Andrea Bor

Gender inequalities in the treatment of osteoporosis

INTRODUCTION Our aim was to perform both gender- and age-specific analysis regarding the utilisation of anti-osteoporotic drugs in Hungary, between 2007 and 2011, and to compare our results with other European countries. METHODS The database of the Hungarian National Health Insurance Fund was screened for anti-osteoporotic medications, covering 100% of the Hungarian population (10 million people). ICD coding system (International Classification of Diseases) and WHO ATC/DDD methodology were used for medication screening and analysis. RESULTS In Hungary, the total bisphosphonate use was 6.66 DDD/TID (Defined Daily Dose/1000 inhabitants/day) in 2007, and 6.22 DDD/TID in 2011; the rate of bisphosphonate combinations slightly increased from 1.60 to 2.81 DDD/TID. The total vitamin D use almost doubled (13.73 DDD/TID in 2011), while the calcium supplementation tripled (4.47 DDD/TID in 2011), and so did the strontium ranelate utilisation (0.70 DDD/TID in 2011) within the investigated time period. Denosumab consumption was marginal. Male patients were disproportionately, 10-20 times undertreated in all age groups, and treatment choice was restricted among men. Several differences were seen in our results compared to those in Baltic countries, Finland and in Norway. CONCLUSIONS Men were significantly undertreated in all age groups, compared to women. The 10 to 20-fold difference calls attention to this unrecognised problem.

Treatment of Community-Acquired Pneumonia in Adults: Analysis of the National Dispensing Database

Crude national ambulatory antibiotic dispensing data (2007–2011) of adult patients (aged between 20 and below 65 years) with CAP were obtained and expressed as DDD per 1000 inhabitants and per day (DID). European quality indicators of antibiotic prescribing were calculated and adherence rate to the national CAP guideline was assessed. Antibiotic use for CAP in adults ranged between 0.27 and 0.30 DID in various years. The most frequently used antibacterials were levofloxacin, co‐amoxiclav and clarithromycin. Antibiotic use in CAP was compliant with the European recommendations in 6.4% in 2007, which decreased to 4.9% by 2011, in contrast to the optimal compliant range of 80–100%. The consumption of fluoroquinolones mounted up to ~40% in both genders, which exceeded the recommended range (0–5%) substantially. National guideline also favoured the use of macrolides in the empiric therapy of CAP in otherwise healthy adults; hence, guideline‐concordant antibiotic use ranged between 24.0–32.3%. Agents that were contra‐indicated in the empiric therapy of CAP were also used in 6.5–9.0% in various years. These data reflect some worrisome figures and trends in the outpatient antibiotic treatment of adults with CAP. Clarified and updated national guidelines focusing on outpatients and incentives/regulations to increase guideline concordance are warranted.

Hazai kórházi antibiotikum-alkalmazás az elmúlt két évtizedben (1996–2015)

Absztrakt Bevezetes: A bakterialis rezisztencia kozegeszsegugyet fenyegető problema, amely mersekelhető, lassithato megfelelő antibiotikum-alkalmazassal. Celkitűzes: A hazai fekvőbeteg-ellatas szisztemas antibiotikum-felhasznalasanak bemutatasa. Modszer: A korhazi antibiotikum-felhasznalasi adatokat az Egeszsegugyi Vilagszervezet anatomiai-terapias-kemiai rendszere szerint osztalyoztak es a Defined Daily Dose metodika szerint kvantifikaltak. A standardizalas korhazi betegforgalmi mutatokra, valamint – a nemzetkozi osszehasonlitas vegett – populaciora tortent. Eredmenyek: A fekvőbetegszektor antibiotikum-felhasznalasa az elmult 20 evben mennyisegileg kiegyenlitett volt (22,4 ± 1,5 DDD/100 apolasi nap), mintazata folyamatos valtozason ment keresztul. Megfigyelhettuk a parenteralis keszitmenyek alkalmazasanak emelkedeset (1996-ban 26,4%, 2015-ben 41,6%). Kiemelendő a felhasznalas osszetetelenek homogenizalodasa az amoxicillin-klavulansav ternyerese miatt, a fluorokinolon (2,3 vs. 4,2 DDD/100 apolasi nap) es ...

CP-117 Risks of surgical intervention in patients taking oral anticoagulants

Background Oral anticoagulants (OAC) play a crucial role in preventing thromboembolic diseases. However, these medications may carry numerous problems and risks while applied. Patients taking oral anticoagulants may have a higher risk of bleeding during a surgical intervention. Purpose Our aim was to analyse the risks that patients on oral anticoagulant therapy may have during their hospitalisation and surgical procedure. Material and methods Patients were recruited from the traumatology department, admitted with osteoporotic hip fractures. A retrospective analysis was performed for the period between January 2011 and August 2012. Data were recorded from the patient charts and documentation. Data comparison was made regarding the risks of patients on OAC and of patients not taking oral anticoagulants (control group). Results 510 patients were enrolled in this study (133 males, 377 females), mean age 79.68 ± 9.81 years (mean ± SD). On admission, 49 patients were taking OAC (14 males, 35 females, mean age 80.88 ± 10.04 years), which was acenocumarol. 119 men and 342 women (mean age 79.56 ± 7.22 years) were included in the control group. In the OAC group, more time elapsed between the admission date and the surgical procedure: 3.43 days (±2.30 days) versus 1.74 days (±2.21 days) in the control group (p ≤ 0.001). At the same time, there was no substantial difference in the length of operation between the two groups: 1 h 54 min versus 1 h 50 min. Following the surgical intervention, the mean length of hospital stay did not differ significantly between the two groups (11.24 days). Complications during the surgical procedure and/or hospital stay occurred in 57.1% in the OAC group and in 51.8% of controls. During the hospital stay, 53.1% of the OAC group received blood transfusion compared with 45.3% of the control group. Mortality rate was 8.16% in OAC patients versus 3.14% in the control group. Autopsy confirmed cause of mortality was not available. Conclusion Although the overall hospital stay did not differ significantly, considerable differences were seen regarding length of time elapsed until surgery, complication rate and mortality rate between the OAC and control groups. The higher mortality rate highlights the frailty of patients receiving oral anticoagulant therapy. No conflict of interest.

DI-069 Compliance of adolescents to the treatment of ACNE vulgaris

Background Acne vulgaris affects almost every adolescent to varying extents. Symptoms can range from mild to severe. Symptoms often require medical treatment with local and/or systemic medication. The success of the treatment is greatly influenced by the compliance of the patients. Adolescents often have poor compliance, and it can be challenging for healthcare providers to improve compliance in this special age group of patients. Purpose The aim of the study was to evaluate compliance of adolescent patients with local and systemic medication for the treatment of acne vulgaris, and to explore the possible causes of non-compliance. Material and methods Adolescent patients treated for acne vulgaris of varying severity in an outpatient paediatric dermatological department were included in the study. An interview was conducted with the patients, using a structured questionnaire, consisting of 32 questions. Further medical history was taken from the medical records. Results 213 adolescent patients (122 males and 91 females) were included in the study; mean age was 15.63 ± 2.22 years (mean±SD). Average time between first symptoms occurring and visiting a dermatologist was 1.77 years. A significant number of the patients did not follow the dosing and medicine taking instructions recommended by the doctor. 73.2% applied the local products less frequently and 56.2% took the medicines less often than recommended. In order to attempt to achieve a faster remission, a very small number of them took the medicine more often or applied the local treatment more frequently. Due to side effects, it was necessary to terminate the medication in 9.3% of cases. 42.3% of patients did not return to at least one control visit. 7.6% of patients did not redeem the prescription for financial reasons. Conclusion Examination and exploration of factors leading to inappropriate patient compliance can provide important help for improving compliance and the development of an efficiently working acne caring system, which in the long run can result in the achievement of more successful treatment. No conflict of interest.

PS-104 Initiative for improving medicines safety in surgical inpatients

Background Audits of the drug prescribing process in hospitals can help to identify problematic fields in relation to drug treatment. This can increase patient safety by preventing potential medicines errors. Purpose To quantify the frequency of drug-related problems (DRPs) and assess consequent interventions in hospitalised patients. Material and methods The study took place in the vascular and general surgery ward over a 6-week period in 2014. Medicines recorded on patient charts were reviewed by a pharmacy resident in order to identify DRPs. DRPs of chronic medicines and those newly prescribed during the stay in hospital were assessed. Interventions were also recorded. The number of chronic medicines (i.e. including polypharmacy status: taking ≥6 medicines) in relation to DRPs were analysed (SPSS, T-test). Results Medicines of 171 patients (vascular surgery: 105, general surgery: 66) were assessed. Overall 123 DRPs were identified from 89 patients. Majority (68%, 84 cases) of DRPs were related to newly prescribed medicines while the rest (32%, 39 cases) were related to chronic medicines. In case of chronic medicines the most frequent type of error (71%) was inaccuracy of product strength or recording of dosing regimen. In newly prescribed drugs the lack of daily update on patient charts was the most frequent DRP (60%). The most frequent types of intervention were clarification of dosage/dosing regimen (60 cases) and clarification of the necessity for daily dosing (50 cases). Association was found between the number of medicines and DRPs: firstly, patients with polypharmacy had significantly higher chances of DRPs (OR: 2.45, 95% CI: 1.14–5.26; p = 0.020), secondly, in the vascular surgical ward, the average number of chronic medicines per patient was significantly higher when DRPs were found (7.1 ± 4.5 vs. 8.9 ± 3.5, p = 0.03). Conclusion We identified drug-related problems (DRPs) in every second patient. Pharmacists are able to detect and solve DRPs and prevent potential medicines errors. Reference PCNE Classification of DRP V 6.2 No conflict of interest.

CPC-036 Connection Between Bone Fractures, Vitamin D Level and Low-Energy Falls in Hospitalised Elderly Patients

Background The ageing of the population in developed countries is a growing problem today. Prevalence of chronic diseases, such as osteoporosis, increases with age. It is estimated that 900,000 people (9% of the population) above the age of fifty suffer from osteoporosis in Hungary. This condition greatly increases the risk of fractures of vertebra and the hip bone, which often lead to fatal consequences. Many studies have proven that a low vitamin D level increases the risk of bone fractures. Adequate vitamin D level is essential to prevent bone loss and structural damage of the bone matrix, which also prevents fractures. Purpose To compare vitamin D levels of hospitalised hip fracture patients with hospitalised non-fractured patients, as well as to detect the prevalence of low-energy falls, and to analyse the differences between the groups. Materials and Methods The fractured group was recruited from the Traumatology Department and the control group was recruited from the Internal Medicine Department. The control group was matched according to age and gender. Vitamin D levels were measured with an ELISA kit and were expressed in ng/ml. Subjects were asked about previous falls during a personal interview. Results Twenty-two patients were in the fractured group (mean age 84.09 years, SD ± 6.78) and 33 patients were in the control group (mean age 80.52 years, SD ± 6.56). The mean vitamin D level was 33.13 ng/ml in the fractured group and 39.7 ng/ml in the control group (P = 0.230). However, the vitamin D level was under the normal range (30–60 ng/ml) in the majority of patients in both groups. Patients of the fractured group reported considerably more falls within one year than the control group. Conclusions Since the difference in vitamin D levels was not significant between the investigated groups, other risk factors could be responsible for fractures besides the low vitamin D level. A noteworthy factor may be falls, because more than half of the fractured patients reported multiple falls in the previous year. No conflict of interest.