Community-Based Pharmacists’ Perceptions of Physician Collaboration and Adherence Promotion Activities Targeting Persons Living with Hiv

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Medical Center, San Diego, CA, USA, 8Air Force Medical Operations Agency (AFMOA), Lackland, TX, USA, 9Naval Medical Center Portsmouth, VA; Infectious Disease Clinical Research Program, Uniformed Services University, Portsmouth, VA, USA, 10Operational Infectious Diseases, Naval Health Research Center, San Diego, CA, USA, 11Children’s National Medical Center, Washington, DC, USA, 12Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico, 13Hospital General Dr. Manuel Gea González, Ciudad de México, Mexico, 14Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de Mexico, Mexico, 15University College London, London, UK, 16The University of North Carolina School of Medicine, Chapel Hill, NC, USA, 17University Hospital of Cologne, Köln, Germany, 18Hospital General de Agudos JM Ramos Mejia Servicio de Inmunocomprometidos, Buenos Aires, Argentina, 19Johns Hopkins University School of Medicine, Baltimore, MD, USA

smokers had significantly lower odds receiving the HPV vaccine; aOR =  0.59; 95% CI: 0.48-0.72 and aOR = 0.56; 95% CI: 0.41-0.76, respectively. Respondents who perceived their health as pair/poor had lower odds of getting the vaccine compared to those who perceived their health as excellent/very good (aOR =  0.75; 95% CI: 0.56-0.99), as were those without health insurance compared to those with insurance (OR =  0.75; 95% CI: 0.62-0.92). Lastly, respondents who live in the South had 27% (OR =  0.73; 95% CI: 0.60-0.89) lower odds of receiving the HPV vaccine compared to participants in the Northeast.  Conclusions: Compared to US born, foreign born respondents had lower odds of HPV vaccination initiation. Research should explore other correlates to better understand low vaccine initiation among foreign born individuals.

Objectives: Evaluate the reliability, validity, and responsiveness of the FLU-PRO for evaluating presence and severity of symptoms in adults with influenza.  Methods: Prospective, observational study of adults (≥ 18 years) with influenza-like illness. Subjects were recruited through clinics in the US, UK, Mexico, and South America and completed the 37-item draft FLU-PRO daily for up to 14 days. Item-level distributional characteristics and factor analyses were used to determine the factor structure and remove redundant/misfitting items. Reliability of the final domain and total scale scores was estimated using Cronbach’s alpha and intraclass correlation coefficients (ICC; 2-day reproducibility). Convergent and known-groups validity was assessed using global assessments related to influenza severity. Patient return to usual health was used to assess responsiveness from Day 1–7.  Results: N= 221 laboratory-confirmed influenza, mean age= 40.7, 60.2% female, 59.7% white. The final model was a 6-factor structure: (Nose [4-item], Throat [3-item], Eyes [3-item], Chest/ Respiratory [7-item], Gastrointestinal [4-item], and Body/Systemic [11-item], with a higher-order factor representing symptom severity (comparative fit index [CFI]= 0.92; root mean square error of approximation [RMSEA]= 0.06). Cronbach’s alpha was high for the total (0.92) and domains (range= 0.71–0.87); test-retest reliability (Day 1–2) was ICC= 0.83 for the total and ranged from 0.57 to 0.79 for domains. At Day 1, FLU-PRO domain and total scores were moderately-to-highly correlated (≥ 0.30) with Patient Global Rating of Flu Severity (except Nose, Throat). Known-groups validity was supported for the total (F= 57.2, p< 0.001) and domains (F= 8.9–67.5, p< 0.001). For the total and all domains (except Gastrointestinal), patients that returned to usual health reported significantly greater (p< 0.05) improvement at Day 7 than patients that did not return to usual health.  Conclusions: FLU-PRO assesses the presence and severity of 32 signs and symptoms of influenza covering 6 body systems. This study suggests FLU-PRO scores are reliable, valid, and responsive to change in adults with acute influenza.

PIN55 Impact of Health-Related Quality of Life and Social Determinants on Yearly Influenza Immunization in the United States

PIN53 Hospital-Acquired Bacterial Pneumonia: Development of a New Patient-Reported Outcome Instrument Howard K1, Clifford S1, Saretsky T1, Cho M1, Hoffmann SC2, Talbot GH3, Powers JH4 1ICON Clinical Research, LLC, San Francisco, CA, USA, 2Foundation for the National Institutes of Health, Bethesda, MD, USA, 3Talbot Advisors, LLC, Anna Maria, FL, USA, 4Leidos Biomedical Research in support of NIH, George Washington University School of Medicine, Rockville, MD, USA

Objectives: Standardized methods to measure symptoms in Hospital-Acquired Bacterial Pneumonia (HABP) are limited. Currently there is no patient-reported outcome (PRO) instrument to capture additional symptoms of how patients feel, function, or survive. The goal of this study was to explore HABP symptoms as reported by patients, and to develop a draft PRO symptom instrument using methods in-line with the FDA PRO Guidance.  Methods: Concept elicitation was conducted by oneon-one telephone interviews with patients within 10 days of HABP diagnosis. Data were analyzed using an iterative process to identify themes and concepts and were recorded in a saturation grid. Saturation was monitored according to the FDA PRO Guidance.  Results: Thus far, 8 patients from 3 clinical sites participated in concept elicitation interviews. Mean age of the sample was 61.1 years (SD =  13.0, range: 41-75); 50% were female. The most common spontaneously reported symptoms of HABP were difficulty breathing (75.0%), weakness (62.5%), and chest pain (62.5%). Half of the patients experienced cough, fever, lack of energy, and chills. Significant impacts on social (62.5%) and physical functioning (e.g. walking) (62.5%) and activities of daily living (75.0%) were also reported.  Conclusions: Qualitative data gathered in the initial concept elicitation interviews will be combined with input from experts to form the basis of a new PRO instrument to assess patient-reported HABP symptoms. Cognitive debriefing interviews will also be conducted to ensure that the newly developed instrument has established qualitative content validity for the HABP patients being interviewed. The final measure can be used to aid the evaluation of new bacterial treatments. PIN54 Does Birthplace Independently Predict Human Papillomavirus Vaccine Initiation? Geneus CJ1, Adjei Boakye E2, Mohammed KA2, Tobo BB3, Osazuwa-Peters N4 1Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 2Saint Louis University Center for Outcomes Research (SLUCOR), Saint Louis, MO, USA, 3Saint Louis University, Saint Louis, MO, USA, 4Saint Louis University Cancer Center, Saint Louis, MO, USA

Objectives: To assess whether birth place (US or Foreign) is a predictor of HPV vaccination initiation using a nationally representative sample.  Methods: Data from the 2014 National Health Interview Survey (NHIS) were analyzed on 23,530 survey participants, aged ≥ 18 years. Weighted, adjusted multivariable logistic regression model was used to assess whether birth place would be indicative of the likelihood of HPV vaccine initiation.  Results: After adjusting for covariates, we found that foreign born respondents had 33% (aOR =  0.67; 95% CI: 0.54-0.84) lower odds of receiving the HPV vaccine compared to U.S. born respondents. In addition, compared to females, males had 60% (aOR =  0.40; 95% CI: 0.35-0.47) lower odds of receiving the vaccine. Participants aged 18-49 years had significantly higher odds of receiving the vaccine compared to their older peers (aged ≥  65 years) (aOR =  10.26; 95% CI: 2.3045.75). Single/unmarried respondentshad two times higher odds of receiving the HPV vaccine compared to married respondents. Furthermore, former smokers and

Davis RE, Geneus CJ Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

Objectives: To assess the health related quality of life (HRQOL) factors and social determinants associated with obtaining the influenza immunization within the past 12 months.  Methods: Data was analyzed on 123,641 survey participants, aged ≥ 18 years, using the 2014 BRFSS. A weighted multivariable logistic regression was used to assess associations between influenza immunization and HRQOL.  Results: The social determinants of sexual orientation, race/ethnicity, income, age, education, marital, drinking and smoking status, and health insurance were significantly associated with influenza immunization. Five domains of HRQOL were examined; general health, mental and physical health (≥ 14 unhealthy days), lifetime depression, and activity limitation. Accounting for social determinants, compared to those who perceived to have excellent health, self-perceived very good health had 1.02 (95% CI: 0.96-1.09) times higher odds of getting the flu vaccine, self-perceived good health had 1.10 (95% CI: 1.03-1.18) times higher odds, and self-perceived fair/poor health had 1.27 (95% CI: 1.16-1.40) times higher odds of getting the flu vaccine. Participants with poor physical health had 1.05 (95% CI: 0.96-1.14) times higher odds of getting the flu vaccine compared to their counterparts. However, participants with poor mental health had 19% (aOR =  0.81; 95% CI: 0.74-0.89) lower odds of getting the flu vaccine compared to their counterparts. Furthermore, compared to those without depression, depressed participants had 1.29 (95% CI: 1.21-1.38) times higher odds of getting the flu vaccine. Compared to those who did not report to be limited in any activity because of physical, mental or emotional problems, those who were limited in any way had 1.13 (95% CI: 1.07-1.21) times higher odds of getting the flu vaccine.  Conclusions: The results of this study show a significant role of HRQOL and social determinants on influenza immunization. Further research is needed to evaluate potential disparities surrounding immunization against influenza to inform and improve current health promotion activities.

INFECTION – Health Care Use & Policy Studies PIN56 Community-Based Pharmacists’ Perceptions of Physician Collaboration and Adherence Promotion Activities Targeting Persons Living with Hiv Kibicho J1, Dilworth T2, Owczarzak J3 1University of Wisconsin-Milwaukee, Milwaukee, WI, USA, 2Wheaton Franciscan Healthcare, Milwaukee, WI, USA, 3John Hopkins University, Baltimore, MD, USA

Objectives: Consistent long-term adherence to antiretroviral therapy (ART) remains a challenge for many persons living with HIV (PLWH) despite advances in treatment. Clinical trials have shown that pharmacist-physician collaboration leads to cost-effective PLWH management. We are not aware of any studies that examine pharmacists’ perceptions of physicians with to adherence promotion activities (APA) for PLWH. Our objective was to examine how physician-pharmacist collaboration impacts APA in community-based settings.  Methods: We surveyed community-based pharmacists providing HIV patient care. We asked pharmacists to rate 27 APA activities and 4 dimensions of physician-pharmacist collaboration (phypharmindex): physician credibility; communication quality (open, positive interactions); relationship mutuality; and relationship vestedness (understands physician needs). We used factor analysis to generate an APA index (Cronbach alpha = 0.92) and a phy-phamindex (Cronbach alpha =  0.95). Both univariate generalized linear modelling (GLM) and multivariate GLM were done to identify significant pharmacist- (e.g., age, education) and pharmacy- (e.g., type, prescription size) level factors associated with APA.  Results: 40% of the 188 pharmacists from 37 U.S. states surveyed worked in top HIV MSAs. Most were female (63%), Caucasian (67%) and HIV certified (73%). 33% worked in specialty-only pharmacies. A majority (85%) worked closely with physicians. In univariate GLM, HIV+ clientele, ART prescription volume, public insurance, HIV certification and HIV organization membership, and phy-pharmindex had higher odds of APA; pharmacist age and fulltime employment status had lower odds. In multivariate GLM, pharmacist HIV certification, pharmacist HIV organization membership and phy-pharmindex had higher odds [ORcertification: 1.692 (p< .01); ORmembership: 2.046 (p< .01); ORpham-phyindex: 1.454 (p< .01)], while fulltime employment status had lower odds [ORfull: 0.702 (p< .01)] of APA.  Conclusions: High quality physician-pharmacist relationship was a significant predictor of adherence promotion activities—even after controlling for HIV certification and HIV organization membership—that may impact patient satisfaction, ensures smooth transitions in patient care, reduces ART-related prescribing errors, thus ensuring high quality care for PLWH. PIN57 Real-World Hepatitis C Treatment Strategies in the United Kingdom and Denmark Jalbert J1, Lee Y1, Thiam A2, Bakshi S2, Weis N3, Hallager S3, McLauchlan J4, Irving W5, Amzal B2