Bidirectional Screening Of Comorbid Tuberculosis And Diabetes And Its Effect On Tuberculosis Treatment Outcomes

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province of Pakistan. In this study, we used the standard WHO/INRUD patient-care and facility-specific indicators.  Methods: This descriptive, non-experimental and cross-sectional study was conducted in the ophthalmology wards of the Bahawal Victoria Hospital and the Civil Hospital. Three hundred patients and all pharmacists available at the time of data collection were interviewed to investigate the patient-care and facility-specific indicators, respectively. We used the published ideal standards for each of the WHO/INRUD indicators. Statistical Package for Social Sciences was used to analyze the data.  Results: Among the patient-care indicators, the average consultation time was 2.2 minutes (SD =  1.1) (optimal value ≥  10 minutes), the average dispensing time was 11.5 seconds (SD =  3.2) (optimal value ≥  90 seconds), the average number of medicines per encounter was 1.9 (SD =  0.8) (optimal value =  1.6–1.8), the percentage of medicines actually dispensed and adequately labelled were 100% (SD =  0.0) (optimal value =  100%) and the patients’ knowledge of correct dosage were 72.5% (SD =  9.2) (optimal value =  100%). Among the facility-specific indicators, both facilities had a copy of essential drugs list, and the key drugs available in the stock were 42.4% (SD =  34.3) (optimal value =  100%).  Conclusions: Patient-care indicators were below the optimal index especially the average consultation and dispensing times, and the patients’ knowledge of correct dosage. Unavailability of all key drugs in the stock is also alarming which requires urgent attention. Continuous education of the physicians, and adequate physician-to-patient and pharmacist-to-patient ratio are some options to promote the rational drug use in the given healthcare setting. PHS7 Use Of Real-World Data To Estimate Cardiovascular Event Rates Among Elderly High Cardiovascular Risk Patients With Medicare Supplemental Insurance In The United States Quek RG1, Hardin J1, Bonafede MM2, Johnson BH2, Gandra SR1 Oaks, CA, USA, 2Truven Health Analytics, Cambridge, MA, USA

1Amgen, Inc., Thousand

Objectives: To estimate the rates of cardiovascular events (CVE) among elderly high cardiovascular risk patients. Methods: The Truven Health MarketScan Medicare Supplemental Database was used to hierarchically identify cohorts of elderly adults (age 65-75) with familial hypercholesteremia (FH), atherosclerotic cardiovascular disease (ASCVD) [myocardial infarction; unstable angina; ischemic stroke; stable angina; coronary revascularization; carotid stenosis; peripheral vascular disease; abdominal aortic aneurysm] or type 2 diabetes mellitus (T2DM) in 2006-2007; a variable-length follow-up was used to describe lipid-lowering therapy (LLT) and rates of new CVE from 2008-2013. The ASCVD and T2DM cohorts included patients prescribed statin at and ≤ 12 months post diagnosis; FH cohort included patients prescribed high intensity statin and ezetimibe concurrently for ≥ 30 days at and < 12 month post diagnosis. The primary outcome was the presence of new CVEs, defined as an inpatient stay with a primary diagnosis of acute coronary syndrome ([ACS] includes myocardial infarction and unstable angina), ischemic stroke, heart failure, revascularization or cardiovascular-related death.  Results: 255,788 patients met the inclusion criteria (0.7% FH, 35.7% ASCVD, 63.7% T2DM) with an average follow-up of 47 months. The majority of FH patients used LLT during follow-up (77.6% used both a statin and ezetimibe, 17.1% used statin alone, 1.5% used ezetimibe alone and 3.7% used neither). Lower rates were seen among ASCVD (18.8%, 58.5%, 1.7%) and T2DM (14.7%, 60.4%, 1.6%) patients as a higher proportion of both cohorts used neither a statin nor ezetimibe (21.1% and 23.3%, respectively). ASCVD patients appeared to have higher CVE rates than FH or diabetes patients (per 1,000 person-years): ACS: 13.0, 8.1, 7.5; ischemic stroke: 8.3, 5.4, 5.8; heart failure: 21.9, 9.2, 13.4; revascularization: 56.1, 43.3, 28.7; and cardiovascular-related death: 1.2, 1.1, 0.7.  Conclusions: The prevalence of LLT and high CVE rates observed will be useful in characterizing the clinical burden among elderly US Medicare Supplemental-insured high cardiovascular risk patients. PHS8 Use Of Real-World Data To Estimate Cardiovascular Event Rates Among Non-Elderly Commercially Insured High Cardiovascular Risk Patients In The United States Quek RG1, Hardin J1, Bonafede MM2, Johnson BH2, Gandra SR1 Oaks, CA, USA, 2Truven Health Analytics, Cambridge, MA, USA

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PHS9 The Burden Of Atopic Dermatitis In Adults: Results From The 2013 United States National Health And Wellness Survey (Nhws) Whiteley J, Emir B, Seitzman R, Makinson G Pfizer, New York, NY, USA

Objectives: To characterize comorbidities, health-related quality-of-life (HRQoL), productivity, and healthcare resource use among adults with atopic dermatitis (AD) relative to those without AD, and to evaluate the impact of patient-reported AD severity on these outcomes.  Methods: Data were from the 2013 NHWS, which collected self-reported information on demographics, comorbidities, HRQoL (SF36 Health Survey), productivity (Work Productivity and Impairment questionnaire [WPAI]), and healthcare utilization, which were weighted to the US general population. The AD cohort consisted of subjects who reported they experienced AD within the past 12 months (n= 428), and the non-AD cohort was all other subjects who did not experience AD within the past 12 months (n= 74,572); 366 AD subjects reported disease severity as mild (n= 182), moderate (n= 148), or severe (n= 36). Univariable and multivariable analyses compared characteristics and outcomes between cohorts and across severity levels.  Results: The AD cohort was younger than non-AD subjects (44.3 vs 46.6 years; P= 0.0033), and had a higher proportion of females (64.4% vs 51.8%; P< 0.0001). Relative to the non-AD cohort, AD subjects had a significantly greater prevalence of atopic conditions including nasal allergies (46.4% vs 19.8%) asthma (22.4% vs 7.9%), neuropsychiatric conditions such as anxiety (42.5% vs 21.3%), depression (37.2% vs 20.9%), and attention deficit hyperactivity disorder (4.5% vs 1.1%) (all P< 0.0001). Units of resource use (healthcare practitioner visits, emergency room, hospitalizations) were greater (all P< 0.05) and HRQoL was poorer (P< 0.0001) with AD. On the WPAI, employed AD subjects reported almost twice as much lost work productivity as non-AD employees (30.0% vs 16.3%; P< 0.0001). No clear patterns were observed across patient-reported AD severity categories on any outcome.  Conclusions: The significant burden associated with AD relative to those without AD suggests an unmet need for more effective management strategies. There also appears a need for greater characterization of disease severity from the patient perspective. PHS10 Knowledge, Awareness, And Prevalence Among Community Regarding Hepatitis B And C In Abbottabad, Kpk, Pakistan Azhar S1, Syed A1, Yousaf A1, Khan TK1, Mansoor Z1, Haq N2 Institute of Information Technology, Abbottabad, Pakistan, 2University of Balochistan, Quetta, Pakistan 1omsats

Objectives: The aim of the present study is to evaluate the prevalence, knowledge, and awareness among community regarding hepatitis B and C in Abbottabad, KPK, Pakistan.  Methods: Retrospective study was conducted. The data of 854 subjects which were screened for HBV and HCV was collected from the COMLABS Abbottabad from May 2012 to December 2014. Knowledge and Awareness was evaluated by cross sectional, descriptive study in four union councils of Abbottabad city from 1st of December 2014 to 30th of March 2015.  Results: Total 854 subjects which were screened for hepatitis B and C. 485 (56.2%) were males and 369 (43.2%) were females with mean age of 34.64 ±12.51. The prevalence of HCV was found to be 12.3% and HBV was 7% where as co-infection was found to be 0.46% prevalent. The total number of questionnaires which were distributed were 457 and 444 were returned with a response rate of 97 percent. 259 (58.3%) were males and 185 (41.7%) were females with mean age of 34.64±10.86 years. Mean scores for knowledge of hepatitis B and C was found to be 11.17±4.81 and 12.34±4.20 respectively whereas awareness regarding HB and HC was assessed on basis of percentages which showed less awareness among the community.  Conclusions: It was concluded from the present study that HCV is more prevalent than HBV as the overall prevalence rates in this study was found to 12.3% for HCV and 7% for HBV in community of Abbottabad city. Most of community of Abbottabad still lack basic knowledge and preventive measures regarding hepatitis B and C. Information regarding prevention of HB and HC should be given in order to decrease the prevalence rate. Moreover the concern authorities should also pay attention to increase the knowledge and awareness regarding these diseases among the community.

1Amgen, Inc., Thousand

Objectives: To estimate the rates of cardiovascular events (CVE) among nonelderly high cardiovascular risk patients.  Methods: The Truven Health MarketScan Commercial Database was used to hierarchically identify cohorts of non-elderly adults (age ≥ 20-<65) with familial hypercholesteremia (FH), atherosclerotic cardiovascular disease (ASCVD) [myocardial infarction; unstable angina; ischemic stroke; stable angina; coronary revascularization; carotid stenosis; peripheral vascular disease; abdominal aortic aneurysm] or type 2 diabetes mellitus (T2DM) in 2006-2007; a variable-length follow-up was used to describe the lipid-lowering therapy (LLT) and rates of new CVE from 2008-2013. The ASCVD and T2DM cohorts included patients prescribed statin at and ≤ 12 months post diagnosis; FH cohort included patients prescribed high intensity statin and ezetimibe concurrently for ≥ 30 days at and < 12 month post diagnosis. The primary outcome was the presence of new CVEs, defined as an inpatient stay with a primary diagnosis of acute coronary syndrome ([ACS] includes myocardial infarction and unstable angina), ischemic stroke, heart failure, revascularization or cardiovascular-related death.  Results: 944,132 patients met the inclusion criteria (0.7% FH, 19.6% ASCVD, 79.9% T2DM) with an average follow-up of 41 months. The majority of FH patients used LLT during follow-up (78.8% used both a statin and ezetimibe, 16.5% used statin alone, 1.5% used ezetimibe alone and 3.2% used neither). Lower LLT usage was seen among ASCVD (14.6%, 44.5%, 1.0%) and T2DM (10.1%, 45.9%, 1.0%) patients as a higher proportion of both cohorts used neither a statin nor ezetimibe (39.9% and 42.9%, respectively). ASCVD patients appeared to have higher CVE rates than FH or diabetes patients (per 1,000 person-years): ACS: 11.8, 6.8, 4.0; ischemic stroke: 5.1, 2.4, 2.3; heart failure: 12.8, 4.5, 4.5; revascularization: 64.2, 38.4, 18.1; and cardiovascular-related death: 0.6, 0.2, 0.2.  Conclusions: The LLT and high CVE rates observed will be useful in characterizing the clinical burden among non-elderly US commercially-insured high cardiovascular risk patients.

PHS11 Bidirectional Screening Of Comorbid Tuberculosis And Diabetes And Its Effect On Tuberculosis Treatment Outcomes Azhar S1, Umer RZ1, Shahid M2 of Pharmacy, Comsats Institute of Information Technology, Abbottabad, Pakistan, 2DHQ Hospital, Bahawalnagar, Pakistan

1Department

Objectives: The major objectives of our study was to investigate the prevalence rate of tuberculosis in our population. Bidirectional screening of established tuberculosis and diabetes patients for comorbid TB-DM individuals and effect of this comorbidity on outcomes of anti-Tuberculosis treatment.  Methods: It was an exploratory, cross-sectional and retro-prospective study. This study took place at the outpatient DOTS clinic for TB, Tuberculosis & Chest Unit and Pharmacy Section at a secondary health care facility in Punjab, Pakistan. Retrospective study was performed by evaluating accessible previous data to check the trend either decreasing or increasing. Both diabetic and tuberculosis patients, consecutive registered during study, were screened for comorbidity and treatment outcomes comparison was done between TB-only and TB-DM groups.  Results: Annual upraise of 6% tuberculosis patients was noted in retrospective study. While prevalence of TB in established DM patients was 10.52% and prevalence of DM in tuberculosis patients was 6.89%. Cure rate, positive treatment outcome, in TB-only and TB-DM groups was 78% and 71% respectively.  Conclusions: We found annual increase in TB cases, while prevalence of TB and DM in established DM and TB population was higher than general population. There was consistency in the sputum smear microscopy and treatment duration among patients with TB-DM and those with TB alone. So no negative effect on outcomes of anti-TB treatment was noted in our study. This highlight the need to promote awareness on nosocomial TB transmission in

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community and emphasized on bidirectional screening. The rising burden of DM may adversely affect TB control program. At present there is a need to have a strong collaboration between National TB and diabetes programs.

programs related to physical and verbal abuse. Family education on communication and problem solving is crucial to family welfare.

PHS12 Emergency Department Visits Associated With Ankle Sprains In The United States

HEALTH SERVICES – Cost Studies

Shah S1, Thomas AC1, Noone JM1, Blanchette CM1, Wikstrom EW2 of North Carolina at Charlotte, Charlotte, NC, USA, 2University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

1University

Objectives: In the United States, more than 628,000 ankle injuries are treated in emergency facilities per year, accounting for 20% of all injury-related emergency department visits. Ankle sprains represent a common injury in emergency departments. We assessed the demographic characteristics, national incidence and burden of ankle sprains in United States emergency departments. We also characterized the most common complications and procedures undertaken for these injuries.  Methods: We conducted a retrospective cross-sectional study using 2010 Nationwide Emergency Department Sample. Utilizing ICD-9 codes, we identified ankle sprain patients. Propensity score (1:1 nearest neighbor) matching was performed between lateral and medial as well as lateral and high ankle sprains to compare multiple dependent variables (e.g. charges, complications, procedures) among ankle sprain diagnoses.  Results: We estimated the incidence of ankle sprains at 1,016,282 cases. The patient mean age was 30.18 years. Females sustained more lateral ankle sprains (57%) than males. After propensity score adjustment, the total charges for lateral sprains were higher than medial sprains [Median (IQR): $1,008 ($702 to $1,408) versus $914 ($741 to $1,108), P <  0.01]. Among complications, pain in the limb (1.92% versus 0.52%, P = 0.03), sprain of the foot (2.96% versus 0.70%, P < 0.01), and abrasion of hip and leg (1.57% versus 0.35%, P=  0.03) were significantly higher in the lateral group. Among procedures, medial ankle sprain patients were more likely to undergo diagnostic radiology and related techniques than lateral (97.91% versus 83.62%, P < 0.0001). High ankle sprains accounted for higher in-patient hospitalization compared to lateral ankle sprains (24 [6.06%] versus 1[0.25%], P< 0.0001).  Conclusions: There are differences in patient characteristics, procedures performed, and charges associated with different ankle sprain types. Demographic risk factors such as age and sex may be useful indicators to identify those at higher risk of sustaining an ankle sprain and more likely to benefit from preventive measures. PHS13 Potential Drug-Drug Interactions In Renal Impairment Patients In Pakistan Saleem A1, Masood I1, Khan TM2, Nawaz M1 1The Islamia University of Bahawalpur, Bahawalpur, Pakistan, 2Monash University Malaysia, Selangor, Malaysia

Objectives: To assess the incidence, nature and severity of potential drug-drug interactions (pDDIs) in renal impairment patients admitted in nephrology ward of a tertiary care hospital in Pakistan.  Methods: A retrospective data of 200 renal impairment patients was obtained conveniently from a tertiary care hospital and evaluated to observe the incidence, nature and severity of pDDIs using Medscape drug interaction checker software [http://reference.medscape.com/drug-interactionchecker]. All of the statistical analysis was carried out using SPSS version 16.  Results: In total, 659 pDDIs were observed in 180 (90.0%) renal impairment patients giving a median value of 2 (IQR= 4) with a range of 1-15 pDDIs per patient. Of those 659 pDDIs, around 10.9% were serious, 59.2% were significant, 3.8% were contraindicated, and nearly 26.1% of pDDIs were minor in severity. Furthermore, nearly 45.2% pDDIs were pharmacokinetic, 38.7% pharmacodynamic, 7.3% electrolyteimbalance, and remaining 8.8% pDDIs were unknown in nature.  Conclusions: Based on the study findings, it is concluded that the incidence of pDDIs is ninety percent in renal impairment patients. The majority of pDDIs are pharmacokinetic in nature and significant in severity. Therefore, the pDDIs should be assessed carefully at the time of drug prescribing to prevent over or underestimation of pDDIs and pDDIs associated adverse outcomes. PHS14 Aspects Of Family Life In Young People In A Region Of Colombia In 2014 Alvis Zakzuk JY1, Alvis Zakzuk J2, Salcedo Mejía F3, Alvis Guzman N4, Paz Wilches J1, Manrique Mclean J1 1Mutual Ser EPS, cartagena, Colombia, 2Alzak foundation, Cartagena, Colombia, 3Alzak Foundation, cartagena, Colombia, 4Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia

Objectives: To describe aspects of family life in young poor people in a region of Colombia in 2014.  Methods: A cross sectional study was conducted. A sample of 10.400 young poor people between 12-24 years old with public health insurance was extracted from a simple random sampling. A questionnaire was designed and applied to collect information about family life, domestic abuse and family function characteristics. A logistic multinomial model was developed to identify associations among variables. Family life with parents was the dependent variable of the model. Explanatory variables were age, sex, physical and verbal abuse, family satisfaction when having problems, family decision making, feeling loved from family and the satisfaction level with family time.  Results: From 10.400 young poor people, 90.7% reported to have a good relationship with their parents, wherein 56.2% were women and 43.8% were men. The mean age of this group was 16.2 years (SD±4.1). Frequency rate of young people who reported to have a regular or a bad relationship with parents was 8.4% and 0.6% respectively. Young people who have been either victim of physical (β = -0.06, p= 0.003) or verbal abuse (β  = -0.09, p= 0.000), or those who not feel loved from family (β = -0.05, p= 0.000) or who feel a low grade of satisfaction with family when having problems (β = -0.03, p= 0.000), have a lower probability to have a good relationship with parents.  Conclusions: Family promotion and prevention programs in young people should encourage the use of primary prevention

PHS15 Death Burden Of Pneumococcal Disease On Brazilian Private Health System Santos MC1, Ferreira CN2, Squiassi HB2, Santana CF2 José do Rio Preto, Brazil, 2Pfizer, São Paulo, Brazil

1Unimed, São

Objectives: Diseases caused by Streptococcus pneumoniae (pneumococcal diseases [PDs]) are a major public health problem worldwide1. This bacterium causes severe pulmonary and invasive diseases, such as pneumonia, meningitis and septicemia, affecting especially young children and the elderly, being responsible for one million children deaths per year1,2. Acknowledging that PDs are an important burden on health systems, this study aims to estimate the impact of deaths from PDs from the Brazilian Private Healthcare System (PHS) perspective.  Methods: The number of hospital discharges due to PD-related deaths (meningitis, pneumonia or septicemia), as well as the hospitalization costs and resources usage by PHS were analyzed using a database with approximately 200,000 patients3, between September 2014 and August 2015.  Results: From the 426 users identified, 18 users were excluded for lack of information and, then, 130 users were identified with one of the PDs (meningitis, pneumonia or septicemia) considered in this study. It was observed that 60% of the deaths were from pneumonia, 38% from septicemia and 2% from meningitis and related total costs of hospitalization were BRL 1,202,921.02, BRL 1,253,653.65, BRL 79,808.28, respectively. The related total cost of hospitalization for all diseases was BRL 7,587,496.19, compared to BRL 2,536,382.95 of hospitalization for PDs (meningitis, pneumonia and septicemia). The average length of stay was 9 days for pneumonia, 12 days for septicemia and 13 days for meningitis. The highest number of deaths relates to elderly people (91%).  Conclusions: Pneumococcal diseases represent a total of 33% of death-related costs for Brazilian PHS, affecting especially elderly people. The total cost of hospitalization was 6% higher than overall costs and the average length of stay until death was greater than for the other diseases analyzed. PHS16 A Budget Impact Analysis Establishing The Economic Benefit Of The Sandostatin® Lar® Mobile Administration Program In Canada Panchmatia HR1, Becker DL2, Choe Y3, Gu Q4 1Optum, Stoneham, MA, USA, 2Optum, Burlington, ON, Canada, 3Novartis

Pharmaceuticals

Corporation, East Hanover, NJ, USA, 4Optum, Waltham, MA, USA

Objectives: Sandostatin® LAR® (SAS LAR), an injectable slow-release synthetic octapeptide analogue of somatostatin, is indicated to control symptoms in patients with acromegaly and neuroendocrine tumors (NET). To optimize patients’ experience with SAS LAR, a fully-subsidized Mobile Administration Program (MAP) has been launched by Novartis Pharmaceuticals Inc., which provides home nurse visits for administration/monitoring of SAS LAR every 4 weeks. The objective of this study was to quantify the economic benefit of the MAP in Canada.  Methods: A threeyear budget impact model was developed to estimate the net benefit of the MAP from the societal perspective. All patients with acromegaly and NET in Canada who are currently treated with SAS LAR were included. The proportion of patients enrolled in the MAP versus those not enrolled was estimated using national SAS LAR sales data and data collected by the MAP. Costs associated with patients participating versus not participating in the MAP were estimated, with assistance from Canadian clinicians, considering costs of: SAS LAR acquisition and utilization rates, administration/monitoring, treatment non-compliance, and patient time lost for administration/monitoring. The primary outcome was the net difference in cost between the world-with versus world-without MAP.  Results: In the current year, it was estimated that 61% of SAS LAR patients in Canada participated in the MAP and, of those, 81% chose to receive home visits. The estimated year 1 savings to society generated by the MAP were $712,000. When MAP participation rates were projected to increase to 100% by year 3, the 3-year cumulative cost savings were estimated at $3,473,000 ($1,171,000 acromegaly; $2,302,000 NET). The largest savings were derived from reduced administration/monitoring costs for MAP patients.  Conclusions: The analysis predicts the MAP is likely to improve treatment compliance while also yielding cost savings. PHS17 Determination Of Medication Errors And Economic Implications To One Year Of The Establishment Of Clinical Pharmacy Service In Medical Oncology Unit: Experience In A Hospital Of Cancer In Mexico Hernández Martínez JF, Morales Perez M, Toledo Vigueras I, Colín Gómez DP, Paredes García P, Sánchez Rodríguez I Centro Oncológico Estatal, ISSEMyM, Toluca, Mexico

Objectives: To determine the amount of medication errors (ME) in the area of medical oncology, from the establishment of clinical pharmacy service (CPS) and determine the economic impact that has had a year of its implementation in that area.  Methods: A retrospective study of the ME database registered by the PSC in the period from November 2014 to December 2015 was conducted, the ME were staged according to the classification of Otero et al 2000. The economic issue was determined saved through direct costs (price of drugs pieces) thanks to pharmaceutical interventions when it presents some discrepancy in the treatment of patients.  Results: The total ME identified and recorded by the CPS in the stipulated period was 1343 (includes the areas of hospitalization, therapy, emergency and medical oncology), 226 correspond to the area of medical oncology. The main ME were: 67% of prescription, 16% of drug ministration and 9% of inadequate patient monitoring, the ME type “B” (do not reach the patient) accounted for 71% (Otero et al 2000). The money saved was $31167.61 (USD), of only 60 of the 226 ME, as they are