The Prevalence Of Chronic Health Conditions And Multimorbidity In The Portuguese Population - Results From The 2014 National Health Interview Survey

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PHP196 Do Changing Attitudes To Death Have Implications For National Tariffs For Health States? Results From An Examination Of Attitudes To Euthanasia In The Republic Of Ireland Barry L1, Hobbins A1, Kelleher D1, Shah K2, Devlin N2, Ramos-Goñi JM3, O’Neill C1 Galway, Galway, Ireland, 2Office of Health Economics, London, UK, 3RTI Health Solutions, Research Triangle Park, NC, USA

1NUI

Objectives: Many religions teach that life has intrinsic value regardless of the condition in which it is experienced. Those who adhere to such religions may be less likely to assign “worse than dead” values to health states or favour access to services such as euthanasia when quality of life is poor. Quantitative methods may be useful in understanding more precisely the role religious adherence and attitudes on access to euthanasia may have on the propensity to assign worse than dead values.  Methods: Using the EuroQol Valuation Technology (EQ-VT), EQ-5D-5L valuation tasks were administered to a sample of 153 residents of the Irish Republic in 2016. Individuals provided data on attitudes to physician provided euthanasia as well as how frequently they attended religious services. Each respondent provided 10 time trade-off valuations for health states drawn at random. Data were analysed using a recursive bivariate probit (RBP) in which endogeneity related to attitudes to euthanasia was identified and addressed in a model examining propensity to assign worse than dead values.  Results: 96% of respondents whose religion was identified were Roman Catholic. A Wald test revealed that attitudes to euthanasia were endogenous at p< 0.01. RBP results revealed that those who favour access to euthanasia were 30 percentage points (p< 0.01) more likely to assign worse than dead values than those who were not. Those who were older were also more likely to exhibit a higher propensity to assign worse than dead values.  Conclusions: Religious adherence and attitudes to euthanasia are examples of social norms. These may influence the values assigned to health states. Societies undergoing social change may experience shifts in social norms that impact on values and the distribution of values assigned to health states in national tariffs. This will have implications for value sets and the frequency with which they require revision. PHP197 A Systematic Review To Evaluate The Association Between Medication Adherence And Personality Traits Kohli RK TheraInsight Pvt. Ltd., Bangalore, India

Objectives: Medication adherence is a matter of concern for clinicians, healthcare systems, and payers. We empirically evaluated the association between prescription medication adherence and personality traits.  Methods: PsycINFO®, Embase®, MEDLINE®, and CINAHL were searched from database start to January 2017. Studies assessing impact of personality constructs on medication adherence in patients with chronic conditions (hypertension, heart failure, HIV, diabetes, asthma, dialysis, organ transplant, etc.) were included in the review. Screening and data extractions were conducted by two independent reviewers, and any discrepancies between reviewers were reconciled by a third independent reviewer.  Results: A total of 9980 individual references were identified through database searches. Personality was found to be associated with adherence across 47 included studies. Prospective observational cohort design was employed in 47% of the included studies. Self-report for measuring adherence was used in 63% of the studies. Neuroticism (16 studies), openness to experience (10 studies), hostility (5 studies), and extraversion (4 studies) were the most commonly investigated personality traits associated with non-adherence. Conscientiousness (17 studies), extraversion (13 studies), and agreeableness (12 studies) were most commonly reported personality traits associated with good adherence. In a random effects logistic regression analyses, neuroticism was associated with medication non-adherence (< 80% of prescribed pills), with an increase in SD by 1 in neuroticism associated with a 4.2% (95% CI: 0.3, 6.1); p< 0.05 increase in probability of non-adherence. Conscientiousness was positively related to adherence, indicating that individuals scoring high tended to be more adherent to treatment, β  (SE) =  0.049 (0.018); p= 0.012.  Conclusions: Although a correlation was observed between personality traits and medication adherence, the results of the study should be interpreted with caution due to heterogeneity across the studies including study design, population, personality inventories, and statistical techniques. PHP198 Patient Outcomes In Wales: The Proms, Prems & Effectiveness Programme (PPEP) Palmer RI, Withers KL, Carolan-Rees G Cardiff & Vale University Health Board, Cardiff, UK

Objectives: The PPEP is a national programme supported by Welsh Government, Welsh health boards and the NHS Wales Informatics Service, with the aim of providing an electronic platform for data collection across the country. The programme has been funded via the Welsh Government Efficiency through Technology Fund. Its purpose is to make patient-level data available during clinic consultations, and collated data to be analysed for clinical effectiveness assessment and benchmarking.  Methods: Patients are invited to submit PROMs at baseline and post-treatment. Tools are available for completion in English and Welsh, and are currently collected at home via a website or in-clinic via tablet computers. Collected data for all consenting patients include the EQ5D, co-morbidities, BMI, employment status and work productivity impairment, as well as lifestyle information such as smoking history, alcohol intake and exercise levels. Condition-specific tools are in use for 3 conditions, while a further 15 condition specific PROMs and a generic PREMs survey will be available imminently. The platform is currently being piloted in 4 of the 7 health boards in Wales with all consenting responses linked to clinical data.  Results: 2,263 generic PROMs have been collected by consenting patients at Cardiff & Vale University Health Board. Analysis confirmed that the 72.2% of responding patients who do not meet the national exercise guideline had worse health scores than those who do (p< 0.01). Furthermore the 25.8% of patients with high blood pressure and the 60.7% who are overweight/obese also had worse generic health scores (p< 0.01).  Conclusions:

Such data analyses will facilitate service improvements while informing patient and clinician decision making as part of the prudent healthcare agenda. The platform has allowed large dataset collection in a small space of time, with the programme continuing to capture datasets for chronic and acute conditions across Wales. PHP199 Local Production Policies In The Turkish Pharmaceutical Market Şentürk A, Tatar M Polar Health Economics & Policy Consultancy, Ankara, Turkey

Objectives: Heath care reforms in the last decade have resulted in improved access to health care services and pharmaceuticals in Turkey. As a result of this, several measures were taken to curb the increasing healthcare expenditures. In recent years, the government has focused on the burden of imported drugs on the Turkish economy and has declared increasing R&D activities and supporting local production as the main objectives of the 10th Development Plan. In this respect, the government has targeted to meet 60% of the pharmaceutical need in terms of value through local production. Pharmaceutical companies are required to invest for local production of their products. This study aimed at outlining the local production policies in Turkey.  Methods: Data for the study are obtained from the Turkish Pharmaceuticals and Medicines Agency (TITCK). Calculations are made by the TITCK with the discount rates published by the Social Security Institution (SSI).  Results: Local production policies are comprised of five stages. There are different policies for drugs with equivalent groups and without equivalent groups. For drugs with equivalent groups, there will be three stages. Local production policies are first applied to drugs with 50% or more local products in the market. Followed by drugs with more than 10% and less than 10% local products. The fourth stage will be applied to imported drugs and fifth stage will be applied to drugs without an equivalent groups.  Conclusions: The first stage of local production policies has been completed where 48 drugs will be delisted from the reimbursement list as of 8 February 2018. The government expects to save 22,3 billion TRY (5,7 billion € ) from this policy. The Ministry is meeting companies for the following stages. Additional incentives for licensing, pricing and reimbursement policies of these locally produced drugs are on the agenda of the government. PHP200 Measurement Of Multimorbidity To Predict All-Cause Mortality In A Nationwide Population, Using The French National Health Insurance Database (SNIIRAM) Constantinou P1, Tuppin P2, Pelletier-Fleury N1 1French National Institute of Health and Medical Research (INSERM), Villejuif, France, 2French National Health Insurance (CNAMTS), Paris, France

Objectives: Summary health-state measures are essential for risk-adjustment in comparative effectiveness or performance measurement studies and to inform policy-makers. The SNIIRAM database provides morbidity information for each beneficiary of the main health insurance scheme, representing over 57 million individuals, through a set of algorithms combining ICD-10 diagnoses and pharmacy data to identify specific conditions. In this study, we developed a multimorbidity measure predictive of 2-years mortality.  Methods: All beneficiaries aged 65 years or older in December 31, 2013 with complete follow-up until December 31, 2015 (n= 7,672,111) were randomly divided into a training (n= 3,836,056) and a validation population (n= 3,836,055). We used age, gender and selected indicator morbidity variables as predictors for 2-years mortality in multivariate logistic regression analyses, in the training population. Predictors were selected according to face validity of their identifying algorithm, number of events, univariate association with mortality and principal components analysis within disease categories. To derive a weighted index from the adjusted regression coefficients, we applied a scoring rule where each additional point reflected risk associated with a 5-years age increase. We assessed the predictive performance of the computed index in the validation population, using discrimination and calibration measures.  Results: Adjusted Odds Ratios [95% confidence interval] for the fifteen selected conditions ranged from 1.35 [1.31-1.38] for Depression, 1.36 [1.32-1.40] for Rheumatic or connective tissue diseases, to 3.89 [3.72-4.07] for End-Stage Renal disease, 4.06 [4.01-4.11] for Cancer. Score values were monotonically related to mortality. The weighted index had a higher discrimination (c-statistic= 0.825) than age and gender (c-statistic= 0.761) or count of all-56 available morbidity variables (c-statistic= 0.790). Within each score value, predicted probability was included in the 95% confidence interval of observed mortality proportion.  Conclusions: We computed a performant score to study multimorbidity in the French context. Such predictive measures could be externally validated in large medico-administrative databases with routinely collected morbidity information. PHP201 The Prevalence Of Chronic Health Conditions And Multimorbidity In The Portuguese Population - Results From The 2014 National Health Interview Survey Laires PA1, Rocha L2, Perelman J1 1Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa, Lisbon, Portugal, 2NA, Lisbon, Portugal

Objectives: In a context of severe population aging, knowing the prevalence of chronic diseases and multimorbidity is crucial to evaluate healthcare needs, as these are the most costly health conditions. We measured the prevalence of selfreported chronic health conditions multimorbidity in the adult Portuguese population for the year 2014.  Methods: Our sample included all people aged above 15 years old from mainland Portugal (7,944 men and 10,260 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. We considered the following chronic conditions: hypertension, diabetes, coronary disease, stroke or myocardial infarction in the previous year, arthrosis, chronic back or neck pain, chronic obstructive pulmonary disease, asthma, allergy, kidney disease, urinary incontinence, liver cirrhosis, and depression. Multimorbidity was measured either by the presence of two or more of these self-reported chronic conditions.  Results: Chronic back pain was the most prevalent self-reported



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condition (32.9%), followed by hypertension (25.3%), neck pain (24.1%), arthrosis (24.1), allergy (19.4%), depression (11.9%) and diabetes (9.3%). Multimorbidity affected 42% the population, was higher among women (49.7%), and increased sharply with age (age ≥ 45 yo: 66.1%; age ≥  65 yo: 78.8%) and decreasing education (high: 24.6%; low: 47.3%; and no education: 81.0%).  Conclusions: Multimorbidity was commonly found in the Portuguese population, especially among women and low-educated people. The co-occurrence of chronic health conditions increased sharply with age. These findings highlight the relevance of the issue, in particular amongst the most vulnerable groups. PHP202 Variation In Opioid Utilization By Physician Specialty And Payer Using A Linked Claims-Emr Database Bonafede MM1, Riehle EC1, Palmer LA2 Health Analytics, an IBM Company, Cambridge, MA, USA, 2Truven Health Analytics, Bethesda, MD, USA 1Truven

Objectives: To describe variation in opioid utilization by provider specialty and payer among patients in the US.  Methods: The IBM® MarketScan® Explorys® Claims-EMR Data Set was used to identify patients with a new opioid claim (index date) in 2015. These data link patient-level claims found in the MarketScan Databases with data for the same patients in the IBM Explorys electronic medical records dataset. Six months of pre-index and 12 months of post-index continuous enrollment was required to establish a new opioid episode and to assess opioid use in the subsequent year. The primary outcome was the number of opioid prescription claims and associated days supply. Opioid use was stratified by initial provider specialty and payer type.  Results: A total of 176,282 patients met the study inclusion criteria (mean age 56.2 [SD= 16.0]; 59.6% female). The mean days supply (DS) on the first opioid claim was 14.2 days [SD= 16.7]. On average, patients received 4.9 [SD= 5.4] opioid claims with total DS of 92.5 [SD= 126.9]. Average number of opioid claims and total DS for the year was similar among family practitioners (4.8 claims, 88.7 DS) and emergency medicine doctors (4.8 claims, 80.3 DS). Higher number of claims and total DS was seen for patients who saw an oncologist (5.7 claims, 110.9 DS), orthopedist (5.6 claims, 108.3 DS), or surgeon (5.7 claims, 108.6 DS), while pain specialists had the highest rates (9.3 claims, 210.7 DS). Pediatricians (3.0 claims; 43.1 DS) and OB/GYN practitioners (3.4 claims; 51.9 DS) had similarly lower opioid utilization. Overall, opioid utilization was slightly higher among Medicare (5.7 claims, 125.2 DS) than privately insured (4.7 claims, 83.8 DS) or Medicaid (5.1 claims, 86.2 DS) patients.  Conclusions: There was substantial variation by provider specialty and payer on top of higher than expected overall opioid utilization among patients starting a new opioid treatment episode in 2015. PHP203 A Review Of Methods For Item Selection In The Development Of A Descriptive System For Quality Of Life Instrument Singh J1, Longworth L2, Coyle D3, Pokhrel S1 University London, London, UK, 2PHMR Ltd, London, UK, 3Brunel University London, Lodon, UK

1Brunel

Objectives: The generation and selection of items is key in the development of any quality of life instrument. Advances in technology over recent years has enabled a range of methodologies for item selection to become more accessible to instrument developers. The aim of this study is to provide a contemporary overview of methods for item selection recommended in guidelines and methods by instrument developers.  Methods: A focused review of key standards and guidelines was used to identify recommended methods and psychometric assessments. A systematic review of the literature was conducted to identify the methods used in empirical studies reporting development processes of descriptive systems and additional methods not included in the guidelines. The search was conducted using COSMIN’s precise search filter for measurement properties, restricted to include health related quality of life studies focusing on development of descriptive systems, and 553 abstracts were identified. Supplementary searches were conducted by reviewing bibliographies and citations of the included studies.  Results: Eleven guidance documents and 61 full text articles were included. Item generation involved three approaches: developing items de novo, identifying items from several existing measures or using a single measure to derive a short form measure. Item selection was determined using statistical analyses in datasets containing completed questionnaires. A staged approach was used to establish dimensions first, with exploratory factor analysis or principal component analysis, before finalising items in each dimension, using item response theory, Rasch or structural equation modelling. These measurement models established construct validity and in most cases further psychometric properties were assessed.  Conclusions: It was common practice to establish dimensionality of the dataset before carrying out item selection. Few of the statistical methods identified are interchangeable in terms of purpose, but may generate very different instruments. The developers seldom explained why one statistical model was chosen over another. PHP204 Adhrence To Routine Medical Screening Among Healthcare Professionals

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using stratified random sampling. Interval variables were reported in terms of mean and standard deviation. Categorical variables were reported in terms of count and percent. Analysis was done using SAS V9.4  Results: 231 nurses, 129 physicians, and 19 pharmacists had filled the questionnaire. Physician’s age was 35.57±10.08, nurses’ 35.46±8.63, pharmacists’ age was 29.17±7.09 years. Diabetes screening was done by 65(52.85%) physicians, 100(49.02%) nurses, 11(61.11%) pharmacists (p= 0.542). Blood pressure screening was done by 82(65.08%) physicians, 163(75.81%) nurses, 15(88.24%) pharmacists (p= 0.033). Cholesterol screening was done by 62(49.6%) physicians, 116(55.24%) nurses, 11(64.71%) pharmacists (p= 0.392). Breast cancer screening among females with positive family history of breast cancer (n= 26) was done by 7(26.92%). The knowledge of screening guidelines of mammogram (age ≥ 40 years) was among 73(57.03%) physicians, 115(50.66%) nurses, 11(57.89%) pharmacists. The knowledge of screening guidelines of colon cancer (age ≥ 50 years) was among 60(47.24%) physicians, 13(5.75%) nurses, and 2(10.53%) pharmacists.  Conclusions: Awareness campaigns are needed for better understanding and adherence of recommended medical and cancer screening guidelines. PHP205 The Association Between Multimorbidity And Subjective Health Status: Mediating Effect Of Activities Of Daily Livings Byeon J KOREA UNIVERSITY, Seoul, Korea, Republic of (South)

Objectives: As the population grow older, many people suffer from multimorbidity. Individuals with multiple chronic conditions may have declined more rapidly in health status. In many case, activities of daily living (ADL) is associated with health status and multimorbidity. This research aims to identify the association multimorbidity with health status and to explore the mediating effect of ADL.  Methods: Individuals with chronic disease who aged 65 and over (n= 2705) were analyzed, based upon the data of the Korean health panel (KHP), which is nationally representative. Multiple linear regression was used not only to analyze the association multimorbidity with health status and identify the mediating effect of ADL.  Results: Mediator analysis revealed that the indirect effect of multimorbidity on SRH through the proposed mediators was significant (b= 0.112, p< 0.001) with an explained variance of adj. R2 =  0.48. We found that functional health and physical limitations such as Activities of Daily Living partially mediate the association between multimorbidity and SRH. Firstly, multimorbidity was a powerful and important determinant of SRH. The effect of physical limitation, ADL, was also significant and remarkable factors about SRH. All analyze was performed with control variables such as SES, lifestyle.  Conclusions: Self-rated health is a very individual index of general health. It is influenced by multiple chronic condition, functional and physical health. In an aging society, young people will not be sufficient to care for the elderly. Self - care will be a factor to improve the health status of the old people in the elderly society. PHP206 Dispute Issues About The Healing And Health Promotion Of Children Fusz K1, Rohmann R1, Pakai A2, Pusztai D1, Váradyné Horváth Á1, Behul B1, Boncz I1, Oláh A1 1University of Pécs, Pécs, Hungary, 2University of Pécs, Zalaegerszeg, Hungary

Objectives: Many parents ask the pediatrician, nurses and health visitors on the Internet forums about fever, not mandatory vaccinations, homeopathy, such as breastfeeding and moving development of the childrens.  Methods: We conducted a cross-sectional quantitative, descriptive survey and shared a questionnaire on a community page among parents with young children (n=  657) with convenience sampling in 2016. The data were analyzed with chi-square test, Mann-Whitney and Kruskal Wallis test.  Results: The participants 97.6% were female the average age is 32.69 year. The first-born children’s average age was 4.71 years. Highest percentage of the parents begin to calm the fever immediately (36.9%). Mostly, (86.9%) they didn’t agree with that fact they should damp the fever, only if the child is sick and don’t want to drink. The most popular antipyretic method was to give medcine (36%), and the cooling bath (22.4%), and only 3% of the parents use homeopathy in this case. Many parents reject the amber jewelry (81%). The 82.4% of the respondents given no mandatory vaccinations. The antipyretic attitudes influenced by the parent’s level of education (p< 0.05) their knowledge level (p< 0.05) and by the confidence in the doctors (p< 0.05). In the gropup of those who are against the vaccination, there are more parents who use laying on of hands method for healing (p< 0.05). The older ones (p< 0.05) and the parents with higher level of education (p< 0.005) agreed with the importance of the movement development and breastfeeding in higher rates.  Conclusions: Our results draw attention to several current problem to the professionals. It would be important to start the education of the parents in time. The knowledge level and the trust in the doctors influenced the parents decisions. An unified, reliable and accessible source of information, or forum would be advisable, which help to serve the uncertain situations. PHP207 EQ-5D-5L Population Norms For Moscow (Russia): Interim Analysis

1King Abdullah

Holownia M1, Tarbastaev A2, Golicki D1 1Department of Clinical & Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland, 2State Budgetary Institution of Moscow City “Clinical Trials and Healthcare Technology Assessment Centre of Moscow Department of Healthcare”, Moscow, Russian Federation

Objectives: Screening is the use of different tests on a healthy person to detect diseases prior to developing symptoms. The aim of the study is to highlight the extent of adherence to screening practices among healthcare professionals working in a tertiary care center.  Methods: A cross-sectional study using self-administered questionnaire was conducted among physicians, nurses and pharmacists. The questionnaire consisted of demographics, past medical history, knowledge of screening tests, and medical screening questions, was distributed as a hard copy. Adherence was defined as 50% and above. Participants were selected at random,

Objectives: To develop the EQ-5D-5L population norms for Moscow (Russia) based on a representative sample of city citizens. The aim of the interim analysis is to investigate feasibility of QoL measurement with the use of Russian version of EQ-5D-5L.  Methods: We used official Russian language paper and pencil version of EQ-5D-5L questionnaire provided by the EuroQol Group in the interview of Moscow adult population. To make our study representative, we used quota sampling, dividing Moscow into ten official administrative districts and using Russian Statistics Office (ROSSTAT) for the district, age and sex sampling. We collected data on: five EQ-5D-5L dimensions - mobility (MO), self-care (SC), usual activities (UA),

Shaheen N1, Hussein M1, Almuflih A2, Muhanna N2, Alsomaie S2 International Medical Research Center, Riyadh, Saudi Arabia, 2King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia