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The Risk Of Chronic Pancreatitis In Patients With Psoriasis: A Population-Based Matched Cohort Study
A10
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
diseases. Conclusions: On average, cancer interventions have offered largely comparable health benefits to interventions for chronic diseases. However, QALY gains vary with respect to by prevention stage and by intervention type.
RESEARCH POSTER PRESENTATIONS – SESSION I
SELECTED HEALTH CARE TREATMENT STUDIES HEALTH SERVICES – Clinical Outcomes Studies PHS1 Post-Operative Pain Management Association With Health Economic Outcomes Robinson SB University of North Carolina, Charlotte, Waxhaw, NC, USA
Objectives: This pilot study examined pain management for selected surgeries by analyzing the association between opioid related adverse drug events (ORADE) and length of stay (LOS), total hospitalization cost and 30-day all cause readmission. Methods: The Premier Healthcare Database was queried to identify adult inpatients discharged between 2011 and 2014 who received postsurgical opioids following open colectomy, Hip Replacement or Knee Replacement defined by ICD-9 procedure code. Comorbidities and adverse drug events were defined using ICD-9 diagnosis codes. Descriptive statistics including the outcomes of LOS, total visit cost, and 30-day readmission were calculated. For comparing patients with and without ORADE, t-tests for continuous variables and chi-squared tests for categorical variables were used (alpha = 0.05). Gamma regression was used to calculate adjusted estimates for LOS and total cost and Logistic regression was used to calculate the adjusted odds of having a 30-day readmission. Results: There were 669,374 patients, average age of 65.5 (SD 11.4) with the majority female (59.4%), that met the study criteria. The percentage of patients with comorbidities ranged from 0.7 % with Regional Enteritis to over 80% with osteoarthritis with significant differences comparing the ORADE and no ORADE patients. Overall, 10.1% of patients had an ORADE. The unadjusted mean LOS (+3.9 days p< 0.0001), total visit cost (+$6,892 p< 0.0001), and readmissions (+5.9% p< 0.0001) were higher for patients with ORADE compared to those without ORADE. Adjusted analysis held similar LOS (5.4 days vs. 3.6 days, p< 0.0001), total cost ($20,163 vs. $17,615, p< 0.0001) and 30-day readmission (odds ratio 1.15, 95% CI 1.12-1.18). Conclusions: Occurrence of ORADE in the selected surgeries significantly increased the LOS, total cost and 30-day readmissions. In this study, higher dosages of opioids are associated with the incidence of ORADE; more research is needed to determine whether strategies to decrease opioid use improves outcomes and reduces ORADEs. PHS2 The Risk Of Chronic Pancreatitis In Patients With Psoriasis: A Population-Based Matched Cohort Study Hsieh C1, Chiu H2, Chiang Y1, Tsai T3, Tsai Y4, Huang W5 1National Yang-Ming University, Taipei, Taiwan, 2National Taiwan University Hospital, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei City, Taiwan, 4Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, 5National Yang Ming University, Taipei, Taiwan
Objectives: Chronic pancreatitis(CP), an irreversible inflammatory disease of the pancreas, is characterized by chronic inflammatory cell infiltration and acinar cell degeneration. Emerging work had strongly suggested autoimmune disease, including psoriasis is frequently associated with autoimmune pancreatitis. The aim of this study was to evaluate the risk of CP in patients with psoriasis. Methods: We conducted a population-based cohort study investigating 48,430 patients with psoriasis and 193,720 subjects without psoriasis matched by age and sex in the Taiwan National Health Insurance Research Database during 2003 through 2011. The occurrence of CP was defined as outcome. The risk of CP in patients was analyzed using Cox proportional hazards models. Results: The incidence of CP during follow-up period was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude HR 1.81; 95% CI 1.53-2.15), which remained significant after adjustment (adjusted HR [aHR] 1.66-1.78). We further grouped patients with psoriasis into those with mild or severe psoriasis and those with or without psoriatic arthritis (PsA). All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased aHRs for CP. Conclusions: Our data showed that the incidence and HR of CP were greater in patients with psoriasis than control subjects after adjusting for potential confounding factors. Moreover, the HRs for CP were increased in all subgroups, including those with mild and severe psoriasis and those with and without Psoriatic arthritis(PsA). PHS3 Retrospective Study To Compare Medication Utilization Between Physician-Managed And Pharmacist-Managed Groups In State Correctional Facilities Among An Hiv Population Vu H1, Shaya FT1, Barnes V2, Seo H2, Rodriguez de Bittner M1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Correct Rx Pharmacy Services, Hanover, MD, USA
Objectives: To compare the total number of medication classes (TNMC) and the differences in medication classes between a physicians managed (MDM) vs pharmacists managed (PHM) state correctional HIV patients from July 2014 until September 2015. Methods: The data was collected retrospectively utilizing administrative pharmacy claims during the study period. The MDM group and the PHM group were determined based on the availability of pharmacists at the correctional facilities. The HIV patients were distributed randomly based on the correctional system. The HIV population in each group was determined based on any antiretroviral medications from the claims data. The TNMC was calculated and the medication
classes that HIV patients were receiving in the two groups were recorded. T-test, Chi-square and Fisher’s exact tests were used for the statistical analysis between two groups. Results: A total of 65 patients were in the MDM group and 864 patients were in PHM group. The TNMC that the HIV patients were on had no significant difference between the PHM and the MDM groups (6.77±2.56 vs 6.2±2.91, p= 0.1268). The PHM group had significantly higher rates of HIV patients who were on antihyperlipidemics (p=0345), dermatologicals (p< 0.0003), endocrine (p= 0.0014), and gastrointestinal (p=0.0003) than the PHM group. PHM group had a higher rate of genitourinary medications than the MDM group (p= 0.0378). Conclusions: The PHM HIV patients in correctional facilities were less likely to be on multiple medication classes than MDM. Medications for chronic conditions and antibiotics were more common in the MDM group. More analysis is needed to examine the differences between the groups to clearly articulate the role of the pharmacists versus the physicians in HIV management in the correctional facilities. In addition, it would be important to identify areas where pharmacists can have the greatest impact. PHS4 The Role Of Sleep Quality Improvement Training Within Workplace Health Promotion Szabó J1, Markó Z2, Csákvári T1, Gombos G1, Steinhausz V1, Sió E1, Turcsányi K1, Boncz I3, Pakai A1 1University of Pécs, Zalaegerszeg, Hungary, 2Csolnoky Ferenc Hospital, Veszprém, Hungary, 3University of Pécs, Pécs, Hungary
Objectives: Sleep disorders are more frequent recently among workers due to negative work environment and working in shifts. Our aim is to measure the occurence of insomnia among industry and health care workers, and to prove the effictiveness of sleep hygiene guidance and other complementary techniques. Methods: A prospective, qualitative survey with non-probability convenience sampling was performed in an assembling department of an electronic company (n= 112) and in the City Hospital of Keszthely, Hungary (n= 102) (N= 214). Inclusion criteria was the to be 18-62 years old. Workers with severe depression, anxiety disorders or psychiatric co-existing disorders, and workers being treated with diseases that affect sleep (diseases of somatic system, internal organs, neurological disorders) were excluded. For measurement we used Athens Insomnia Scale. People struggling with insomnia (n= 34) were participating in a training about sleep hygiene, simple behavioral therapy techniques and progressive relaxation. Descriptive statistics, T-test and ANOVA was calculated (p< 0,05) with SPSS 17.0 program. Results: 69% (n= 148) weren’t struggling with insomnia, 20% (n= 48) were having a subclinical disease and 11% (n= 23) were having severe cases of insomnia. Test results before and after one month of training were compared. We detected a significant improvement in people working 8 or 12 hours, and people working in rotating- or three shifts (p< 0.05). Analysis of variance on age did not show any significant difference between the therapic groups (p= 0.596). Conclusions: Results showed that our applied methods were effective. Counseling about sleep hygiene combined with progressive relaxation and behavioral therapy techniques was viable to treat insomnia formed from either kind of shifts. Besides these techniques, there is more chance of recovering by using light therapy, sleep compression, herbs, diet and individualized exercise programs. Our method alone or combined with the above mentioned ones could be an important part of workplace health promotion. PHS5 Role Of Glycemic Control In Development Of Atrial Fibrillation In Patients With Type 2 Diabetes Mellitus Singhal M1, McAdam-Marx C1, LaFleur J2, Witt DM1, Nelson RE1, Biskupiak JE1 1University of Utah, Salt Lake City, UT, USA, 2George E. Whalen Veterans Health Administration IDEAS Center, Salt Lake City, UT, USA
Objectives: Type 2 diabetes mellitus (T2DM) is a known risk factor for atrial fibrillation (AF). The association between glycemic control and developing AF is not clear. This study identifies the association between glycemic control level during the previous 12 months and AF diagnosis in patients with T2DM. Methods: This case control study used incidence density sampling to identify patients of age ≥ 18 years with T2DM in the US Veteran Affairs (VA) national EMR database from 20002014. Patients were required to have ≥ 2 hemoglobin A1c (HbA1c) measurements in the year prior to index date. Index date of cases was first AF diagnosis date. Patients with all HbA1c < 7% were considered to have good glycemic control; those with 1 or more HbA1c ≥ 7% were poor control. Cases had an AF or atrial flutter diagnosis ≥ 12 months after T2DM diagnosis, identified by ICD 9 codes between February 1, 2002 and December 1, 2014. Controls were selected from the same population but without AF diagnosis on or before index date. Cases and controls were matched 1:4 based on diabetes duration and T2DM diagnosis calendar year. Logistic regression was used to assess the association between glycemic control and AF controlling for age and sex. Results: Of 1,752,409 patients with T2DM, 38,094 cases were matched to 152,342 controls. The mean age (SD) of cases and controls was 71.2 (9.7) and 66.2 (10.3) years, respectively, (p< 0.001) and 98.2% (cases) and 96.1% (controls) were male. After adjusting for age and gender, patients with AF were 48% more likely to have poor glycemic control compared to patients without AF [OR 1.48 (95%CI 1.45-1.52)] (p-value < 0.001). Conclusions: Patients with AF had poor glycemic control in previous year of AF diagnosis, compared to patients without AF. However, analyses were not controlled for all the potential confounders, which can affect estimate. PHS6 Assessment Of Who/Inrud Patient-Care And Facility-Specific Indicators In The Ophthalmology Wards Of Two Tertiary Care Hospitals In Pakistan Atif M, Rehan Sarwar M, Azeem M, Qamar-Uz-Zaman M, Arslan B, Nauman A, Zeshan M The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Objectives: Medicines should be used appropriately to ensure patients’ health. The aim of this study was to evaluate the drug use practices in the ophthalmology wards of two tertiary care hospitals situated in the Bahawalpur district of the Punjab
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
diseases. Conclusions: On average, cancer interventions have offered largely comparable health benefits to interventions for chronic diseases. However, QALY gains vary with respect to by prevention stage and by intervention type.
RESEARCH POSTER PRESENTATIONS – SESSION I
SELECTED HEALTH CARE TREATMENT STUDIES HEALTH SERVICES – Clinical Outcomes Studies PHS1 Post-Operative Pain Management Association With Health Economic Outcomes Robinson SB University of North Carolina, Charlotte, Waxhaw, NC, USA
Objectives: This pilot study examined pain management for selected surgeries by analyzing the association between opioid related adverse drug events (ORADE) and length of stay (LOS), total hospitalization cost and 30-day all cause readmission. Methods: The Premier Healthcare Database was queried to identify adult inpatients discharged between 2011 and 2014 who received postsurgical opioids following open colectomy, Hip Replacement or Knee Replacement defined by ICD-9 procedure code. Comorbidities and adverse drug events were defined using ICD-9 diagnosis codes. Descriptive statistics including the outcomes of LOS, total visit cost, and 30-day readmission were calculated. For comparing patients with and without ORADE, t-tests for continuous variables and chi-squared tests for categorical variables were used (alpha = 0.05). Gamma regression was used to calculate adjusted estimates for LOS and total cost and Logistic regression was used to calculate the adjusted odds of having a 30-day readmission. Results: There were 669,374 patients, average age of 65.5 (SD 11.4) with the majority female (59.4%), that met the study criteria. The percentage of patients with comorbidities ranged from 0.7 % with Regional Enteritis to over 80% with osteoarthritis with significant differences comparing the ORADE and no ORADE patients. Overall, 10.1% of patients had an ORADE. The unadjusted mean LOS (+3.9 days p< 0.0001), total visit cost (+$6,892 p< 0.0001), and readmissions (+5.9% p< 0.0001) were higher for patients with ORADE compared to those without ORADE. Adjusted analysis held similar LOS (5.4 days vs. 3.6 days, p< 0.0001), total cost ($20,163 vs. $17,615, p< 0.0001) and 30-day readmission (odds ratio 1.15, 95% CI 1.12-1.18). Conclusions: Occurrence of ORADE in the selected surgeries significantly increased the LOS, total cost and 30-day readmissions. In this study, higher dosages of opioids are associated with the incidence of ORADE; more research is needed to determine whether strategies to decrease opioid use improves outcomes and reduces ORADEs. PHS2 The Risk Of Chronic Pancreatitis In Patients With Psoriasis: A Population-Based Matched Cohort Study Hsieh C1, Chiu H2, Chiang Y1, Tsai T3, Tsai Y4, Huang W5 1National Yang-Ming University, Taipei, Taiwan, 2National Taiwan University Hospital, Taipei, Taiwan, 3National Taiwan University Hospital, Taipei City, Taiwan, 4Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, 5National Yang Ming University, Taipei, Taiwan
Objectives: Chronic pancreatitis(CP), an irreversible inflammatory disease of the pancreas, is characterized by chronic inflammatory cell infiltration and acinar cell degeneration. Emerging work had strongly suggested autoimmune disease, including psoriasis is frequently associated with autoimmune pancreatitis. The aim of this study was to evaluate the risk of CP in patients with psoriasis. Methods: We conducted a population-based cohort study investigating 48,430 patients with psoriasis and 193,720 subjects without psoriasis matched by age and sex in the Taiwan National Health Insurance Research Database during 2003 through 2011. The occurrence of CP was defined as outcome. The risk of CP in patients was analyzed using Cox proportional hazards models. Results: The incidence of CP during follow-up period was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude HR 1.81; 95% CI 1.53-2.15), which remained significant after adjustment (adjusted HR [aHR] 1.66-1.78). We further grouped patients with psoriasis into those with mild or severe psoriasis and those with or without psoriatic arthritis (PsA). All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased aHRs for CP. Conclusions: Our data showed that the incidence and HR of CP were greater in patients with psoriasis than control subjects after adjusting for potential confounding factors. Moreover, the HRs for CP were increased in all subgroups, including those with mild and severe psoriasis and those with and without Psoriatic arthritis(PsA). PHS3 Retrospective Study To Compare Medication Utilization Between Physician-Managed And Pharmacist-Managed Groups In State Correctional Facilities Among An Hiv Population Vu H1, Shaya FT1, Barnes V2, Seo H2, Rodriguez de Bittner M1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Correct Rx Pharmacy Services, Hanover, MD, USA
Objectives: To compare the total number of medication classes (TNMC) and the differences in medication classes between a physicians managed (MDM) vs pharmacists managed (PHM) state correctional HIV patients from July 2014 until September 2015. Methods: The data was collected retrospectively utilizing administrative pharmacy claims during the study period. The MDM group and the PHM group were determined based on the availability of pharmacists at the correctional facilities. The HIV patients were distributed randomly based on the correctional system. The HIV population in each group was determined based on any antiretroviral medications from the claims data. The TNMC was calculated and the medication
classes that HIV patients were receiving in the two groups were recorded. T-test, Chi-square and Fisher’s exact tests were used for the statistical analysis between two groups. Results: A total of 65 patients were in the MDM group and 864 patients were in PHM group. The TNMC that the HIV patients were on had no significant difference between the PHM and the MDM groups (6.77±2.56 vs 6.2±2.91, p= 0.1268). The PHM group had significantly higher rates of HIV patients who were on antihyperlipidemics (p=0345), dermatologicals (p< 0.0003), endocrine (p= 0.0014), and gastrointestinal (p=0.0003) than the PHM group. PHM group had a higher rate of genitourinary medications than the MDM group (p= 0.0378). Conclusions: The PHM HIV patients in correctional facilities were less likely to be on multiple medication classes than MDM. Medications for chronic conditions and antibiotics were more common in the MDM group. More analysis is needed to examine the differences between the groups to clearly articulate the role of the pharmacists versus the physicians in HIV management in the correctional facilities. In addition, it would be important to identify areas where pharmacists can have the greatest impact. PHS4 The Role Of Sleep Quality Improvement Training Within Workplace Health Promotion Szabó J1, Markó Z2, Csákvári T1, Gombos G1, Steinhausz V1, Sió E1, Turcsányi K1, Boncz I3, Pakai A1 1University of Pécs, Zalaegerszeg, Hungary, 2Csolnoky Ferenc Hospital, Veszprém, Hungary, 3University of Pécs, Pécs, Hungary
Objectives: Sleep disorders are more frequent recently among workers due to negative work environment and working in shifts. Our aim is to measure the occurence of insomnia among industry and health care workers, and to prove the effictiveness of sleep hygiene guidance and other complementary techniques. Methods: A prospective, qualitative survey with non-probability convenience sampling was performed in an assembling department of an electronic company (n= 112) and in the City Hospital of Keszthely, Hungary (n= 102) (N= 214). Inclusion criteria was the to be 18-62 years old. Workers with severe depression, anxiety disorders or psychiatric co-existing disorders, and workers being treated with diseases that affect sleep (diseases of somatic system, internal organs, neurological disorders) were excluded. For measurement we used Athens Insomnia Scale. People struggling with insomnia (n= 34) were participating in a training about sleep hygiene, simple behavioral therapy techniques and progressive relaxation. Descriptive statistics, T-test and ANOVA was calculated (p< 0,05) with SPSS 17.0 program. Results: 69% (n= 148) weren’t struggling with insomnia, 20% (n= 48) were having a subclinical disease and 11% (n= 23) were having severe cases of insomnia. Test results before and after one month of training were compared. We detected a significant improvement in people working 8 or 12 hours, and people working in rotating- or three shifts (p< 0.05). Analysis of variance on age did not show any significant difference between the therapic groups (p= 0.596). Conclusions: Results showed that our applied methods were effective. Counseling about sleep hygiene combined with progressive relaxation and behavioral therapy techniques was viable to treat insomnia formed from either kind of shifts. Besides these techniques, there is more chance of recovering by using light therapy, sleep compression, herbs, diet and individualized exercise programs. Our method alone or combined with the above mentioned ones could be an important part of workplace health promotion. PHS5 Role Of Glycemic Control In Development Of Atrial Fibrillation In Patients With Type 2 Diabetes Mellitus Singhal M1, McAdam-Marx C1, LaFleur J2, Witt DM1, Nelson RE1, Biskupiak JE1 1University of Utah, Salt Lake City, UT, USA, 2George E. Whalen Veterans Health Administration IDEAS Center, Salt Lake City, UT, USA
Objectives: Type 2 diabetes mellitus (T2DM) is a known risk factor for atrial fibrillation (AF). The association between glycemic control and developing AF is not clear. This study identifies the association between glycemic control level during the previous 12 months and AF diagnosis in patients with T2DM. Methods: This case control study used incidence density sampling to identify patients of age ≥ 18 years with T2DM in the US Veteran Affairs (VA) national EMR database from 20002014. Patients were required to have ≥ 2 hemoglobin A1c (HbA1c) measurements in the year prior to index date. Index date of cases was first AF diagnosis date. Patients with all HbA1c < 7% were considered to have good glycemic control; those with 1 or more HbA1c ≥ 7% were poor control. Cases had an AF or atrial flutter diagnosis ≥ 12 months after T2DM diagnosis, identified by ICD 9 codes between February 1, 2002 and December 1, 2014. Controls were selected from the same population but without AF diagnosis on or before index date. Cases and controls were matched 1:4 based on diabetes duration and T2DM diagnosis calendar year. Logistic regression was used to assess the association between glycemic control and AF controlling for age and sex. Results: Of 1,752,409 patients with T2DM, 38,094 cases were matched to 152,342 controls. The mean age (SD) of cases and controls was 71.2 (9.7) and 66.2 (10.3) years, respectively, (p< 0.001) and 98.2% (cases) and 96.1% (controls) were male. After adjusting for age and gender, patients with AF were 48% more likely to have poor glycemic control compared to patients without AF [OR 1.48 (95%CI 1.45-1.52)] (p-value < 0.001). Conclusions: Patients with AF had poor glycemic control in previous year of AF diagnosis, compared to patients without AF. However, analyses were not controlled for all the potential confounders, which can affect estimate. PHS6 Assessment Of Who/Inrud Patient-Care And Facility-Specific Indicators In The Ophthalmology Wards Of Two Tertiary Care Hospitals In Pakistan Atif M, Rehan Sarwar M, Azeem M, Qamar-Uz-Zaman M, Arslan B, Nauman A, Zeshan M The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Objectives: Medicines should be used appropriately to ensure patients’ health. The aim of this study was to evaluate the drug use practices in the ophthalmology wards of two tertiary care hospitals situated in the Bahawalpur district of the Punjab