- Email: [email protected]
what Do we Pay for Compounded Drugs?
A818
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
indicators. Methods: A cross sectional study was carried out in private paediatric hospital. The data were collected from prescriptions of OPD patients with age newborn to 18 years. Written informed consent was obtained from parents of paediatric patients. Patients’ demographics, diagnosis, name(s) of drugs, dose, route of administration, frequency and duration were captured. Prescriptions were analysed for WHO recommended prescribing indicators. Results: The results are based on data collected from 300 patients; 58.6% were male and 41.4% were female. The average age of patients was 44 months. No medicines were prescribed to 2% of the patients. The largest set of patients was diagnosed to have URTI (21.3%) followed by allergic rhinitis (15%). The other common diagnosis were viral infection, gastritis, gastroenteritis and fever under investigation. The average number of drugs prescribed was 2.6 (range 1-6). Less than 1 % of drugs were prescribed by the generic name. None of the prescription had injection prescribed in it. 9.8% of all outpatient encounters were prescribed one or more antibiotics. Beta lactamase inhibitor was most extensively prescribed antibiotic. 41% of the drug prescribed appeared on the national list of essential medicines 2011. Nasal decongestants were mostly prescribed followed by nutritional supplements. 47% of drugs were prescribed as syrup. Oral administration was the most common route of administration (74%) while nebulization counts 13%. Conclusions: These early findings are a pointer to the prescribing practice; however, the minimal use of antibiotics is an encouraging signal to follow further. The integration of these results in prescribing shall lead to promotion of rational pharmacotherapy. PHP21 Drug Utilization Study of Antibiotics in A Secondary Care Referral Hospital Rathikanti V chalapathi institute of pharmaceutical sciences, Vijayawada, India
Objectives: The main aim is to Study the appropriateness and quantify the utilization of antibiotics. Methods: A Cross Sectional study was conducted in a secondary care referral hospital for a period of three months using the prescriptions of the patients suffering with the various infections Results: Altogether 150 patients, (67.15%) males and 236 (32.85%) females were enrolled. Among these, highest rate of drug prescription was observed for patients aged between 40 to 60 years, which consist of 85(56.6%) patients . Highest rate of antimicrobial prescription was observed for patients of respiratory and urinary tract infections .Highest frequency of drug prescription was observed for Azithromycin which consist of 30.35% which was followed by Amoxicillin 18.12%, Cifixime (6.52%), Doxycycline (24.13%),ceftriaxone(12.3%) , ciprofloxacin (8.58%), Overall 76.84% of the patients were treated with a combination therapy of antibiotics, But if antibiotics are not used rationally then there will be increase chances of resistance of bacteria as also as increase the total cost of treatment and adverse reactions. Conclusions: Drug utilization studies are used as powerful tools to ascertain the role of drugs in the management of various diseases. There is a need of patient education and counseling on use of antimicrobial drugs (AMDs) by the clinical pharmacist. PHP22 Perliminary Study of Medication Regimen Complexity Among Taiwanese Elderly who Have Used Anxiety or Hypnotics Prescriptions Chen J1, Simonavice CA2, Chen Y2, Lin H1 Medical University, Taichung, Taiwan, 2China Medical University Hospital, Taichung, Taiwan
database contains 4,153,588 pharmacy-dispensed claims with 112,523 ingredient entries and 16,944,271 physician-dispensed claims with 2,222,342 ingredient entries. The average amount paid per CD ingredient per year for pharmacy-dispensed CDs increased by 37% from 2011 to 2012 and 67% from 2012 to 2013, while physiciandispensed increased by 14% from 2011 to 2012 and 20% from 2012 to 2013. The current CA AB 378 regulation does not significantly reduce CD cost, in fact the cost increased. The change in cost of CD using the alternative Colorado pricing scheme is lower. In 2011, mean CA CD cost (pharmacy-dispensed after combining all ingredients) is currently $87 but would be $84 under Colorado pricing. In 2012, the price is currently $149, and $141 under Colorado pricing and in 2013, the price is currently $419, and $241 under Colorado pricing. Conclusions: The cost of CD in CAWC is increasing despite the current regulation to remedy the situation. An alternative solution may be to adopt the Colorado pricing scheme, which offers a disincentive to expand number of ingredients inflating prices. PHP24 A Nationwide Survey on Infection Control Activities Within Hospitals Allowed to Implement Preferential Infection Prevention Countermeasure Fee in Japan Hirose M1, Nishimura N2, Naora K2, Imanaka Y3 University, Izumo, Japan, 2Shimane University Hospital, Izumo, Japan, 3Kyoto University, Kyoto, Japan 1Shimane
Objectives: The preferential Infection prevention countermeasure fee (PIPCF) was divided into PIPCF 1 and 2 in case of meeting the requirement for infection prevention within a hospital as of April, 2012. This study aims to explore the current condition of infection control activities in hospitals with allowed to calculate PIPCF in Japan. Methods: We nationwide surveyed the situation of infection control activities in hospitals with PIPCF in 2015, by using an anonymous and self-administered questionnaire. Results: Of 3,680 target hospitals (domestic hospitals: 8,484) in Japan, 718 hospitals responded (response rate: 19.5%). The 708 hospitals were classified into two classes; 304 hospitals with PIPCF 1 and 404 hospitals with PIPCF 2. With regard to the assignments for infection control of physicians, nurses, pharmacists and laboratory technicians, full-time nurses were working approximately at 277 hospitals (91.1%) of hospitals with PIPCF 1. However, full-time medical staff except nurses was assigned at less than 10% of 304 hospitals with PIPCF I. And, fulltime nurses were working at only 38 hospitals (9.5%) of 404 hospitals with PIPCF 2. Regarding in-hospital walk round for infection control, more than 90% of any health professionals were participating in in-hospital walk round at 304 hospitals with PIPCF 1. However, less than 70% of physicians were participating in in-hospital walk round at 404 hospitals with PIPCF 2, and the participation rate of in-hospital walk round for physicians was the lowest among health professionals. No pharmacist and laboratory technicians participated in in-hospital walk round at 404 hospitals with PIPCF 2. Conclusions: Judging from these findings, hospitals with PIPCF 2 were owned by small-scale and private sectors, and it was difficult for those hospitals to set up an in-hospital infection control system. Therefore, it was suggested that this issue has to be considered when performing infection control in near future. PHP25 Association of Socioeconomic Conditions and Drug Offences and Reincarceration
1China
Huang C, Yang M National Taiwan University, Taipei, Taiwan
Objectives: Anxiety and hypnotic medications are commonly used for elderly patients but are potentially inappropriate and need more attention. Medication regimen complexity index (MRCI) provides method to evaluate the complexity of medication using factors beyond the medication count. This study aimed to use the MRCI to explore the complexity of all medications used by elderly patients taking anxiety-hypnotics prescriptions. Methods: This retrospective cohort study was piggy-backed under an ongoing sleep-medicine project in Taiwan. The first 60 patients from this larger study conducted in an academic medical center in Taiwan were included. The difference between MRCI score and medication count within patients with anxiety-hypnotic disease and other comorbidities. The score was calculated at baseline at one month later. The demographic, disease status, and corresponding MRCI scores were compared to or medication counts using appropriate t tests and chi-square test. Results: Baseline characteristics, total MRCI, and MRCI section score were comparable between both sexes and all ages on the first date of visit, but females were older than males. Total MRCI, and medications requiring additional instruction were higher during one-month follow up, especially among male elderly. Higher MRCI scores were related to factors other than anxiety-hypnotic prescriptions. Additional medication-use instructions accounted for the majority of anxiety-hypnotics related MRCI score. Frequency of use accounted for the majority of other comorbidity MRCI scores. Conclusions: Anxietyhypnotic medications did not have a large effect on the MRCI. A difference in MRCI score existed over one-month, and changes in regimen complexity for anxiety-hypnotics and other medications in the elderly should be continuously monitored and evaluated over time to ensure safe medication use in the elderly.
Objectives: The influence of socioeconomic status on drug-related offences is widely recognized, but there is poor understanding about the factors affecting drug reincarceration. This study thus aimed to examine the association of socioeconomic conditions and drug offences and reincarceration. Methods: We analyzed the Aggregate data on socioeconomic conditions, drug offences and reincarceration that were reported annually by government agencies in Taiwan’s Statistical Yearbook between 2000 and 2014. Drug offence rate was defined as the number of drug offences per 100,000 mid-year population. Drug reincarceration rate was defined as the number of reincarceration for drug offenders divided by the number of drug prisoners. Socioeconomic indicators included economic growth rate, ratio of income share of highest 20% to that of lowest 20% households, unemployment rate, and divorce rate of married couples per 1,000 mid-year population. In addition, police employees per 10,000 mid-year population, drug-related conviction rate, and drug abstention rate were selected as covariates. Generalized linear regression with robust maximum likelihood estimation was used to test the associations of socioeconomic indicators with outcomes. Results: Multivariate analysis indicated that economic growth rate (β 4.88, P< 0.001) and ratio of income share of highest 20% to that of lowest 20% households (β 89.59, P= 0.005) had significantly positive association with drug offence rate after adjusting for covariates, whereas divorce rate of married couples (β -8.93, P< 0.001) and unemployment rate (β -18.8, P< 0.001) had significantly negative associations. Additionally, both rate of economic growth (β -0.72, P= 0.001) and unemployment (β -1.85, P= 0.001) had negative association with drug reincarceration after adjustment. Conclusions: Not all the socioeconomic conditions in our study had the same magnitude of association with drug offences and reincarceration. These findings suggest that enhancing illegal drug adverse effects and strengthening the source control of illegal drugs may play an important role.
PHP23 what Do we Pay for Compounded Drugs? Lin T1, Tran DM2, Shoair OA2, Huang W1, Cao V1, Wilson L2 1UCSF, San Francisco, CA, USA, 2University of California, San Francisco, San Francisco, CA, USA
Objectives: The billing practices of compounding drug ingredients makes overpayment likely. This study examines the current pattern of use and pricing of compounded drugs (CD) within California Workers’ Compensation System (CAWC), evaluates the effect of new pricing regulation, and provides an alternative pricing scheme. Methods: CAWC claims database of all physician and pharmacy-dispensed CD from 2011-2013 were reviewed. Changes in CD use after the California Assembly Bill 378 (AB 378) was implemented were compared with t-tests. An alternative Colorado-based pricing scheme, which limits CD payment by four different pricing categories were employed to re-price California (CA) CDs. Results: The
PHP26 Assessment of Prescribing Indicators in Public and Private Primary Health Care Facilities in Indonesia Yuniar Y, Susyanty AL, Sari ID National Institute of Health Research and Development, Central Jakarta, Indonesia
Objectives: The assessment of prescribing indicators is beneficial to understand prescribing rationality and drug utilization. Drug utilization has to be monitored regularly and prescribing indicator is one easy core indicator to evaluate it as stated in WHO guideline. This study aimed to assess the prescribing pattern in public and private primary health care facilities which were included in the National Health Insurance
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
indicators. Methods: A cross sectional study was carried out in private paediatric hospital. The data were collected from prescriptions of OPD patients with age newborn to 18 years. Written informed consent was obtained from parents of paediatric patients. Patients’ demographics, diagnosis, name(s) of drugs, dose, route of administration, frequency and duration were captured. Prescriptions were analysed for WHO recommended prescribing indicators. Results: The results are based on data collected from 300 patients; 58.6% were male and 41.4% were female. The average age of patients was 44 months. No medicines were prescribed to 2% of the patients. The largest set of patients was diagnosed to have URTI (21.3%) followed by allergic rhinitis (15%). The other common diagnosis were viral infection, gastritis, gastroenteritis and fever under investigation. The average number of drugs prescribed was 2.6 (range 1-6). Less than 1 % of drugs were prescribed by the generic name. None of the prescription had injection prescribed in it. 9.8% of all outpatient encounters were prescribed one or more antibiotics. Beta lactamase inhibitor was most extensively prescribed antibiotic. 41% of the drug prescribed appeared on the national list of essential medicines 2011. Nasal decongestants were mostly prescribed followed by nutritional supplements. 47% of drugs were prescribed as syrup. Oral administration was the most common route of administration (74%) while nebulization counts 13%. Conclusions: These early findings are a pointer to the prescribing practice; however, the minimal use of antibiotics is an encouraging signal to follow further. The integration of these results in prescribing shall lead to promotion of rational pharmacotherapy. PHP21 Drug Utilization Study of Antibiotics in A Secondary Care Referral Hospital Rathikanti V chalapathi institute of pharmaceutical sciences, Vijayawada, India
Objectives: The main aim is to Study the appropriateness and quantify the utilization of antibiotics. Methods: A Cross Sectional study was conducted in a secondary care referral hospital for a period of three months using the prescriptions of the patients suffering with the various infections Results: Altogether 150 patients, (67.15%) males and 236 (32.85%) females were enrolled. Among these, highest rate of drug prescription was observed for patients aged between 40 to 60 years, which consist of 85(56.6%) patients . Highest rate of antimicrobial prescription was observed for patients of respiratory and urinary tract infections .Highest frequency of drug prescription was observed for Azithromycin which consist of 30.35% which was followed by Amoxicillin 18.12%, Cifixime (6.52%), Doxycycline (24.13%),ceftriaxone(12.3%) , ciprofloxacin (8.58%), Overall 76.84% of the patients were treated with a combination therapy of antibiotics, But if antibiotics are not used rationally then there will be increase chances of resistance of bacteria as also as increase the total cost of treatment and adverse reactions. Conclusions: Drug utilization studies are used as powerful tools to ascertain the role of drugs in the management of various diseases. There is a need of patient education and counseling on use of antimicrobial drugs (AMDs) by the clinical pharmacist. PHP22 Perliminary Study of Medication Regimen Complexity Among Taiwanese Elderly who Have Used Anxiety or Hypnotics Prescriptions Chen J1, Simonavice CA2, Chen Y2, Lin H1 Medical University, Taichung, Taiwan, 2China Medical University Hospital, Taichung, Taiwan
database contains 4,153,588 pharmacy-dispensed claims with 112,523 ingredient entries and 16,944,271 physician-dispensed claims with 2,222,342 ingredient entries. The average amount paid per CD ingredient per year for pharmacy-dispensed CDs increased by 37% from 2011 to 2012 and 67% from 2012 to 2013, while physiciandispensed increased by 14% from 2011 to 2012 and 20% from 2012 to 2013. The current CA AB 378 regulation does not significantly reduce CD cost, in fact the cost increased. The change in cost of CD using the alternative Colorado pricing scheme is lower. In 2011, mean CA CD cost (pharmacy-dispensed after combining all ingredients) is currently $87 but would be $84 under Colorado pricing. In 2012, the price is currently $149, and $141 under Colorado pricing and in 2013, the price is currently $419, and $241 under Colorado pricing. Conclusions: The cost of CD in CAWC is increasing despite the current regulation to remedy the situation. An alternative solution may be to adopt the Colorado pricing scheme, which offers a disincentive to expand number of ingredients inflating prices. PHP24 A Nationwide Survey on Infection Control Activities Within Hospitals Allowed to Implement Preferential Infection Prevention Countermeasure Fee in Japan Hirose M1, Nishimura N2, Naora K2, Imanaka Y3 University, Izumo, Japan, 2Shimane University Hospital, Izumo, Japan, 3Kyoto University, Kyoto, Japan 1Shimane
Objectives: The preferential Infection prevention countermeasure fee (PIPCF) was divided into PIPCF 1 and 2 in case of meeting the requirement for infection prevention within a hospital as of April, 2012. This study aims to explore the current condition of infection control activities in hospitals with allowed to calculate PIPCF in Japan. Methods: We nationwide surveyed the situation of infection control activities in hospitals with PIPCF in 2015, by using an anonymous and self-administered questionnaire. Results: Of 3,680 target hospitals (domestic hospitals: 8,484) in Japan, 718 hospitals responded (response rate: 19.5%). The 708 hospitals were classified into two classes; 304 hospitals with PIPCF 1 and 404 hospitals with PIPCF 2. With regard to the assignments for infection control of physicians, nurses, pharmacists and laboratory technicians, full-time nurses were working approximately at 277 hospitals (91.1%) of hospitals with PIPCF 1. However, full-time medical staff except nurses was assigned at less than 10% of 304 hospitals with PIPCF I. And, fulltime nurses were working at only 38 hospitals (9.5%) of 404 hospitals with PIPCF 2. Regarding in-hospital walk round for infection control, more than 90% of any health professionals were participating in in-hospital walk round at 304 hospitals with PIPCF 1. However, less than 70% of physicians were participating in in-hospital walk round at 404 hospitals with PIPCF 2, and the participation rate of in-hospital walk round for physicians was the lowest among health professionals. No pharmacist and laboratory technicians participated in in-hospital walk round at 404 hospitals with PIPCF 2. Conclusions: Judging from these findings, hospitals with PIPCF 2 were owned by small-scale and private sectors, and it was difficult for those hospitals to set up an in-hospital infection control system. Therefore, it was suggested that this issue has to be considered when performing infection control in near future. PHP25 Association of Socioeconomic Conditions and Drug Offences and Reincarceration
1China
Huang C, Yang M National Taiwan University, Taipei, Taiwan
Objectives: Anxiety and hypnotic medications are commonly used for elderly patients but are potentially inappropriate and need more attention. Medication regimen complexity index (MRCI) provides method to evaluate the complexity of medication using factors beyond the medication count. This study aimed to use the MRCI to explore the complexity of all medications used by elderly patients taking anxiety-hypnotics prescriptions. Methods: This retrospective cohort study was piggy-backed under an ongoing sleep-medicine project in Taiwan. The first 60 patients from this larger study conducted in an academic medical center in Taiwan were included. The difference between MRCI score and medication count within patients with anxiety-hypnotic disease and other comorbidities. The score was calculated at baseline at one month later. The demographic, disease status, and corresponding MRCI scores were compared to or medication counts using appropriate t tests and chi-square test. Results: Baseline characteristics, total MRCI, and MRCI section score were comparable between both sexes and all ages on the first date of visit, but females were older than males. Total MRCI, and medications requiring additional instruction were higher during one-month follow up, especially among male elderly. Higher MRCI scores were related to factors other than anxiety-hypnotic prescriptions. Additional medication-use instructions accounted for the majority of anxiety-hypnotics related MRCI score. Frequency of use accounted for the majority of other comorbidity MRCI scores. Conclusions: Anxietyhypnotic medications did not have a large effect on the MRCI. A difference in MRCI score existed over one-month, and changes in regimen complexity for anxiety-hypnotics and other medications in the elderly should be continuously monitored and evaluated over time to ensure safe medication use in the elderly.
Objectives: The influence of socioeconomic status on drug-related offences is widely recognized, but there is poor understanding about the factors affecting drug reincarceration. This study thus aimed to examine the association of socioeconomic conditions and drug offences and reincarceration. Methods: We analyzed the Aggregate data on socioeconomic conditions, drug offences and reincarceration that were reported annually by government agencies in Taiwan’s Statistical Yearbook between 2000 and 2014. Drug offence rate was defined as the number of drug offences per 100,000 mid-year population. Drug reincarceration rate was defined as the number of reincarceration for drug offenders divided by the number of drug prisoners. Socioeconomic indicators included economic growth rate, ratio of income share of highest 20% to that of lowest 20% households, unemployment rate, and divorce rate of married couples per 1,000 mid-year population. In addition, police employees per 10,000 mid-year population, drug-related conviction rate, and drug abstention rate were selected as covariates. Generalized linear regression with robust maximum likelihood estimation was used to test the associations of socioeconomic indicators with outcomes. Results: Multivariate analysis indicated that economic growth rate (β 4.88, P< 0.001) and ratio of income share of highest 20% to that of lowest 20% households (β 89.59, P= 0.005) had significantly positive association with drug offence rate after adjusting for covariates, whereas divorce rate of married couples (β -8.93, P< 0.001) and unemployment rate (β -18.8, P< 0.001) had significantly negative associations. Additionally, both rate of economic growth (β -0.72, P= 0.001) and unemployment (β -1.85, P= 0.001) had negative association with drug reincarceration after adjustment. Conclusions: Not all the socioeconomic conditions in our study had the same magnitude of association with drug offences and reincarceration. These findings suggest that enhancing illegal drug adverse effects and strengthening the source control of illegal drugs may play an important role.
PHP23 what Do we Pay for Compounded Drugs? Lin T1, Tran DM2, Shoair OA2, Huang W1, Cao V1, Wilson L2 1UCSF, San Francisco, CA, USA, 2University of California, San Francisco, San Francisco, CA, USA
Objectives: The billing practices of compounding drug ingredients makes overpayment likely. This study examines the current pattern of use and pricing of compounded drugs (CD) within California Workers’ Compensation System (CAWC), evaluates the effect of new pricing regulation, and provides an alternative pricing scheme. Methods: CAWC claims database of all physician and pharmacy-dispensed CD from 2011-2013 were reviewed. Changes in CD use after the California Assembly Bill 378 (AB 378) was implemented were compared with t-tests. An alternative Colorado-based pricing scheme, which limits CD payment by four different pricing categories were employed to re-price California (CA) CDs. Results: The
PHP26 Assessment of Prescribing Indicators in Public and Private Primary Health Care Facilities in Indonesia Yuniar Y, Susyanty AL, Sari ID National Institute of Health Research and Development, Central Jakarta, Indonesia
Objectives: The assessment of prescribing indicators is beneficial to understand prescribing rationality and drug utilization. Drug utilization has to be monitored regularly and prescribing indicator is one easy core indicator to evaluate it as stated in WHO guideline. This study aimed to assess the prescribing pattern in public and private primary health care facilities which were included in the National Health Insurance