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Evaluation of Appropriateness of Antibiotics in the Intensive Care Unit of a Tertiary Care Hospital
A910
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3
drugs with recommendation of incorporation. Six drugs without active registration in Anvisa were incorporated. Main clinical indications were related to infectiousparasitic and musculoskeletal diseases. Main reasons given for incorporation decision were additional clinical benefits, low budgetary impact and unmet clinical needs in SUS. Conclusions: CONITEC´s establishment represents the development of HTA´s institutionalization in the Brazilian health system. This study´s results show increases in rationality and use of clinical and economic evidence in supporting decisions regarding medicines in the period. PHP46 NATIONAL POLICY ON HEALTH TECHNOLOGY MANAGEMENT: A CASE STUDY OF THE NATIONAL COMMITTEE FOR TECHNOLOGY INCORPORATION, BRAZIL (CONITEC) Yuba TY, Novaes HM, De Soárez PC University of Sao Paulo, Sao Paulo, Brazil
Introduction: In Brazil, the institutionalization of HTA as a health policy is recent. Two important landmarks in this context are the creation of the National Policy on Health Technology Management (Política Nacional de Gestão de Tecnologias em Saúde - PNGTS) in 2009, and the establishment of the National Committee for Technology Incorporation (Comissão Nacional de Incorporação de Tecnologias no SUS - CONITEC) in 2011. A fundamental proposition of this policy is the formal and systematic use of scientific evidence to support the management of health technologies. CONITEC was chosen as a single instrumental case study for the PNGTS implementation analysis, since it is responsible for advising the Brazilian Ministry of Health in the incorporation or disinvestment of health technologies into the Brazilian Public Health System (SUS) and development clinical guidelines at national level. This committee seeks to address the conflicts of interest among stakeholders and reflects the perspectives and challenges of policy implementation. Objectives: To understand the PNGTS implementation process within the CONITEC scenario. Methods: We used three types of data sources: document analysis, interviews with stakeholders and direct observation of CONITEC meetings. The main information observed in the first phase (document analysis) was the use of economic evaluation and the comparison with cost-effectiveness thresholds (CET) in the “CONITEC’s Recommendation Reports”. Results: The analysis of the documents showed that most of the reports that recommended the incorporation of the technology into the public health system presented partial health economic evaluations (HEE). Use of a cost-effectiveness threshold (CET) was not an essential criterion for recommendation, although it is an explicit criterion in the formal documents. Conclusions: This context reflects the current challenges in the implementation process of a National Policy on Health Technology Management, and will be explored with the qualitative data collected.
HEALTH CARE USE & POLICY STUDIES – Population Health PHP47 Eating Habits and Physical Exercise Practices of Beneficiaries and Non-Beneficiaries of Private Health Plans In Brazil Nardi E1, Minami B2 Health, Campinas, Brazil, 2Instituto de Estudos de Saúde Suplementar, São Paulo, Brazil
1Evidencias-Kantar
Objectives: To describe differences in eating habits and physical exercise practices among beneficiaries and non-beneficiaries of private health insurance plans in Brazil Methods: Analysis of data from Pesquisa Nacional de Saúde-2013 (PNS2013), a population-based cross-sectional household survey conducted by the Brazilian Institute of Geography and Statistics (IBGE). Differences between private health insurance beneficiaries and non-beneficiaries eating habits and physical activities were assessed using the Chi-square test. Results: According to PNS, 28% (N= 55,985,271) of population had private health insurance in Brazil in 2013 (Southeast: 55.66 %; South: 16.86%; Northeast: 15.43%; Midwest: 8.08%; North: 3.97%). Regarding eating habits, 45.82% (IC95% 44.48-47.16) of beneficiaries and 36.53% (IC95% 35.73-37.33) of non-beneficiaries declared they consume fruit and/or vegetables at least five times a day (p-value< 0.01). Proportion of beneficiaries that declared eating meat or chicken with excess fat (30.28%; IC95% 29.05-31.52) is smaller than among non-beneficiaries (40.14%; IC95% 39.32-40.97; p< 0.01). On the other hand, 25.95% (IC95% 24.75-27.16) of beneficiaries and 19.82% (IC95% 19.14-20.50) of nonbeneficiaries declared consuming sweets five times or more a week (p< 0.01) and 9.42% (IC 95% 8.61-10.22) of beneficiaries and 5.38% (IC 95% 4.98-5.78) of non-beneficiaries declared replacing meal for sandwiches/pizzas five times or more a week (p< 0.01). Regarding physical activities, 56.2% (IC95% 54.87-57.54) of beneficiaries and 73.77% (IC95% 73.01-74.53) of non-beneficiaries declared they have not practiced any type of exercise or sport in the last three months (p < 0.01). Conclusions: Intake of fruits and vegetables among beneficiaries is more appropriate. On the other hand, consumption of sweets and the replacement of meals for snacks is smaller among non-beneficiaries. Less than half of the Brazilian population did not do physical exercises, and this proportion is markedly higher among non-beneficiaries. Poor eating habits and physical exercise practices are related to higher frequencies of chronic diseases in the population. PHP48 Chronic Non-Communicable Diseases (NCDS) and Body Mass Index (BMI) of Beneficiaries and Non-Beneficiaries of Private Health Plans In Brazil
health insurance plans in Brazil. Methods: Analysis of data from Pesquisa Nacional de Saúde-2013 (PNS-2013), a population-based cross-sectional household survey conducted by the Brazilian Institute of Geography and Statistics (IBGE). The interviewee was asked if any doctor had already given the diagnosis of the NCDs. Obesity (body mass index, BMI≥ 30) and overweight (25.0< BMI< 29.9) were assessed. Differences between NCDs of private health insurance beneficiaries and non-beneficiaries were evaluated using the Chi-square test. Results: According to the PNS, 28% (N= 55,985,271) of population had private health insurance in Brazil in 2013 (Southeast: 55.66 %; South: 16.86%; Northeast: 15.43%; Midwest: 8.08%; North: 3.97%). Among beneficiaries, 22.26% (IC95% 21.11-23.41) had arterial hypertension, 6.75% (IC95% 6.057.45) diabetes and 15.52% (IC95% 14.55-16.50) hypercholesterolemia. In comparison, 21.03% (IC95% 20.36-21.70) of non-beneficiaries had arterial hypertension, 6.01% (IC 95% 5.61-6.41) diabetes and 11.25% (IC95% 10.72-11.78) hypercholesterolemia. For all analysis, p-value was less than 0.01. More than one third of Brazilian population was overweight (beneficiaries: 37.57%; IC95% 36.14-39.01 and non-beneficiaries: 33.79%; IC95% 32.79-34.80; p< 0.01) and proportion of beneficiaries and non-beneficiaries who was obese was 18.79% (IC95% 17.63-19.95) and 18.60% (IC95% 17.7519.45; p-value< 0.01), respectively. Conclusions: Higher proportion of beneficiaries had arterial hypertension, diabetes and hypercholesterolemia when compared with non-beneficiaries. Although differences of proportion of hypertension and diabetes between both populations were statistically significant, they are very small. More than half of Brazilian population were obese or overweight in 2013, mainly beneficiaries. NCDs and overweight are becoming one of the main public health issues in Brazil and policies for their prevention and control should be implemented. PHP49 Which Are The Most Common Quality of Life Health States In Latin America? A Pareto Analysis of A Collaborative Project Using Euroqol Eq-5d In Argentina, Brazil, Chile and Uruguay Rey-Ares L1, Kind P2, Viegas M3, Zarate V4, Gianneo O5, de Souza Noronha K3, Fernandez G5, Augustovski F6 1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina, 2University of Leeds, Leeds, London, UK, 3Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 4Universidad de los Andes, Santiago, Chile, 5Fondo Nacional de Recursos, Montevideo, Uruguay, 6Universidad de Buenos Aires, Buenos Aires, Argentina
Objectives: To describe the most common health related quality of life (HRQOL) states in the general population of Argentina, Brazil, Chile and Uruguay using the EuroQol EQ-5D descriptive system, either with the 3L (243 possible states) or the 5L (3,125 states). Methods: We included data from the national health risk survey in Argentina (3L; n= 41,392) and from the valuation studies of Brazil (3L; n= 3,362), Chile (3L; n= 2000) and Uruguay (5L; n= 792). We report which are the most frequent health states (those which represent at least 90% of the population) and perform a Pareto analysis. Results: The healthiest state (11111, or having no limitations in the 5 domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) was by far the most frequent: 60.9%, 44.3%, 49.8%, and 44.6% in Argentina, Brazil, Chile and Uruguay respectively. Out of the 243 possible EQ-5D-3L health states only eight accounted for at least 90% of the population in Argentina, nine in Brazil, and 19 in Chile. In Uruguay, only 33 out of the possible 3125 EQ-5D-5L health states were reported by at least 90% of the participants. Most prevalent states were the ones with mild limitations in pain/discomfort, anxiety/depression and mobility. Considering the three countries that used EQ-5D-3L, 90% of their population reported a total of 19 health states. Only six of these most common states were shared among these countries. Conclusions: Our study shows a strong ceiling effect of the EQ-5D in the general population, as nearly half is in the best health state. The bulk of the rest is distributed in less than 10% of the total health “space”. These results, together with similar ones from other regions, direct to an important agenda regarding both the reevaluation of the descriptive classification as well as in the design of future valuation studies.
HEALTH CARE USE & POLICY STUDIES – Prescribing Behavior & Treatment Guidelines PHP50 Evaluation of Appropriateness of Antibiotics in the Intensive Care Unit of a Tertiary Care Hospital Khatri B1, Kk S2 and BM Reddy College of Pharmacy, Bangalore, India, 2Dr. BR Ambedkar Medical College, Bangalore, India
1Acharya
Objectives: To evaluate the appropriateness of antibiotics used in the intensive care unit (ICU) settings of a tertiary care hospital. Methods: The study was of prospective type. All patients admitted in ICU, above 18 years of age, and willing to participate were included for the study. Results: A total of 117 patients were included for the study. Majority of them were males (63%). A total of 21 different antibiotics were used during their stay. The most commonly used antibiotics were cephalosporins (35%), penicillin (22%), fluoroquinolones (8%) etc. Antibiotics were started empirically in 54% of the patients. Parenteral route was the most common route for drug administration (61%). Most of the patients were prescribed two antibiotics (48%). Overall, appropriateness was found in 39% of the patients. Conclusions: Antibiotics were found to be prescribed inappropriately in most of the patients. More adherence to the standard guidelines should be followed along with other steps such as mandatory culture test should be followed to reduce microbial resistance.
Nardi E1, Minami B2 1Evidencias-Kantar Health, Campinas, Brazil, 2Instituto de Estudos de Saúde Suplementar, São Paulo, Brazil
PHP51 Constituição De Protocolos Clínicos E Diretrizes Terapêuticas Para Doenças Negligenciadas No Brasil
Objectives: To describe the frequency of chronic non-communicable diseases (NCDs), obesity and overweight of beneficiaries and non-beneficiaries of private
Carvalho IP, Junior EV, Lupatini Ed, Ebeidalla JS, Nunes Jd, Oliveira WT, Toledo JP Ministry of Health, Brasília, Brazil
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3
drugs with recommendation of incorporation. Six drugs without active registration in Anvisa were incorporated. Main clinical indications were related to infectiousparasitic and musculoskeletal diseases. Main reasons given for incorporation decision were additional clinical benefits, low budgetary impact and unmet clinical needs in SUS. Conclusions: CONITEC´s establishment represents the development of HTA´s institutionalization in the Brazilian health system. This study´s results show increases in rationality and use of clinical and economic evidence in supporting decisions regarding medicines in the period. PHP46 NATIONAL POLICY ON HEALTH TECHNOLOGY MANAGEMENT: A CASE STUDY OF THE NATIONAL COMMITTEE FOR TECHNOLOGY INCORPORATION, BRAZIL (CONITEC) Yuba TY, Novaes HM, De Soárez PC University of Sao Paulo, Sao Paulo, Brazil
Introduction: In Brazil, the institutionalization of HTA as a health policy is recent. Two important landmarks in this context are the creation of the National Policy on Health Technology Management (Política Nacional de Gestão de Tecnologias em Saúde - PNGTS) in 2009, and the establishment of the National Committee for Technology Incorporation (Comissão Nacional de Incorporação de Tecnologias no SUS - CONITEC) in 2011. A fundamental proposition of this policy is the formal and systematic use of scientific evidence to support the management of health technologies. CONITEC was chosen as a single instrumental case study for the PNGTS implementation analysis, since it is responsible for advising the Brazilian Ministry of Health in the incorporation or disinvestment of health technologies into the Brazilian Public Health System (SUS) and development clinical guidelines at national level. This committee seeks to address the conflicts of interest among stakeholders and reflects the perspectives and challenges of policy implementation. Objectives: To understand the PNGTS implementation process within the CONITEC scenario. Methods: We used three types of data sources: document analysis, interviews with stakeholders and direct observation of CONITEC meetings. The main information observed in the first phase (document analysis) was the use of economic evaluation and the comparison with cost-effectiveness thresholds (CET) in the “CONITEC’s Recommendation Reports”. Results: The analysis of the documents showed that most of the reports that recommended the incorporation of the technology into the public health system presented partial health economic evaluations (HEE). Use of a cost-effectiveness threshold (CET) was not an essential criterion for recommendation, although it is an explicit criterion in the formal documents. Conclusions: This context reflects the current challenges in the implementation process of a National Policy on Health Technology Management, and will be explored with the qualitative data collected.
HEALTH CARE USE & POLICY STUDIES – Population Health PHP47 Eating Habits and Physical Exercise Practices of Beneficiaries and Non-Beneficiaries of Private Health Plans In Brazil Nardi E1, Minami B2 Health, Campinas, Brazil, 2Instituto de Estudos de Saúde Suplementar, São Paulo, Brazil
1Evidencias-Kantar
Objectives: To describe differences in eating habits and physical exercise practices among beneficiaries and non-beneficiaries of private health insurance plans in Brazil Methods: Analysis of data from Pesquisa Nacional de Saúde-2013 (PNS2013), a population-based cross-sectional household survey conducted by the Brazilian Institute of Geography and Statistics (IBGE). Differences between private health insurance beneficiaries and non-beneficiaries eating habits and physical activities were assessed using the Chi-square test. Results: According to PNS, 28% (N= 55,985,271) of population had private health insurance in Brazil in 2013 (Southeast: 55.66 %; South: 16.86%; Northeast: 15.43%; Midwest: 8.08%; North: 3.97%). Regarding eating habits, 45.82% (IC95% 44.48-47.16) of beneficiaries and 36.53% (IC95% 35.73-37.33) of non-beneficiaries declared they consume fruit and/or vegetables at least five times a day (p-value< 0.01). Proportion of beneficiaries that declared eating meat or chicken with excess fat (30.28%; IC95% 29.05-31.52) is smaller than among non-beneficiaries (40.14%; IC95% 39.32-40.97; p< 0.01). On the other hand, 25.95% (IC95% 24.75-27.16) of beneficiaries and 19.82% (IC95% 19.14-20.50) of nonbeneficiaries declared consuming sweets five times or more a week (p< 0.01) and 9.42% (IC 95% 8.61-10.22) of beneficiaries and 5.38% (IC 95% 4.98-5.78) of non-beneficiaries declared replacing meal for sandwiches/pizzas five times or more a week (p< 0.01). Regarding physical activities, 56.2% (IC95% 54.87-57.54) of beneficiaries and 73.77% (IC95% 73.01-74.53) of non-beneficiaries declared they have not practiced any type of exercise or sport in the last three months (p < 0.01). Conclusions: Intake of fruits and vegetables among beneficiaries is more appropriate. On the other hand, consumption of sweets and the replacement of meals for snacks is smaller among non-beneficiaries. Less than half of the Brazilian population did not do physical exercises, and this proportion is markedly higher among non-beneficiaries. Poor eating habits and physical exercise practices are related to higher frequencies of chronic diseases in the population. PHP48 Chronic Non-Communicable Diseases (NCDS) and Body Mass Index (BMI) of Beneficiaries and Non-Beneficiaries of Private Health Plans In Brazil
health insurance plans in Brazil. Methods: Analysis of data from Pesquisa Nacional de Saúde-2013 (PNS-2013), a population-based cross-sectional household survey conducted by the Brazilian Institute of Geography and Statistics (IBGE). The interviewee was asked if any doctor had already given the diagnosis of the NCDs. Obesity (body mass index, BMI≥ 30) and overweight (25.0< BMI< 29.9) were assessed. Differences between NCDs of private health insurance beneficiaries and non-beneficiaries were evaluated using the Chi-square test. Results: According to the PNS, 28% (N= 55,985,271) of population had private health insurance in Brazil in 2013 (Southeast: 55.66 %; South: 16.86%; Northeast: 15.43%; Midwest: 8.08%; North: 3.97%). Among beneficiaries, 22.26% (IC95% 21.11-23.41) had arterial hypertension, 6.75% (IC95% 6.057.45) diabetes and 15.52% (IC95% 14.55-16.50) hypercholesterolemia. In comparison, 21.03% (IC95% 20.36-21.70) of non-beneficiaries had arterial hypertension, 6.01% (IC 95% 5.61-6.41) diabetes and 11.25% (IC95% 10.72-11.78) hypercholesterolemia. For all analysis, p-value was less than 0.01. More than one third of Brazilian population was overweight (beneficiaries: 37.57%; IC95% 36.14-39.01 and non-beneficiaries: 33.79%; IC95% 32.79-34.80; p< 0.01) and proportion of beneficiaries and non-beneficiaries who was obese was 18.79% (IC95% 17.63-19.95) and 18.60% (IC95% 17.7519.45; p-value< 0.01), respectively. Conclusions: Higher proportion of beneficiaries had arterial hypertension, diabetes and hypercholesterolemia when compared with non-beneficiaries. Although differences of proportion of hypertension and diabetes between both populations were statistically significant, they are very small. More than half of Brazilian population were obese or overweight in 2013, mainly beneficiaries. NCDs and overweight are becoming one of the main public health issues in Brazil and policies for their prevention and control should be implemented. PHP49 Which Are The Most Common Quality of Life Health States In Latin America? A Pareto Analysis of A Collaborative Project Using Euroqol Eq-5d In Argentina, Brazil, Chile and Uruguay Rey-Ares L1, Kind P2, Viegas M3, Zarate V4, Gianneo O5, de Souza Noronha K3, Fernandez G5, Augustovski F6 1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina, 2University of Leeds, Leeds, London, UK, 3Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 4Universidad de los Andes, Santiago, Chile, 5Fondo Nacional de Recursos, Montevideo, Uruguay, 6Universidad de Buenos Aires, Buenos Aires, Argentina
Objectives: To describe the most common health related quality of life (HRQOL) states in the general population of Argentina, Brazil, Chile and Uruguay using the EuroQol EQ-5D descriptive system, either with the 3L (243 possible states) or the 5L (3,125 states). Methods: We included data from the national health risk survey in Argentina (3L; n= 41,392) and from the valuation studies of Brazil (3L; n= 3,362), Chile (3L; n= 2000) and Uruguay (5L; n= 792). We report which are the most frequent health states (those which represent at least 90% of the population) and perform a Pareto analysis. Results: The healthiest state (11111, or having no limitations in the 5 domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) was by far the most frequent: 60.9%, 44.3%, 49.8%, and 44.6% in Argentina, Brazil, Chile and Uruguay respectively. Out of the 243 possible EQ-5D-3L health states only eight accounted for at least 90% of the population in Argentina, nine in Brazil, and 19 in Chile. In Uruguay, only 33 out of the possible 3125 EQ-5D-5L health states were reported by at least 90% of the participants. Most prevalent states were the ones with mild limitations in pain/discomfort, anxiety/depression and mobility. Considering the three countries that used EQ-5D-3L, 90% of their population reported a total of 19 health states. Only six of these most common states were shared among these countries. Conclusions: Our study shows a strong ceiling effect of the EQ-5D in the general population, as nearly half is in the best health state. The bulk of the rest is distributed in less than 10% of the total health “space”. These results, together with similar ones from other regions, direct to an important agenda regarding both the reevaluation of the descriptive classification as well as in the design of future valuation studies.
HEALTH CARE USE & POLICY STUDIES – Prescribing Behavior & Treatment Guidelines PHP50 Evaluation of Appropriateness of Antibiotics in the Intensive Care Unit of a Tertiary Care Hospital Khatri B1, Kk S2 and BM Reddy College of Pharmacy, Bangalore, India, 2Dr. BR Ambedkar Medical College, Bangalore, India
1Acharya
Objectives: To evaluate the appropriateness of antibiotics used in the intensive care unit (ICU) settings of a tertiary care hospital. Methods: The study was of prospective type. All patients admitted in ICU, above 18 years of age, and willing to participate were included for the study. Results: A total of 117 patients were included for the study. Majority of them were males (63%). A total of 21 different antibiotics were used during their stay. The most commonly used antibiotics were cephalosporins (35%), penicillin (22%), fluoroquinolones (8%) etc. Antibiotics were started empirically in 54% of the patients. Parenteral route was the most common route for drug administration (61%). Most of the patients were prescribed two antibiotics (48%). Overall, appropriateness was found in 39% of the patients. Conclusions: Antibiotics were found to be prescribed inappropriately in most of the patients. More adherence to the standard guidelines should be followed along with other steps such as mandatory culture test should be followed to reduce microbial resistance.
Nardi E1, Minami B2 1Evidencias-Kantar Health, Campinas, Brazil, 2Instituto de Estudos de Saúde Suplementar, São Paulo, Brazil
PHP51 Constituição De Protocolos Clínicos E Diretrizes Terapêuticas Para Doenças Negligenciadas No Brasil
Objectives: To describe the frequency of chronic non-communicable diseases (NCDs), obesity and overweight of beneficiaries and non-beneficiaries of private
Carvalho IP, Junior EV, Lupatini Ed, Ebeidalla JS, Nunes Jd, Oliveira WT, Toledo JP Ministry of Health, Brasília, Brazil