A Transitions of Care Collaboration between Pharmacy Academia and a Community Health System

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Ohinmaa A1, Zheng Y2, Jeerakathil T3, Klarenbach S1, Hakkinen U4, Nguyen T2, Chuck A2, Friesen D5, Ruseski J6, Kaul P1, Ariste R7, Jacobs P2 1University of Alberta, Edmonton, AB, Canada, 2Institute of Health Economics, Edmonton, AB, Canada, 3Alberta Health Services, Edmonton, AB, Canada, 4National Institute for Health and Welfare, Helsinki, Finland, 5Alberta Medical Association, Edmonton, AB, Canada, 6West Virginia University, Morgantown, WV, USA, 7Canadian Institute for Health Information, Ottawa, ON, Canada

Objectives: The Alberta Provincial Stroke Strategy established 18 stroke centers and aimed to improve access to high quality stroke care for the province of Alberta, Canada. This study explored whether patients from lower socioeconomic status (SES) neighborhoods had lower probability of being admitted to stroke center and whether this had an impact on mortality after ischemic and ill-defined stroke.  Methods: We linked hospital discharge abstracts and National Ambulatory Care Report System for all patients admitted to hospitals with ICD-10 I63 and I64 in Alberta between April 2004 and March 2013. We used median neighbourhood income from 2011 census data to represent patient income. We categorized the patients as quintile 1 (lowest) to 5 (highest) by the income level. We applied a Recursive Pobit Model using differential distance to hospitals as an instrumental variable to correct potential pre-hospital selection bias. In the first equation, we examined the association between SES and admission to stroke centers, adjusting for distance to nearest hospital and other patient characteristics. The effect of stroke center on mortality was estimated in the second equation.  Results: Among 17,240 patients, the percentages being admitted to a stroke center were 61.6%, 64.6%, 67.2%, 70.6%, and 73.7% for income quintiles1 to 5, respectively. The overall unadjusted 30-day all-cause mortality rate was 10.6% for patients first admitted to stroke centers and 13.9% for patients admitted to non-designated hospitals. Adjusting for patient characteristics and other factors, we found the patients from higher SES neighborhood are more likely to be admitted to a stroke center (p< 0.001). First admission to a stroke center was negatively associated with 30-day all-cause in-hospital mortality (marginal effect=  -0.065, 95%CI: -0.123, -0.065, p= 0.029).  Conclusions: In Alberta, SES had pronounced effects on first admission to stroke centers which was significantly associated with lower in-hospital mortality for stroke patients. PHS145 Factors Influencing Access to Medicines in Nigeria: Views and Experiences of Residents of the Federal Capital Territory Umoru A, Alfa J, Adigwe OP National Assembly, Abuja, Nigeria

Objectives: Access to medicines for Nigerians remains a critical factor influencing national healthcare. Currently, life expectancy at birth is under 60 years and is representative of other poor health indices. This indicates urgent need for improvement. This study therefore aimed at assessing public opinion regarding access to medicines, together with perceptions of the associated quality, both of the medicines, and of the service.  Methods: A cross-sectional survey was designed to collect the relevant data from 650 randomly selected residents of Abuja between January and April 2012. The questionnaire was developed based on the themes that emerged from information and data collected from peer reviewed journals, online sources and official documents from the Ministry of Health. Face and content validation were carried out using an expert panel. Piloting was carried out and this did not result in any major changes. Data were analysed using Microsoft Excel and ethics approval was received from the National Assembly Management.  Results: An 85% response rate was achieved with the majority of the respondents belonging to the female gender (53%). Three quarters (75%) of the respondents had confidence in the quality of medicines dispensed in government establishments, but more than half (58%) reported that prescribed medicines were not readily available. The majority of respondents (80%) reported that medicines were cheaper in pharmacies in government hospitals, compared to private hospitals, but close to half (45%) expressed discontent with the level of health information provided by pharmacists.  Conclusions: The high level of confidence in the quality of medicines dispensed in government hospitals can help improve access to medicines, especially as the provider is perceived to be the more cost effective option. Pharmaceutical Care and CPD can improve pharmacists’ ability to provide health information. Strategies that can improve medicines’ availability include Essential Drugs’ principle and Drug Revolving Fund. PHS146 Satisfaction of Clients with the Services of an Outpatient Pharmacy at a University Hospital in Northwestern Ethiopia: A Cross-Sectional Study 1, Teni

FS2, Girmay

G1, Tesfa

M1, Moges

E1, Abraha

M1

Surur AS 1University of Gondar, Gondar, Ethiopia, 2Addis Ababa University, Addis Ababa, Ethiopia

Abstract Objectives: Evaluation of patient/client satisfaction with pharmacy services as a crucial part of the health services through appropriate studies is important. The current study aimed at assessing the level of client satisfaction with the services of the outpatient pharmacy of Gondar University Referral Hospital (GURH) in northwestern Ethiopia.  Methods: An institution-based cross-sectional study was conducted involving 400 clients who had prescriptions/orders filled at the outpatient pharmacy of the hospital during the period of 5th to 25th of November 2013. The data on the level of satisfaction of clients with the services of the outpatient pharmacy in the hospital was collected using a structured interview guide adopted from an instrument translated into Amharic and validated. The data collected was entered into and analyzed using SPSS version 16.  Results: The overall mean score the respondents gave to satisfaction with the pharmaceutical services was 2.48 out of a maximum of 5.00 score. The mean scores for all the individual parameters rated were less than 3.00. Maximum mean scores were given for parameters asking about the promptness of prescription medication service (2.99), and professionalism of the pharmacy staff (2.96) with the lowest being scored for information given to clients about the storage of medication (1.25), and explanations of possible side effects (1.27). Clients who were served free of fee recorded significantly higher

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level of satisfaction than those who paid. Higher levels of satisfaction were also reported among illiterates, older adults and those with no job compared to those with higher education, merchants and government employees.  Conclusions: This study showed that the overall mean satisfaction level of clients of the outpatient pharmacy was low and it differed among different socio-demographic characteristics. Further research in to the reasons behind the low satisfaction should be done to provide appropriate solutions to improve the service. PHS147 Incentives to Honor Maternal Health Referrals in a Setting with Inequitable Access to Health Care in the Amansie West District in Ashanti Region Nuamah GB1, Agyei-Baffour P2, Akohene KM1, Boateng D1, Dobin D3, Donkor KA4 1Kwame Nkrumah University of Science and Technology, Ghana, Kumasi, Ghana, 2Kwame Nkrumah University of Sciences and Technology (KNUST), Kumasi, Ghana, 3Ghana Health Service, Manso Nkwanta, Ghana, 4Ghana Health Service, Accra, Ghana

Objectives: Obstetric referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of referral systems is however marred by the lack of accessible transportation and socio economic disparities in access to healthcare. This paper assesses incentives to honour maternal health referrals in a setting with inequitable access to healthcare.  Methods: This was a descriptive cross-sectional study, involving 720 randomly sampled pregnant women from five (5) sub districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured interviewing and analyzed using STATA 11.0 for windows. A logistic regression models was fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals at 95% confident interval.  Results: About 21.7% of the women studied had ever been referred by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58%) and lack of transport (17%). A higher household wealth quintile increased the odds of being referred as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as an emergency were also more likely to honour referral (OR= 2.3; 95% CI= 1.3, 3.9).  Conclusions: Clients’ perception and low income remain as barriers to seeking healthcare and disincentives to honour referrals in a setting with inequitable access to healthcare. Implementing social interventions could leap-frog the attainment of maternal health targets in deprived areas. PHS148 Drug Therapy of Epileptic Seizures in Adult Epileptic Outpatients of University of Gondar Teaching Hospital, Gondar, North West Ethiopia Birru EM University of Gondar, Gondar, Ethiopia

Objectives: To assess antiepileptic therapy prescription patterns and treatment outcomes in adult epileptic outpatients, University of Gondar Teaching Hospital, Gondar, North West Ethiopia.  Methods: Institution based, retrospective crosssectional study was conducted on the medical charts of 336 adult epileptic patients on follow-up at the outpatient of Neurology Department of University of Gondar Teaching Hospital from May 2014, April 2015. Reviewing follow-up information on medical cards was used to evaluate AED prescribing pattern and treatment outcome. Data was collected by using data collection format and analyzed using SPSS software version 16.  Results: The common type of seizure diagnosed was generalized tonic clonic seizure, 245 (72.91%). Monotherapy with AED accounted for 80.35% of the cases, whereas dual therapy and polythearap with three AED combinations accounted for 16.37% and 3.28%, respectively. The most frequently prescribed AED was phenobarbitone (62.47%) followed by carbamazepine (17.91%). From the total epileptic cases, 277(82.4%) were having well-controlled seizure status in the last three consecutive months.  Conclusions: Most of the patients were maintained on monotherapy and largely this was covered by the older antiepileptic, phenobarbitone as per the standard treatment guideline. And this may need the revision of the treatment regimen as well as the treatment guideline considering the efficacy, safety of the drugs as well as the patients’ adherence to those prescribed medicines. PHS149 A Transitions of Care Collaboration between Pharmacy Academia and a Community Health System Bradford C1, Thanh D2, Kwong M2, Chang L2, Shah BM2, Sui L2, Young G2 HealthCare, San Diego, CA, USA, 2Touro University California, Vallejo, CA, USA

1Sharp

Objectives: With the emergence of the Affordable Care Act and Hospital Readmission Reduction Program, health-system performance is increasingly being evaluated through readmission rates. As a result, health organizations are investigating novel ways to reduce readmissions; however, funding new programs remains a challenge. This has created opportunities for pharmacy service expansion through combined efforts of hospitals and academia. The purpose of this study is to describe the collaborative care model established by Touro University California and Sharp Healthcare, focused on expanding pharmacist roles and reducing readmissions.  Methods: This is a retrospective, descriptive study conducted from July 2011 to July 2015. A faculty pharmacist, PGY2 pharmacist resident, and student pharmacist were integrated into a multidisciplinary team called the Continuum of Care Network (CCN). Transitions of care (TOC) services impacted post-discharge medication adherence and readmission rates. A constructed timeline illustrates phases of program implementation, expansion, and future direction.  Results: The CCN includes 2.0 FTE’s, supporting up to nine student pharmacists per rotation. TOC services were provided to over 1650 physician-referred and heart failure inpatients. From 2011-13, CCN contributed to a significant readmission rate reductions following index hospitalization for heart failure (ARR 12%; RRR =  48%, p= 0.0005). Additionally, CCN expansion into skilled nursing from 2013-14 shows similar reductions in mean time to readmissions (from 17.6 days to 11.0 days,

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p= 0.0019).  Conclusions: The implementation of CCN is associated with significant reduction in readmission rates in multiple settings such as community hospitals, skilled nursing facilities, and acute care. The interventions of TOC pharmacists in transition programs demonstrate an effective method to reduce rate of readmissions and time to readmissions . Future collaborative practice between healthsystems and academia may prove successful in TOC for other disease states as well. PHS150 Assessment of Drug Utilization Practice in Ophthalmology Department of University of Gondar Referral and Teaching Hospital, North West Ethiopia Eshetie Melese Birru ME University of Gondar, Gondar, Ethiopia

Abstract Objectives: This study is designed to assess the rationality of drug utilization practice among outpatients in the ophthalmology department of University of Gondar referral and teaching hospital, North West Ethiopia. Methods: A descriptive, prospective, cross-sectional study was conducted on 846 outpatients of Ophthalmic Pharmacy of University of Gondar teaching hospital in Gondar, Ethiopia. Data was collected by interviewing patients and/or caregivers who were visiting the ophthalmic pharmacy unit and from their ophthalmic drug prescription from March to May, 2014. The data was entered and analyzed using SPSS version 21 statistical package.  Results: The mean number of drug per prescription was 1.59. Percentage of prescriptions containing ≤  2 drugs per prescription was 92.44%. About 86.48% of the drugs were prescribed with their generic name. In more than 50% of cases the dose and duration of therapy supposed to be taken was determined incorrect as per the standard treatment guideline. In this study there was statistically significant association between post-dispensing knowledge of the subjects and age and number of drugs per prescription.  Conclusions: According to this study the most frequently prescribed ophthalmic drugs were found antibiotics and most of the prescribing information was inadequate and incomplete indicating the need of improving the prescribing practice. Most of the prescribing indicators were below the recommended WHO standards and furthermore the understanding of the subjects on their medications was also poor which seeks immediate amendment due to the more sensitive nature of eye care. PHS151 A Cross-Sectional Assessment of Knowledge, Attitude, and Practice on Hepatitis B and C Patients in Ayub Medical Complex Abbottabad, Pakistan Azhar S, Syed A, Mansoor Z, Yousaf A Comsats Institute of Information Technology, Abbottabad, Pakistan

Objectives: The objectives of this study is to determine the knowledge, attitude and practice on hepatitis B and C patients towards hepatitis B & C.  Methods: A Cross sectional descriptive study was conducted from 15th December 2014 to 31st March 2015 in Ayub Medical Complex Abbottabad. Data was collected from infected individuals who visited Ayub Medical Complex, Abbottabad during study duration. A pre-designed questionnaire was used to collect data.  Results: In the study duration a data of 400 infected individuals was collected for KAP analysis. Among 400 respondents, 223 (55.8%) were males and 177 (44.3%) were females, Mean age of the population was 37.2±12, 124 (31%) were uneducated, 94 (23.5%) had primary level of education while 182 (45.6%) had beyond primary level of qualification. Mean score for knowledge of Hepatitis B of entire study was 9.93±5.5 while Out of 400, 248 (62%) respondents reported poor level of knowledge and 152 (38%) reported with adequate level of knowledge. Mean score of knowledge of hepatitis C was 10.33±6.0 in which 250 out 400 showed poor knowledge about hepatitis C while 150 showed adequate level of knowledge about hepatitis C. Mean score of the attitude was 3.89±1.2 in which 271( 67.8%) showed overall negative attitude while 129 (32.2%) reported positive attitude toward hepatitis B and hepatitis C. The mean score for practice was 3.59±1.8 in which 265 showed negative practice towards hepatitis B and hepatitis C while 135 (33.75%) were within good practice.  Conclusions: It is concluded from the present study that overall population lack adequate level of knowledge and have poor attitude and practices against hepatitis B and Hepatitis C. Efforts are needed to raise knowledge and awareness among individuals for prevention and control of hepatitis B and C. PHS152 Development and Implementation of the Medical Audit Process in Health Services at the First Level of Care: A Contextualized Model Adapted to Ecuador Torres Toala FG Makroscopio, Quito, Ecuador

Objectives: This study is a description of the development of medical audit strategy as a cooperative process of continuous quality improvement in health services in the Health Insurance Program (PAS) of the Ministry of Public Health of Ecuador (MSP).  Methods: The development and implementation of a methodology was performed, the results are described through a cross-sectional design.  Results: Problems were identified in the areas of full reporting of clinical information, and therapeutic aspects of coding schemes; many of these problems were invisible to the coordinators and decision makers. In the evaluation, the increase in the percentage values of evaluations around 20 points, both in the clinic as part of the legal registration and 10 months of intervention is demonstrated.  Conclusions: The process of medical audit in situ is essential for the identification and resolution of problems of errors in health care; it is demonstrated by the target values of the indicators also increased by the identification of hidden information for managers PHS153 A Systematic Analysis of the Regulatory Process of Drug Delivery in Social Networks and the Impact on Health Care Russia Starostina I, Krupnova I

Federal Service for Surveillance in Healthcare (Roszdravnadzor), Moscow, Russian Federation

Objectives: The objective of this research is to provide an overview of the regulatory process of drug delivery in social networks and the impact on healthcare in Russia. This analysis was carried out to evaluate the availability and reliability of innovation methods (drug delivery by social networks) in Russian healthcare.  Methods: Studies were retrieved from relevant regulatory authorities’ databases (Roszdravnadzor, AIS Roszdavnadzor and Ministry of Health of the Russian Federation web portals), using relevant search strategies. Included studies were primarily conducted in various healthcare settings in Russia. The search methodology employed was in line with AIS guidelines. The search language was limited to Russian.  Results: In total, 50 records were included in the qualitative synthesis of this review. The governance, process and implementation of drug market access have been analyzed in detail. The successful implementation of drugs delivery was primarily used in cities. Further use included identification of knowledge dissemination of drugs delivery by networks in villages and small cities. Challenges are related to the interim nature of legislation. In addition there is a lack of transparency and electronic databases. Detailed analyses of the findings from studies are still ongoing.  Conclusions: Preliminary analysis shows that limited evidence exists on the impact of innovatiom methods on healthcare in Russia. In Russia drugs delivery by social network access is straightforward if there is proof of authorization to sell a product and licenses. It also highlights the disparity in the awareness among people regarding the utility of drug delivery by social networks. For a country with divergent health systems and a huge rural population, the use drug delivery by social networks may be very impactful in improving healthcare. However, this system has disadvantages in terms of safeguarding patient safety. Lack of transparency, incomplete regulations are challenges faced by Russia. PHS154 Erosion of Empathy in Primary Care Trainees McRae J1, Calusi G2, Liu M1, Scognamiglio V2, Messina E2, Polenzani L2, Maio V1 1Thomas Jefferson University, Philadelphia, PA, USA, 2AUSL 4 Prato, Prato, Italy

Objectives: Empathic engagement in patient care is fundamental for a meaningful physician–patient relationship. However, there is evidence of an erosion of empathy in medical school and residency during clinical training. We sought to examine changes in empathy among family medicine trainees as they progress through residency training.  Methods: We conducted a cross-sectional study. The Jefferson Scale of Physician Empathy (JSPE) was translated into Italian and administered online in June 2015 to 119 physicians in a three-year family medicine training program within the Tuscany regional Healthcare System, Italy. Participation was voluntary and anonymous. Participants were also asked demographic questions regarding their age, sex, trainee year, and years of service. An empathy score (range, 20-140) was calculated for each survey participant. Student’s t-test, ANOVA, and Student’s Tukey tests were utilized to test statistical differences in mean empathy scores in trainee year and other trainees’ characteristics (sex, age, and years of service).  Results: A total of 98 trainees responded to the survey (82.4% response rate). Majority of the trainees were female (69%) with a mean age of 29 years old. Trainees in year three had a significantly lower mean empathy score than trainees in year one (108.4 vs. 116.0, p< 0.035). Older (age subcategory 29-31 years) trainees were also found with a significant lower mean empathy score than younger (26-28 years) trainees (116.00 vs. 108.43, p<  0.036,). No significant differences in mean empathy scores were found among sex and years of service subcategories.  Conclusions: These results suggest that once a family medicine trainee progresses through apprentice phase, empathy significantly declines, which may jeopardize the patient-physician relationship. Further research is needed to identify factors that contribute to changes in empathy and to examine whether targeted educational programs can help to retain, reinforce and enhance empathy among family medicine trainees for improving clinical outcomes.

PHS155 Caesarian Section Rate in Hungary between 1960-2013 Kovács G1, Nagy S2, Endrei D3, Boncz I3 1Széchenyi István University, GyÅ‘r, Hungary, 2Széchenyi István University, GyÅ‘r, Hungary, 3University of Pécs, Pécs, Hungary

Objectives: The frequency of caesarean section alters worldwide and shows great varieties and spatial differences in countries with developed health system by various health service providers. This study investigates caesarean section’s frequency and distribution by health service providers.  Methods: Data of National Health Insurance Fund (NHIF) of Hungary and Hungarian Central Statistical Office were processed. Analyzes covers the period of 1960-2013. We calculated the rate of cesarean section within the total number of deliveries.  Results: Based on the comprehensive analysis of statistical data, the ratio of caesarean section in Hungary rose from 2,5% to 37% in the investigated period. There is a tenfold difference among health service provider institutions. (9%-97%) The increased number of caesarean section is obviously connected to the increased ratio of primer caesarean section and the decreased number of spontaneous delivery after caesarean section. A number of studies have justified that reaching the optimal ratio is a health and social challenge. 2,5% of Hungarian deliveries ended up in caesarean section in 1960, 7% in the ‘70s. However, its frequency increased to 10% in the ‘90s, 20% in 2000, 28.9% in 2006, and by today, it has overstepped 37%. Via analyzing distribution according to health service providers, extraordinary differences prevail. NHIF’s data show that the ration of caesarean section between 2000 and 2013 varied from 9% to 97%, i.e., almost a tenfold difference exists among various providers.  Conclusions: Determined steps need to be regarding professional and financing areas in order to decrease differences. The efficiency of parental care and the identification of highrisk expectants need to be improved, financing interest has to be established during patient care in hospitals and via shedding light to statistical data, transparency of professional activity has to be established.