Involvement Of Community Pharmacists In Public Health Priorities: A Multi-Center Descriptive Survey In Ethiopia

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VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1

Orthopaedics, 7 relevant indicators for country-specific assessment were selected. Countries were categorised according to their overall alignment to VBHC in orthopaedics. Sources of data included: academic organisations; clinical orthopaedic organisations; national registry organisations; and expert opinion.  Results: All countries had a national orthopaedic body, but few provided professional training in VBHC. These training programmes were minimal More economically developed countries have multiple centres providing data to formal national and internationally linked orthopaedic speciality registries Most countries had more than one centre with orthopaedic speciality coordinated care services Countries with high levels of healthcare spending also tend towards outcome-based payment approaches in orthopaedics, though bundled-payment systems are not widely implmented.  Conclusions: Alignment to VBHC in orthopaedics is in its early phases globally Almost universally, countries could improve their alignment with orthopaedic VBHC through the introduction and development of bundled payment models Moving towards coordinated orthopaedic care remains a challenge, though progress in this domain appears to be more developed in orthopaedics than in other specialities Further analysis of this nature aims to generate an understanding of the global landscape of VBHC from a speciality perspective. PHS75 Analysis Of Hospital Episode Statistics To Identify Hopsital Resource Use Due To Skin Cancer In Ireland Gorry C1, Barry M1, McCullagh L2 Centre for Pharmacoeconomics, Dublin, Ireland, 2Trinity College, Dublin, Ireland

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Objectives: There were over 10,700 cases of melanoma and first-incidence nonmelanoma skin cancer (NMSC) recorded in Ireland in 2013, with incidence rates increasing by 3-4% annually. We aim to identify hospital resource use at a national level, associated with these conditions. MethodsWe obtained and analysed hospital episode statistics (HES) from the national Hospital Inpatient Enquiry (HIPE) service for all discharges with any diagnostic code C43.0-C43.9, C44.0-C44.9, C79.2 (ICD 10th revision), from 2010 to 2014. This data captures daycase and inpatient activity for all patients in acute public hospitals in Ireland. Diagnosis Related Group (DRG) costs were taken from the 2011 Ready Reckoner published by the Health Service Executive inflated to 2017 prices. The data was analysed using Microsoft Excel.  Results: There was a consistent increase in total discharges for patients with diagnostic codes C43 and C44 from 2010-2014. This increase was driven by an increase in daycase discharges; inpatient discharges decreased by between 6 and 9% annually. Highest numbers of discharges were for patients aged 65-84 years, in line with the epidemiology of melanoma and NMSC in Ireland. The most common adjacent DRGs for daycase discharges were J11 Other Skin, subcutaneous tissue and breast procedures, R64 Radiotherapy and J69 Skin Malignancy. The largest increase in daycase discharge DRGs was for R63 Chemotherapy, an average of 29% over the period 2011-2014. The most common adjacent DRGs for inpatient discharges were J11Z Other Skin, SC tissue and breast procedures, J69B Skin malignancy without CCCC, and J08B Other skin graft &/ debridement procedures –CC. The estimated cost for the day case and inpatient discharges was € 44.88 million and € 38.5 million respectively, over the 5 year period.  Conclusions: Increasing incidence of melanoma and NMSC is reflected in increasing resource use in the hospital setting, primarily in the daycase setting. Limitation:HIPE excludes outpatient discharges. PHS77 Does The Early Bird Catch The Worm: Early Cancer Detection And Survival In The UK Squirrell D Open Health, London, UK

Objectives: Cancer has a significant burden on NHS resources and there is a need to improve cancer outcomes in the UK. This analysis investigated if there is variation in the early diagnosis of breast, colorectal, and lung cancers across NHS clinical commissioning groups (CCGs) in England, and if this is associated with improved outcomes.  Methods: One-year survival and percentage of breast, colorectal, and lung cancer detected at stage I–II from CCGs was extracted from the 2016 NHS England cancer and tumour focus pack tool. Linear regression analyses were conducted to determine the relationship between the percentage of cancers detected at stage I–II versus 1-year survival.  Results: Data were available from 209 CCGs. This analysis revealed significant variation in early detection of cancers across England. The percentage of cancers detected at stage I–II ranged from 36.3% to 88%, 13.5% to 54.4%, and 9.1% to 35.1% in patients with breast, colorectal, and lung cancer, respectively. Similarly, 1-year survival rates varied, and ranged from 93.2% to 98.6%, 68.2% to 85.3%, and 23.5% to 47.1% for breast, colorectal, and lung cancer, respectively. A statistically significant positive correlation between the percentage of cancers detected at stage I–II and 1-year survival for lung cancer was observed (R= 0.28; p< 0.001). No similar correlation was found for breast and colorectal cancer (R= 0.10; p= 0.15 and R= 0.07; p= 0.32, respectively).  Conclusions: These data indicate that rates of detection of cancers at stage I–II vary considerably. We find that detection at stage I–II is associated with improved survival in lung cancer which has poorer outcomes at later stages of disease versus breast and colorectal cancer which have more favourable outcomes at later stages. CCGs should continue to take action to improve detection rates and thus survival outcomes in difficult-to-treat cancers. PHS78 Real World Data Analysis Of A Patient-Tailored, Post-Discharge Support Program For Patients Undergoing An Ostomy Surgery In Lowering Readmissions And Emergency Room Visits Rojanasarot S1, Gardner-Westmark M2, Au A2, Carlson AM3 of Pharmacy, University of Minnesota, Minneapolis, MN, USA, 2Coloplast Corporation, Minneapolis, MN, USA, 3Data Intelligence Consultants, LLC, Eden Prairie, MN, USA

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Objectives: Most patients undergoing ostomy surgery have experienced life adjustment difficulties and post-operative complications, resulting in emergency

room (ER) visits. A patient-tailored, post-discharge support program (Coloplast Care) has been developed as an adjunct to nurse-led ostomy care to provide patients with post-operative education and easily accessible assistance. This study investigated the effectiveness of the patient support program on real-world, preventable healthcare utilization in patients living with an ostomy.  Methods: This study employed a cross-sectional online survey design. Coloplast, an ostomy patient support program provider, maintains an ostomy patient database. Patients in this database were eligible to participate in the survey; they were stratified into program enrollees and non-enrollees. Both patient groups received a survey containing questions addressing the following domains: characteristics of ostomy surgery, readmissions and ER visits within the first month or after the first month of discharge including reasons for preventable events; and level of healthcare access. Two multivariate logistic regressions controlling for covariates were applied to assess any association between program enrollment and ostomy-related readmissions or ER visit rates.  Results: Of 7,026 surveys sent to program enrollees, 493 (7%) responded compared with 225 (5%) out of 4,149 surveys sent to nonenrollees. The two groups were similar in demographics; there were no statistically significant differences in gender, race, the medical condition requiring ostomy surgery, whether the patients visited an ostomy clinic after surgery, or received other patient support programs. Logistic regressions showed that compared with non-enrollees, program enrollees had a significantly lower likelihood of being readmitted and visiting the ER due to ostomy complications one month or more following discharge (odds ratio, 0.45; 95% CI, 0.27-0.73 and 0.37; 95% CI, 0.22,0.64, respectively).  Conclusions: This study suggests that enrolling patients with an ostomy in the post-discharge support program is effective in reducing potentially preventable healthcare utilization. PHS79 Involvement Of Community Pharmacists In Public Health Priorities: A Multi-Center Descriptive Survey In Ethiopia Mersha AG, Erku DA University of Gondar, Gondar, Ethiopia

Objectives: Located in the heart of the community and widely distributed geographically, community pharmacies provide a platform for a more proactive involvement in public health services. So far, little information has been gathered in Ethiopia on community pharmacists’ level of involvement in public health services. The aim of the present study was, therefore, to document the level of involvement of community pharmacy professionals in the provision of public health services and the barriers to such involvement.  Methods: This study employed a self-administered questionnaire based survey, which asked participants to indicate their frequency and level of involvement in providing public health services and their perceived barriers in providing such services. Surveys were undertaken from May to July, 2016 with 472 community pharmacy professionals working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya and Debre Birhan.  Results: Among 472 community pharmacy professionals approached, 412 (233 pharmacists and 179 pharmacy technicians) completed the survey with a response rate of 87.3%. Most respondents reported as being either “not at all involved” or “little involved” in counselling on smoking cessation (79.3%), and screening for hypertension (86.9%), diabetes (89.5%), and dyslipidemia (88.9%). On the other hand, they reported a higher level of involvement in the management and screening of infectious diseases (72.8%) and counseling with partners when initiating treatment for sexually transmitted diseases (68.9%). Lack of knowledge or clinical skills and lack of personnel or resources were the most commonly reported barrier for expanding such services.  Conclusions: This survey revealed a low level of involvement of community pharmacists in public health services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of community pharmacy professionals, interventions should focus on overcoming the identified barriers. PHS80 Tools For Improving Efficiency In Clinical Management And Safety Of Hypertensive Patients. Efigie-hta Project Hidalgo A1, Orozco-Beltrán D2, Górriz JL3, Ferrer D4, Sabaté N5, Martell N6, Muñiz O7, Galgo A8 1University of Castilla-La Mancha, Toledo, Spain, 2Cabo Huertas Health Centre, San Juan de Alicante, Spain, 3Hospital Clínico Universitario, Valencia, Spain, 4Institut Català de la Salut, Tarragona, Spain, 5Hospital Vall d´Hebron, Barcelona, Spain, 6Hospital Clínico Universitario, Madrid, Spain, 7Hospital Universitario Virgen del Rocío, Sevilla, Spain, 8Centro de Salud Espronceda, Madrid, Spain

Objectives: Hypertension, due to its high prevalence, is estimated to account for 5.6%-7.5% of the total health spending in Spain. The objective of this study is to detect areas for improvement in the management of hypertensive patients within the Spanish National Health System (SNHS), so it may help clinicians, health managers and decision-makers to get the best possible clinical results.  Methods: A website tool for self-diagnosis was launched in 2015, with access to primary healthcare centres to detect their hypertension-related areas for improvement. Health managers could complete an ad hoc questionnaire, and compare their answers to three different scenarios: “control” (ideal results based on literature and a committee of experts), “national” (results from participating centres) and “regional” (results from centres from the same region). Areas for self-evaluation were: information systems, diagnostic tests, organizational aspects, resource consumption and training for patients and healthcare professionals. After any intervention implemented by centres to solve an area for improvement, a before-after results comparison could be made, also in economic terms.  Results: A total of 31 centres participated in the pilot project at national level. Related to diagnosis, 57.1% of centres followed any Preventive Care Program, 45.7% hadn´t easy access to ambulatory monitoring for diagnosis and management of hypertension and 42.9% of clinicians didn’t ask patients about substances that may modify blood pressure. Most of centres