Exploring the challenges of accessing medication for patients with cystic fibrosis

Reducing treatment burden in cystic fibrosis (CF) is the top research priority for patients and clinicians. Difficulty accessing medication is one aspect of treatment burden. We investigated this with an online survey available globally for patients with CF and healthcare professionals. Almost three quarters of patients with CF in our survey report difficulty getting repeat prescriptions on time, and most community pharmacists experience interrupted supplies of CF-specific medications. These barriers affect emotional and physical health of people with CF. Two-thirds of people with CF would like to get all their CF medication from one place, their CF centre.

Trends in the prescription of drugs used for insomnia in Australian general practice, 2011-2018

Background: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs often used for managing insomnia. Aim: To explore changes in the pattern of benzodiazepine (BZD), z-drugs (zolpidem, zopiclone) and non-BZD prescriptions. Design and Setting: Open cohort study including 1,773,525 patients (55,903,294 consultations) regularly attending 404 Australian general practices from 2011-2018 (MedicineInsight). Method: Prescription rates per 1,000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent recorded insomnia diagnosis (i.e. within 2 years) were analysed using adjusted regression models. Results: Rates of BZD, z-drugs and non-BZD prescriptions were 56.6, 4.4 and 15.5/1,000 consultations in 2011 and 41.8, 3.5 and 21.5/1000 consultations in 2018, respectively. Temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined from 2011-2018 [annual change varying from -1.4% to -10.8%], while non-BZD and zopiclone prescriptions increased in the same period [annual change: +5.0% to +22.6%]. Repeat prescriptions above recommendations remained below 10% for most medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%) and alprazolam (13.3%). In 2018, almost 50% of z-drugs and melatonin prescriptions were for patients with insomnia. There was 3.2%-5.9% annual increase in the proportion of prescriptions associated with a recently recorded insomnia diagnosis. Conclusion: Overall, BZD prescriptions in Australia declined from 2011-2018. However, the prescription of some of these drugs increased for patients with a recently recorded insomnia diagnosis. This is concerning because of potential adverse effects and risk of dependence.

A79 PROVINCIAL DATA IN ALBERTA REVEAL A CLEAR NEED TO ADDRESS OVERPRESCRIBING OF PROTON PUMP INHIBITORS

Background Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in Canada. They are effective for several upper GI-disorders, have a very favorable safety profile and therefore there are few barriers to prescribing. Concern about overuse of PPIs has been growing. Many patients do not need long term treatment. Patients starting PPI should receive short term therapy (e.g. 8 weeks) and if they respond the need for long term therapy needs to be determined. The usual starting dose is once a day for most indications. Evidence suggests a lack of ongoing indication for PPI in 40–55% of primary care patients.There are economic implications of overuse of PPIs. Public drug spending on PPIs in Canada totaled $288.3 million of $13.5 billion spent in 2017. Aims To analyze prescribing data for all PPI prescriptions in Alberta for the years 2017–18 and 2018–19 and 2019–2020, to document number of prescriptions >60 days, the number of new versus repeat prescriptions, proportion of new prescriptions at a greater than 1x daily dose, the proportion of prescriptions written by primary care physicians and to estimate the number of prescriptions targetted for deprescribing. Methods Data were obtained anonymously from the Pharmaceutical Information Network (PIN) database from community based pharmacies in Alberta. PPIs were identified using DIN numbers. Prescribed dose and duration were obtained, as well as data on repeat prescriptions. The number of prescriptions that could be targeted for deprescribing was also estimated. Results The results are shown in table 1. More than 10% of the population receives a prescription each year. Of these 25–31% were new prescriptions and 69–75% were refills. The percentage of patients who were prescribed PPIs for more than 60 days was 26–28%. Furthermore, 23% of all prescriptions had a defined daily dosage greater than the recommended standard dose of once a day therapy for most indications.75% of all prescriptions are written by family physicians. Conclusions Prescription rates of PPIs are very high in Alberta and 75% of patients are on longer term therapy. There likely is significant overprescribing of PPIs, estimated to be up to 40% of patients filling PPI prescriptions in Alberta. This represents a significant avoidable medication and system burden and patient costs. The starting dose of new prescriptions is also high, despite the fact that for most indications the daily dose should be 1x a day. A 20% reduction in prescribing would save at least $ 9 million in Alberta. A deprescribing project has been initiated by the Digestive Health Strategic Clinical Network, a multi-stakeholder network, which addresses important GI issues in Alberta. Funding Agencies None

P08 The impact of patient’s compliance and delivery delays: a cost-saving audit on biologics

Background Inflammatory arthritis or ankylosing spondylitis patients who are qualified for biologics treatment will have their medications delivered to their homes by Healthcare at Home (HaH). HaH sends rheumatology department the requests for repeat prescriptions in which the drug delivery due date should be within two weeks of the faxed date on the prescription. Anti-TNF is costly and if the patient already has excess stocks of medications at home then future delivery should be postponed in order to reduce the economic impact on the Trust. This audit aims to investigate the amount of money that could be saved by checking patient’s available medications at home and delay future deliveries. Methods 168 patients were contacted at Croydon University Hospital between 1 - 19 November 2018 by telephone before signing the biologics repeat prescriptions. Patients were asked regarding the number of injections/tablets they have left and whether they had missed any and their reasons for non-adherence. Number of weeks the next prescriptions could be delayed due to the excess amount of injections/medications patients have was calculated and the amount of money saved by delaying the prescription was calculated. Results 133 out of 168 patients answered the phone. Among patients who answered the phone, 59 of them were on etanercept, 6 were on secukinumab, 13 were on etanercept, 24 were on adalimumab, 9 were on methotrexate, 17 were on baricitinib and 5 were on golimumab. Their drug stock at home varied between 0 to 12 weeks. There are various reasons for their excess drug stock in the last 2 months including previous delivery delays or double-delivery (3 patients), infection (20 patients), simply forgotten (7 patients), high liver function tests (1 patient), holiday (6 patients), underwent surgery (1 patient), and underwent a dental procedure (1 patient). By analysing the number of injections/tablets patients have left, we were able to delay repeat prescriptions in 62 patients by 1 to 8 weeks. Theoretically, by delaying sending prescription out to Healthcare at Home for all 62 patients, we would be able to save £13,546.585 for the Trust during the month of November. This made up 6.5% of the monthly cost of anti-TNF inflicted on the Trust in November 2018 (£208,099.94). Conclusion This is a cost-saving audit concerning patient’s adherence to biologics. By verifying the number of excess biologics at patients’ home prior to requesting the repeat prescription, we would be able to reduce the cost inflicted on the Trust greatly. This calls for an improvement in patient education and compliance monitoring. We have launched a biologic patient education programme at Croydon University Hospital which enhances patient’s understanding of biologic treatment. Patients are also encouraged to contact our biologic coordinator if they are non-compliant for any reasons. Disclosures P. Pookarnjanamorakot None. R. Suresh None. P. Webb None.

Inhaler Refill Adherence among Patients with COPD/Asthma at a General Hospital in Northern Peninsular Malaysia

Background: Most adherence studies are based on self-report measures. There are limited studies on medication refill adherence (MRA) conducted in Malaysia, especially on bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). The study aimed to investigate the MRA for inhalers with fixed dosing indicated for BA or COPD, prescribed from paediatric and medical clinics in Hospital Tuanku Fauziah and the factors that may affect MRA of COPD/BA inhalers. Methods: A cross-sectional study was conducted on repeat prescriptions (fixed-dose inhalers dispensed as the units of analysis) collected from 1st January 2015 to 31st December 2015 from the specialist clinic pharmacy. Descriptive analysis was conducted based on satisfactory MRA which was set as the dispensed refill of inhalers covering 80-120% of the prescribed treatment time. Logistic regression analysis was used to explore each variable (diagnosis, gender, ethnicity and age) in relation to MRA: overall satisfactory MRA (≥80% MRA) with undersupply (<80% MRA) as the reference group. Results: Out of the repeat prescriptions analysed (N=199), the majorities were COPD (N=118; 64.3%), male (N=122; 61.4%), Malay (N=175; 88.0%), and aged 60-69 years old (N=56; 28.3%). 44.5% of repeat prescriptions (N=57) for COPD showed satisfactory MRA, compared to only 25.4% (N=18) in BA. Repeat prescriptions for fluticasone/salmeterol accuhalers showed the highest satisfactory MRA at 18.1% (N=36). Diagnosis, gender and ethnicity did not significantly influence the overall MRA while age marginally influenced the overall MRA. Conclusion: More than half of the repeat prescriptions for BA and COPD inhalers showed undersupply and oversupply: patients may not be compliant nor using the inhaler correctly.

282 A Time to Wean: An Audit on Benzodiazepine and Z-drug Use Amongst Patients Attending a Geriatric Ambulatory Care Day Hospital

Background Benzodiazepine prescription is common among the Irish patient cohort. 23% of medical card holders have been prescribed a benzodiazepine or Z-drug, with a third of these being for a period longer than three months. This is despite these drugs being associated with addiction, falls, cognitive and psychomotor impairment, mood disorder, sleep automatism and drug interactions. We performed an audit looking at the repeat prescriptions of patients attending a geriatric day hospital. Methods The repeat prescriptions of all patients currently enrolled at a day hospital were analysed for benzodiazepines or Z-drugs. Medical records were then analysed to look for indication and whether these patients were currently attending psychiatric services. Subsequent to this, notices were placed in the patient consult room in direct line of sight of the registrar reminding them to consider weaning these drugs and detailing the negative side effects and guidelines for weaning from the Canadian National Pain Centre. Results 59 patients were enrolled at the day hospital when the audit was performed. 11 (19%) had either a benzodiazepine or Z-drug as part of their repeat prescription (benzodiazepine-5, Z-drug-5, both-1). The most common benzodiazepines prescribed were diazepam and clonazepam (2 patients on each). Of those prescribed a benzodiazepine, none were currently being weaned. Of those on benzodiazepines, 4 of 6 had a documented psychiatric diagnosis, and 1 of 6 had documented that they were currently attending psychiatric services. A re-audit three months later showed no change in those prescribed benzodiazepines (5/59), and a non-significant increase in those on Z-drugs (9/59, p=0.26). Conclusion This audit showed a significant number of patients attending our day hospital are being prescribed long term benzodiazepines or Z-drugs, and highlights that this setting is an opportune time and place to establish a supported program to wean people off these medications.