95. Reduced Antibiotic Duration Defaults in Outpatient Automated Dispensing Cabinets Change Antibiotic Prescribing Habits in a Tertiary VA Healthcare System

Background Ten percent of adult, outpatient visits result in an antibiotic prescription (Rx). At the start of our intervention, our VA healthcare system consisted of 13 community-based outpatient clinics (CBOCs), 9 of which did not have an onsite pharmacy but utilized automated dispensing cabinets (ADCs) for prepackaged outpatient Rxs. ADC antibiotic orders are generated from electronic medical record (EMR) order sets. The stewardship team shortened the durations of 5 antibiotics in the ADC order sets to make them consistent with current literature and guidelines. We assessed the impact of these changes on antibiotic prescribing habits. Methods We compared outpatient antibiotic Rx data between 10/1/2018-9/30/2019 (pre-intervention) and 10/1/19-9/30/20 (post-intervention) from 8 CBOCs with ADCs (1 closed during the pandemic). Amoxicillin-clavulanate 875/125mg (AMC), cephalexin 500mg (CPH), levofloxacin 500mg and 750mg (LEV 500 and LEV 750), and sulfamethoxazole-trimethoprim 800/160mg (SXT) prescription durations were all reduced by 3 days. Process metrics included days supplied/1000 prescriptions (DS/1000 Rx), median DS, and ADC utilization rates. We used Mann-Whitney U and correlation statistical analyses to assess differences and associations. Results The DS/1000 Rx of antibiotics with a default duration change decreased in the post-intervention phase for CBOCs with ADCs (AMC, -25.4%; CPH, -21.1%; LEV 500, -18.9%; LEV 750, -28.0%; SXT, -27.4%). The median DS for these antibiotics all reduced by 3 days in concordance with new ADC prescriptions defaults (AMC, 10 vs 7 days, P< 0.001; CPH, 10 vs 7 days, P< 0.001; LEV 500, 8 vs 5 days, P< 0.001; LEV 750, 8 vs 5 days, P< 0.001; SXT 10 vs 7 days, P< 0.001). Due to COVID-19, 7/8 ADC CBOCs closed for in-person visits from 3/20/20-5/4/20. ADC utilization was inversely proportional to DS/1000 Rx for most antibiotics (R: -0.51 to -0.77) except SXT. Conclusion EMR-driven reductions in ADC default Rx durations led to a corresponding decrease in overall outpatient antibiotic prescribing. Higher DS/1000 Rx were often associated with lower ADC utilization. Informatics-driven antibiotic interventions may be potential outpatient stewardship tools to increase guideline-concordant prescribing across multisite healthcare systems. Disclosures Sharanie Sims, PharmD, AbbVie (formerly Allergan) (Speaker’s Bureau)

Effect of the COVID-19 Pandemic Preparation and Response on Essential Health Services in Primary and Tertiary Healthcare Settings of Amhara Region, Ethiopia

Countries like Ethiopia have had to make difficult decisions to balance between the demands of the COVID-19 pandemic and maintaining the essential health service delivery. We assessed the effect of preventive COVID-19 measures on essential healthcare services in selected health facilities of Ethiopia. In a comparative cross-sectional study, we analyzed and compared data from seven health facilities over two periods: the pre-COVID-19 period before the first reported COVID-19 case in the country and during the COVID-19 period. Data were summarized using descriptive statistics and the independent t test. During the COVID-19 period the average number of monthly patient visits in the emergency department, pediatrics outpatient, and adult outpatient dropped by 27%, 30%, and 27%, respectively compared with the pre-COVID-19 period. Family planning; institutional delivery; childhood immunization; antenatal care-, hypertension- and diabetic patient follow-up, did not vary significantly between pre-COVID-19 and during COVID-19. Moreover, the monthly average number of tuberculosis (TB) and HIV patients who visited health facilities for drug refill and clinical evaluation did not vary significantly during the two periods. In conclusion, the study highlights that the effect of public restrictions to mitigate the COVID-19 pandemic on essential care systems should be considered.

Algorithms for adult outpatient care of coronavirus disease 2019 (COVID-19) and its Assumption

The paper presents algorithms for adult outpatient care of coronavirus disease 2019 (COVID-19) and its assumption.

Utprøving av en tilpasset gruppebehandling for unge voksne

Background: There is a need for special attention to patients in the transition between adolescent and adult psychiatric services. This study investigates effects of a group therapy on depression, anxiety, self-esteem and personal experiences among the youngest patients in an adult outpatient clinic. Method: Patients between 18 and 25 years participated in a 10-week group treatment based on psychoeducation and cognitive therapy. Outcomes were self-reported and both quantitative and qualitative. Results: Of 35 included patients (equal gender distribution, mean age 21 years), 31 completed treatment. Forty-nine percent were diagnosed with depression and 23 % with anxiety. Depressive symptoms and self-esteem improved after treatment, whereas anxiety symptoms did not. Group participation gave new perspectives on own difficulties and a sense of belonging in a safe setting with people they could relate to. Conclusion: Group treatment adapted to young adults may be a suitable and feasible treatment intervention for this vulnerable patient group. Keywords: Depression, anxiety, young adults, cognitive therapy, group therapy, users’ experience.

Self-referral and associated factors among patients attending adult outpatient departments in Debre tabor general hospital, North West Ethiopia

Background Self-referral leads to diminished quality of health care service; increase resource depletion and poorer patient outcomes. However, a significant number of patients referred themselves to the higher health care facilities without having referral sheets globally including Ethiopia. Even though the problem is much exacerbated in Ethiopia, there is limited evidence regarding self-referral patients in Ethiopia in particular in the study area. Objective To assess the magnitude and associated factors of self-referral among patients at the adult outpatient department in Debre Tabor general hospital, North West Ethiopia. Method Institution-based cross-sectional study was conducted from March 11–April 9, 2020 among 693 patients who attended adult outpatient departments. A systematic sampling technique was employed. Structured and pretested interviewer-administered questionnaire was used for data collection. Data were coded, cleaned and entered into Epi Info version 7.1 and exported to SPSS version 23 for further analysis. Binary logistic regression analysis was employed. In bivariable analysis p-value, less than 0.25 was used to select candidate variables for multivariable analysis. P-values less than 0.05 and 95% confidence intervals were used to select significant variables on the outcome of interest. Result The proportion of self-referral was 443(63.9%) with 95% CI (60.5; 67.5). Formally educated, (AOR = 1.83; (95% CI: 1.12, 3.01)), enrolled to Community Based Health Insurance (AOR = 1.57; (95% CI: 1.03, 2.39)), poor knowledge about referral system (AOR = 2.07; 95% CI: (1.28, 3.39)), not and partially available medication in the nearby Primary Health Care facilities (AOR = 2.12; (95% CI: 1.82, 6.15)) & (AOR = 3.24; (95% CI: 1.75, 5.97)) respectively and history of visiting general hospital (AOR = 1.52; (95%CI: 1.03, 2.25)) were factors statistically associated with self-referral. Conclusion and recommendation The proportion of self-referral was low compared to the Ethiopian health sector transformation plan 2015/16–20. Socio-demographic and institutional factors were associated with self-referral. Therefore, regional health bureau better to work to fulfill the availability of medications in the primary health care facilities. In addition, Community Based Health Insurance (CBHI) agency should work to implement the law of out-of-pocket expenditure which states to pay 50% for self-referred patients who claim utilization of healthcare.

P064 The impact of the COVID-19 pandemic on outpatient services: an analysis of patient feedback of virtual outpatient clinics in a tertiary teaching centre with a focus on musculoskeletal and rheumatology services

Background/Aims Due to the COVID-19 pandemic there have been changes to NHS services to limit unnecessary patient hospital visits and comply with new social restriction rules. One of these changes has been the introduction of virtual consultations in outpatient clinics to replace traditional face to face appointments. Methods A retrospective analysis of patient feedback from adult outpatient virtual appointments in a 4-month period was collated and reviewed (May-September 2020). After an appointment, patients were sent a text message asking for feedback. The text consisted of one main question asking patients to rate their experience and a comment section. The data from this brief patient survey was obtained for all rheumatology patient responses. At the end of the text there was a link for a more comprehensive online survey which patients could fill out if they wish to provide more detailed feedback. Responses to this survey encompasses all adult outpatient specialities including musculoskeletal services. Results There were 269 responses to the detailed patient survey from various adult outpatient clinics. The most common type of virtual consultation was telephone which was the case in 79%, of which 91% of patients stated the caller was polite and 89% felt they had an opportunity to ask questions. When asked what their overall view 43% of patients stated they would not mind conducting all future appointments via telephone, 23.5% felt that in the current situation a telephone consultation was acceptable but would have preferred a face to face and 7% were completely unsatisfied. From the musculoskeletal group there were 36 responses (20 orthopaedic, 15 rheumatology and 1 musculoskeletal). 92% of patients stated they were given the opportunity to ask questions and 86% were satisfied with the advice given to them. 33% (n = 12) stated they would not mind having virtual consultations in the future even after the pandemic, but 28% stated they would have preferred a face to face consultation. There were 784 responses to the shorter patient survey via text message from rheumatology patients. When asked to rate their experience 94% (n = 739) of patients stated it was either good or very good, and only 1% said it was poor or very poor. There were largely positive comments in the feedback. Most frequent points were patients felt listened to, communication was good and virtual consultations were less stressful. Conclusion At present the use of virtual clinics seems to be well received by patients and most importantly their quality of care is not compromised. From a patient’s perspective there are many benefits and cumulative feedback so far suggests that majority of the patients are willing to adapt to this new approach to outpatient appointments both now and post-COVID-19. Disclosure S. Byravan: None. K. Sunmboye: None.