A342
V A L U E I N H E A L T H 1 4 ( 2 0 1 1 ) A 2 3 3 - A 5 1 0
maceutical health care standards and outcomes. Without close monitoring of key
health care indicators and outcomes, volume (prescription) limitations introduced
by the recent Healthcare Reform can have adverse and inevitable long term impact.
aged 16-30 years (n ϭ 53), 2.6Ϯ1.11 for those 31-45 years (n ϭ 992), 2.8Ϯ1.18 for those
46-60 years (n ϭ 5 768), 2.8Ϯ1.23 for those 61-75 years (n ϭ 7 641) and 2.5Ϯ1.17 for
those older than 75 years (n ϭ 3 410). CONCLUSIONS: Metabolic syndrome patients
are prescribed multiple drug therapies. Our results show that the average pill bur-
den among private health care South African patients receiving antidiabetic-, an-
tihypertensive- and lipid-lowering agents concurrently were the highest among
men, and increased progressively with age to peak in those aged 61-75 years. Fur-
ther studies are necessary to determine the influence of pill burden on adherence,
drug interactions and treatment cost.
PHP49
THE PHARMACIST’S PERCEPTION OF THE SPLITTING EXTENDED RELEASE AND
ENTERIC-COATED FORMULATION DRUGS
Jang HM, Lee EK
Sookmyung Women’s University, Seoul, South Korea
OBJECTIVES: Extended release and enteric coated formulations make up 7.8% of all
drugs, and the most frequently used drug is an agent affecting circulatory, digestive
system. The objective of this study is to analyze of extended release and enteric
coated drugs on pharmaceutical reimbursement item list in Korea and evaluate the
dispensing of extended release and enteric coated drugs, which is enforced by the
National Health Insurance. METHODS: The analysis used a questionnaires survey
for 169 pharmacists in the hospital pharmacy and community pharmacy(Response
rate: 73.8%). The questions include; prescribing change after enforcement by Na-
tional Health Insurance, prescription correction, change of pharmacy works, ex-
pansion of the range of enforcement, provision of information and prescribing
error prevention. The statistics methods use Chi-square, AVOVA, t-test, McNemar
test by STATA/SE10.(pϽ0.05). RESULTS: Of extended release and enteric coated
formulations, 33.9% were not available in other dosage forms. After enforcement
by National Health Insurance, the rate of splitting and crushing of extended release
and enteric coated drugs decreased, but pharmacies in tertiary care hospitals had
increased workload because of prescription corrections. Prescription was not
changed, because patients take medicines for a long time. Most of pharmacists
agreed on the expansion of drug range, but 65.7% of pharmacists wanted the en-
forcement only for hospitals. When pharmacists corrected their prescribing error,
the biggest problem was a lack of other dosage forms. To prevent extended release
and enteric coated from splitting and crushing, pharmacists want in the following
ways; prescribing code prohibits into order computer system, warnings and alerts
on prescribing, developing many other dosage forms. CONCLUSIONS: What is
needed are medication-use system improvements and the creation of lists with
suggestions for alternative products on the formulary. Also, pharmaceutical com-
panies should make an effort to develop other dosage forms.
Health Care Use & Policy Studies – Equity And Access
PHP52
INEQUALITIES IN THE UTILIZATION OF HOME HOSPICE SERVICES IN HUNGARY
1
1
1
1
2
2
2
2
Turcsanyi K , Domján P , Pakai A , Gombos G , Ágoston I , Vas G , Molics B , Éliás Z ,
2
2
Kriszbacher I , Boncz I
University of Pécs, Zalaegerszeg, Hungary, University of Pécs, Pécs, Hungary
1
2
OBJECTIVES: Hospice service appeared in 1991, when Hungarian Hospice Founda-
tion was established. More and more hospice institutions were started their works
in this period, which type was home care, palliative hospital ward and complex,
which provides both of them. In our study we are analyzing the spatial distribution
of Hungarian hospice service. METHODS: In 2008, number and activities of hospice
service was examined and we have been drawn attention for financial data by our
survey with data of National Health Insurance Fund and Central Statistics Office.
We analyzed the county and regional distribution of hospice services. RESULTS:
Thirty hospice care providers were reimbursed by the National Health Insurance
Fund Administration in 2008. The total number of nursing days were 53,113 in
Hungary. The number of nursing days per 10,000 populations showed a significant
difference across the regions with a national average of 52.88 days: Western Trans-
danubian Region (86.64), Northern-Hungarian Region (83.84), Southern-Transdu-
bian Region (81.28), Southern Great-Plain Region (77.31), Central-Transdanubian
Region (59.62), Central Hungarian Region (32.23) and Northern Great-Plan Region
(1.68). At county level we found similar within country differences with the highest
value in Nógrád county (190.83 days/per 10,000 population) and the lowest in
county Jász-Nagykun-Szolnok and Fejér (Ͻ
7 days/per 10,000 population).
CONCLUSIONS: The regional differences in hospice care are high among Hungar-
ian regions and counties. A further analysis is required to explore the reasons
behind these huge differences.
PHP50
IRRATIONAL USE OF INJECTABLE FORM OF DEXAMETHASONE: A WARNING
FOR HEALTH SYSTEM IN IRAN
1
2
3
Soleymani F , Haerizadeh M , Dinarvand R
PHP53
1
2
3
Tehran University of Medical Science, Tehran, Iran, Minitry of Health, tehran, Iran, Tehran
University of Medical Sciences, Tehran, Iran
ASSESSMENT OF THE ATTITUDES OF THE GENERAL PUBLIC TOWARDS
SUPPLEMENTARY CRITERIA TO BE USED IN P&R DECISION MAKING PROCESS IN
POLAND
OBJECTIVES: Irrational prescribing of injections is widespread in Iran. According to
statistics of National Committee of Rational Drug Use (NCRUD), based on data from
insured prescriptions, more than 40% of prescriptions have at least one injection in
which injectable dosage form of dexamethasone is on the top of list. The aim of this
study is to describe the prescribing pattern of dexamethasone in general practitio-
ners’ prescriptions from 2006 to 2009. METHODS: A retrospective cross-sectional
study was done on insured prescription during 4 years. All insured prescriptions
which were collected in special software called Rx Analyst during the study period
in the NCRUD were reviewed for prescriptions included injectable dosage form of
dexamethasone. RESULTS: A total of 150,630,381 Prescriptions were reviewed in
which 73,808,887 were detected to be included at least one injection. Among pre-
scriptions with injections, there were more than 30 percent of prescriptions which
had at least one injection form of dexamethasone making it the first prescribed
medicine by general practitioner. An overall increasing linear trend in prescribing
pattern of injectable dosage form of dexamethasone was evident over the obser-
vation period. The percent of general practitioners’ prescriptions which had inject-
able dosage form of dexamethasone is 15.46 in 2006, 15.93 in 2007, 16.64 in 2008 and
16.94 in 2009. CONCLUSIONS: Irrational prescribing pattern of dexamethasone
injection is obviously determined according to the results of this study. It seems
that general practitioners are trying to substitute pain relievers’ drugs by injectable
dosage form of dexamethasone. A multi-interventional policy is needed to correct
the pattern use of dexamethasone.
1
2
Kolasa K , Lees M
1
2
Bristol-Myers Squibb, Warsaw, Poland, BMS, Uxbridge , UK
OBJECTIVES: To explore the attitudes of the general public towards the principle of
QALY maximization in pricing and reimbursement decision-making process in
Poland. METHODS: Cross sectional survey of a random representative sample of
1000 residents was preformed. Face-to-face interviews were conducted using a
structured questionnaire. The final format of the questionnaire included refine-
ments based on a pilot survey. Respondents rated statements concerning attitudes
to equity on a Likert scale. Two hypothetical experiments were designed to elicit
preferences for QALY maximization. In the first experiment, responders had to
allocate a given limited budget to 400 patients with non-fatal disease, 100 patients
with fatal disease, or a combination of patients with fatal and non-fatal disease.
The QALY gain per patient was assumed the same for both groups. In the second
experiment, responders prioritized a given treatment to either 100 patients with
eight years or 100 patients with two years of baseline life expectancy. The survival
gain per patient resulting from the new treatment was eight years for first group
and varied from two to eight years for the second group. RESULTS: The study
indicated strong support for the statements about equity (42% agreed and 44%
strongly agreed). In the first experiment, 75% chose to allocate budget to both
groups of which 50% preferred equal distribution. In the second experiment, if
survival gain per patient was equal for both groups, 57% chose treatment for group
with shorter baseline life expectancy. If survival gain per patient was larger for
group with longer baseline life expectancy, 49% still chose treatment for group with
shorter life expectancy. CONCLUSIONS: General support for statements express-
ing equity was confirmed by two experiments. Instead of QALY maximization, a
significant group of responders took into consideration needs of both patients’
groups irrespective of costs and disease severity irrespective of QALY gain.
PHP51
PILL BURDEN IN SOUTH AFRICAN PATIENTS WITH MULTIPLE RISK FACTORS
FOR METABOLIC SYNDROME
Burger JR, Lubbe MS, Serfontein JHP
North-West University, Potchefstroom, South Africa
OBJECTIVES: Metabolic syndrome is a cluster of several common metabolic distur-
bances, including inter alia hypertension, hyperglycaemia and dyslipidaemia. Each
of these risk factors requires multiple agents to reach desired therapeutic goals.
The aim was to determine the average pill burden level in patients treated concur-
rently with antidiabetic-, antihypertensive- and lipid-lowering agents. METHODS:
A retrospective, quantitative drug utilization review was conducted utilizing na-
tional medicine claims data obtained from a South African Pharmaceutical Benefit
Management company for the period of January 1, 2008 to December 31, 2008.
Average pill burden (AvPB) was calculated as the average number of tablets re-
ceived per prescription over the study period divided by the number of days med-
ication was supplied for. Combination products were counted once. As-needed-
medication and other chronic medication were excluded from the analysis. Data
for 17 866 patients were analysed using the SAS for Windows 9.1® programme.
RESULTS: Patients had an overall AvPB of 2.7Ϯ1.20 per prescription, with a rate of
2.8Ϯ1.21 among males (n ϭ 9 632) vs. 2.6Ϯ1.18 for females (n ϭ 8 234). Patients aged
0-15 years (n ϭ 2) had an AvPB of 1.2Ϯ0.30 per prescription, vs. 2.3Ϯ1.49 for those
PHP54
PREDICTORS OF AVOIDABLE EMERGENCY ROOM VISITS AMONG HIGH COST
MEDICAID ENROLLEES
1
1
2
Ganduglia C , Franzini L , Dunn K
1
University of Texas Health Science Center Houston, School of Public Health, Houston, TX, USA,
University of Texas Health Science Center Houston, School of Biomedical Informatics, Houston,
2
TX, USA
OBJECTIVES: Research has shown that Medicaid enrollees in the USA are the most
frequent users of the Emergency Department (ED) services. Several studies have
demonstrated that a high proportion of the ED visits could be avoided. The purpose
of this analysis is to examine the demographic and health system delivery charac-
teristics that are associated with avoidable ED visits (AEDV) among a high risk, high
cost Medicaid population between 2008 and 2009. METHODS: One year claims
dataset of a sample of high cost, high risk Medicaid enrollees in Houston, Texas was
used for the analysis. This was design following the Andersen-Aday theoretical