing Age (WoCBA) is associated with higher risk of pregnancy complications and adverse outcomes. Tumour necrosis factor antagonists (anti-TNFs) are effective, but data on utilisation for these patients (pts) are limited. Objective/Hypothesis To understand physicians’ attitudes towards anti-TNF use around pregnancy, and differences between Europe- and US-based physicians. Methods The online survey was conducted in the US (Jul-17) and EU5 (France, Italy, Spain, UK, Germany; Nov/Dec-17). WoCBA were female pts aged 18–45. Participants included rheumatologists (RH) and obstetrician/gynaecologists (OB) among other healthcare professionals (HCPs). Results 203 US HCPs participated (50 RH, 50 OB) and 401 EU5 (152 RH, 114 OB). EU5 HCPs were less inclined to prescribe anti-TNFs for WoCBA; US RH (43%) had the highest proportion prescribed anti-TNFs (EU5 RH: 33%). Both US and EU5 HCPs’ comfort with prescribing anti-TNFs declined with onset of family planning. EU5 RH (61%) and OB (67%) were more likely to recommend stopping anti-TNFs pre-conception than US HCPs (RH: 46%; OB: 62%); similarly, > 50% EU5 RH and OB agreed women should stop anti-TNFs post-conception (US RH: 34%; OB: 54%). These findings may be due to more US RH strongly agreeing on making disease control during pregnancy a priority (42% vs EU5 RH: 25%) and that controlled disease reduces risk of pregnancy complications (US RH: 42%; EU5 RH: 28%), as well as more EU5 (34%) than US RH (12%) being very concerned about adverse events in pregnant pts on anti-TNFs. More EU5 (16%) than US RH (6%) strongly believed breastfeeding pts should not take anti-TNFs; uncertainty was high. Discussion Confidence in clinical management of WoCBA with CID varies, highlighting differences in physicians’ attitudes. Uncertainty and concerns about anti-TNFs for WoCBA are common, emphasising a need for better information/education of HCPs on anti-TNF use before/during/after pregnancy.

Earnings of Employed and Self-employed US Health Care Professionals, 2001 to 2015

Over the last 15 years, the health care practitioner landscape has changed significantly. Fewer practitioners are self-employed and more are employed by for-profit or nonprofit organizations. These shifts can have an impact on annual labor earnings. To examine trends in self-employment and employment and to assess the gap in annual labor earnings between self-employed and employed US health care professionals from 2001 to 2015. Survey study in which data on employment type (self-employed, employed by private sector, or employed by government) and annual labor earnings for 50 states and the District of Columbia were extracted from the 2001 to 2015 American Community Survey. The analyses were restricted to 175 714 self-identified dentists, physicians, pharmacists, optometrists, podiatrists, chiropractors, and physical therapists aged 30 years and older who worked at least 40 weeks per year and 20 hours per week. Controlling for age, sex, race/ethnicity, year, and state of residence, median regression models were used to measure the gap in annual labor earnings between self-employed and employed health care professionals. Annual labor earnings, defined as the sum of self-employment and wages or salary income. Our sample of 175 714 respondents included 99 077 physicians, 20 008 dentists, 26 143 pharmacists, 4238 optometrists, 6076 chiropractors, 1164 podiatrists, and 19 008 physical therapists. The weighted percentage of self-employed physicians decreased from 35.2% (95% CI, 34.4%-36.1%; 6807 of 18 726 physicians) in 2001 through 2005 to 24.7% (95% CI, 24.2%-25.2%; 10 974 of 41 205 physicians) in 2011 through 2015. The percentage of self-employed dentists decreased from 73.0% (95% CI, 71.2%-74.8%; 3117 of 4153 dentists) in 2001 through 2005 to 65.1% (95% CI, 63.7%-66.4%; 5260 of 7820 dentists) in 2011 through 2015. Among physicians, the regression-adjusted earnings gap reversed from $19 679 (95% CI, $14 431-$24 927; P < .001) during 2001 through 2005 to -$10 623 (95% CI, -$14 547 to -$6699; P < .001) during 2011 through 2015. Among dentists, the regression-adjusted earnings gap narrowed from $30 448 (95% CI, $23 040-$37 855; P < .001) during 2001 through 2005 to $21 291 (95% CI, $15 723-$26 859; P < .001) during 2011 through 2015. From 2001 to 2015 the earnings gap also reversed among pharmacists, optometrists, and podiatrists. The regression-adjusted earnings gap narrowed among chiropractors and physical therapists. Since 2001, the percentage of health care professionals who are self-employed declined, and the gap in earnings between self-employed and employed health care professionals narrowed.

Nexplanon Procedure-Related Events: Final Results From the Nexplanon Observational Risk Assessment Study (NORA) [9G

INTRODUCTION: To characterize the frequency of insertion- and removal-related events among Nexplanon users in the US during standard clinical practice. METHODS: This large, prospective, non-interventional cohort study followed 7,369 new users of Nexplanon recruited by US health care professionals (HCPs) between December 2011 and March 2014. Questionnaires were completed by patients at 6-month intervals (beginning on the day of insertion and ending 6 months after implant removal) and by HCPs who inserted or removed the implant. Data analysis characterized the frequency of procedure-related events. RESULTS: During 7,369 insertions, HCPs reported 208 events involving 189 patients (2.6% of the study population). Difficulty removing the needle protection cap was the most common event (93 insertions). In total, 49 patients (0.7% of the study population) reported an event at insertion. The most common event was pins/needles/numbness in the arm/hand/fingers (17 patients; 2.3 per 1,000 insertions; 95% CI, 1.3-3.7), which was significantly more likely in repeat/consecutive implant users (10.1 per 1,000 insertions; 95% CI, 4.6-19.0) than first-ever implant users (1.2 per 1,000 insertions; 95% CI, 0.5-2.4). Follow-up data through April 2017 show that 345 patients reported 592 events in the implant arm: pins/needles/numbness (190), severe pain (160), altered strength (65) and other events (e.g. bruising) (100). Of 3,551 removal procedures, 48 (1.4%) involved challenge(s): encasement in fibrotic tissue (26), multiple removal attempts (9), local migration (4), deep implant (4) and other challenges (e.g. fragmented implants) (10). Final study results will be available at ACOG. CONCLUSION: Insertion- and removal-related events involving Nexplanon are rare.

Estimating preferences for modes of drug administration: The case of US healthcare professionals.

There are hidden drug administration costs that arise from a mismatch between end-user preferences and how manufacturers choose to formulate their drug products for delivery to patients. The corollary of this is: there are "intangible benefits" from considering end-user preferences in manufacturing patient-friendly medicines. It is important then to have some idea of what pharmaceutical manufacturers should consider in making patient-friendly medicines and of the magnitude of the indirect benefits from doing so. This study aimed to evaluate preferences of healthcare professionals in the US for the non-monetary attributes of different modes of drug administration. It uses these preference orderings to compute a monetary valuation of the indirect benefits from making patient-friendly medicines. A survey collected choice preferences of a sample of 210 healthcare professionals in the US for two unlabelled drug options. These drugs were identical except in the levels of attributes of drug administration. Using the choice data collected, statistical models were estimated to compute gross welfare benefits, measured by the expected compensating variation, from making drugs in a more patient-friendly manner. The monetary value of end-user benefits from developing patient-friendly drug delivery systems is: (1) as large as the annual acquisition costs per full treatment episode for some biologic drugs; and (2) likely to fall in the "high end" of the distribution of the direct monetary costs of drug administration. An examination of end-user preferences should help manufacturers make more effective and efficient use of limited resources for innovations in drug delivery system, or manufacturing research in general.

Training US health care professionals on human trafficking: where do we go from here?

ABSTRACTSome 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick’s Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base.Abbreviations: AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training