ART-related medication errors in hospitalized people with HIV in the INSTI-era: analysis from 2 health systems in South Georgia, U.S

ABSTRACTART-related medication errors occur at high rates in hospitalized people with HIV (PWH), but few studies included modern regimens. As such, we evaluated ART-related medication errors in hospitalized PWH in an era where use of INSTI-based regimens dominate. This multi-center, retrospective cohort included PWH at least 18 years hospitalized in South Georgia, U.S. between March 2016 and March 2018. Of those eligible for inclusion, 400 were randomly selected and included. Three hundred sixty-three inpatient ART-related medication errors occurred in 203 patients during the study period due to incorrect scheduling (44%), an incorrect or incomplete regimen (27%), and drug-drug interactions (27%). Approximately 25% of errors persisted to discharge. Medication errors were more likely to occur in patients receiving NNRTI- or PI-containing multi-tablet regimens, whereas those receiving INSTI-containing multi-tablet regimens were less likely to experience a medication error. ART-related medication errors are less likely in patients receiving INSTI-containing multi-tablet regimens. Ensuring appropriate transition of ART throughout hospitalization remains an area in need of significant improvement.

The availability of fentanyl test strips in Georgia community pharmacies

BACKGROUND

Fentanyl test strips (FTS) are increasingly being used to test counterfeit pharmaceuticals and illicit drugs for fentanyl before consumption. On July 1, 2022, Georgia legalized the distribution of FTS. One strategy for expanding FTS distribution in the community involves leveraging community pharmacies. However, less is known about FTS distribution through community pharmacies.

OBJECTIVES

This preliminary study aimed to assess the availability of FTS in Georgia community pharmacies and examine pharmacists' knowledge and attitudes regarding FTS provision.

METHODS

This study used a cross-sectional design. A randomized telephone survey of 700 pharmacies, stratified by pharmacy type, was carried out from September 2022 to January 2023. Survey questions assessed FTS stock status, pharmacists' awareness of Georgia's FTS legalization, willingness to receive FTS information, and comfort in providing FTS education. Descriptive statistics and multivariate logistic regression analyses were used to analyze the data.

RESULTS

Of the 376 survey respondents, the vast majority were not aware of the Georgia FTS legalization (82.71% [n = 311]) and did not have FTS stocked in their pharmacies (94.91% [n = 354]). While most participants were willing to receive FTS information (70.21% [n = 264]), only slightly over half reported feeling comfortable providing FTS education (54.70% [n = 205]). Multivariate analyses showed that female participants were less likely to feel comfortable providing FTS education to patients/clients at the pharmacy (adjusted odds ratio: 0.58; confidence interval: 0.36 to 0.92).

CONCLUSION

Findings suggest that Georgia community pharmacies may not stock FTS and that pharmacists may be unaware of the state's FTS legalization, but they are willing to receive information about FTS. Future studies should use a representative sample to design and implement strategies to support pharmacists' provision of FTS, including a destigmatization approach for those not comfortable discussing FTS.

Addressing buprenorphine supply barriers: A guidance commentary

The current supply-side constraints limiting buprenorphine availability at pharmacies may reduce the potential impact of recent initiatives to improve medications for opioid use disorder (MOUD) access. The recent opioid litigation combined with existing federal regulation and enforcement has resulted in significant restrictions to the distribution and dispensing practices of pharmaceutical wholesalers and pharmacies countrywide. Previously discussed solutions to these problems do not seem to have produced actionable improvements to the current landscape. However, a novel solution to this problem may exist in the form of a Drug Enforcement Administration (DEA) guidance letter. These guidance letters allow the DEA to communicate directly to registrants, providing detailed interpretation and clarity regarding the DEA's expectations and enforcement realities. Recently, the DEA guidance letter portal was used to remind registrants that the DEA does not create quantitative thresholds or volume limits on controlled substance distribution. An additional guidance letter could be issued to ease the concerns about liability connected to the distribution and dispensing of buprenorphine. In particular, this guidance could acknowledge certain terms of the distributor settlement agreement as legal precedent and clarify that buprenorphine is not subject to the same restriction as other defined "highly diverted" controlled substances. Such guidance may also serve to provide both pharmaceutical wholesalers and pharmacies with assurance that an increase in buprenorphine distribution would not directly result in increased DEA scrutiny. This strategy represents an actionable step toward the goal of providing better access to MOUD by reducing existing supply-side limitations.

Collaborative drug therapy modification (CDTM): Facilitators, barriers, and perceptions of individual pharmacist participation in Georgia

BACKGROUND

Georgia Board of Pharmacy (BOP) regulations permit pharmacists to engage in collaborative drug therapy modification (CDTM) with physicians, allowing them to perform patient assessments, adjust pharmacotherapy, and order laboratory tests. Pharmacist-led CDTM can positively affect health outcomes leading to reduced healthcare expenditures. CDTM is underutilized, with < 1% of Georgia pharmacists holding an active license to practice CDTM.

OBJECTIVE(S)

The objective of this study was to examine CDTM licensed pharmacists' perceptions of facilitators and barriers in providing CDTM.

METHODS

Georgia-licensed CDTM pharmacists were invited to participate in a 60-minute qualitative interview. Interview questions were developed from electronic survey responses. The interview was designed to elicit information regarding perceived benefits and barriers to CDTM implementation. Guided by the Consolidated Framework for Implementation Research, thematic analysis was applied to identify themes using ATLAS.ti software to code. Themes were described qualitatively and prevalence of each was reported.

RESULTS

Nine interviews were conducted, and data saturation was achieved at interview 6. After resolution of discrepancies, 100% coding agreement was reached among 2 independent researchers. Nine themes were identified, and each was categorized as a facilitator or barrier to establishing pharmacist-led CDTM in Georgia. Themes associated with facilitating were (prevalence %) (1) practice autonomy (100), (2) personal attributes (100), (3) having support (100), and (4) institutional logistics (88). Barrier themes included issues concerning (5) the Georgia BOP (100), (6) pharmacist autonomy (88), (7) lack of provider status (88), (8) institutional restrictions (75), and (9) personal development (e.g., confidence) (22).

CONCLUSION

Facilitators to the establishment of pharmacist-led CDTM exist and pharmacists can capitalize on these to create successful CDTM programs. Barriers are varied, and it may be difficult to systematically address individual barriers such as pharmacist autonomy and personal development. Barriers associated with institutional restrictions, the Georgia BOP, and lack of provider status can likely be removed or addressed by policy.

Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019

Background

Emerging risk factors highlight the need for an updated understanding of cryptococcosis in the United States.

Objective

Describe the epidemiological trends and clinical outcomes of cryptococcosis in three patient groups: people with HIV (PWH), non-HIV-infected and non-transplant (NHNT) patients, and patients with a history of solid organ transplantation.

Methods

We utilized data from the Merative Medicaid Database to identify individuals aged 18 and above with cryptococcosis based on the International Classification of Diseases, Tenth Revision diagnosis codes from January 2017 to December 2019. Patients were stratified into PWH, NHNT patients, and transplant recipients according to Infectious Diseases Society of America guidelines. Baseline characteristics, types of cryptococcosis, hospitalization details, and in-hospital mortality rates were compared across groups.

Results

Among 703 patients, 59.7% were PWH, 35.6% were NHNT, and 4.7% were transplant recipients. PWH were more likely to be younger, male, identify as Black, and have fewer comorbidities than patients in the NHNT and transplant groups. Notably, 24% of NHNT patients lacked comorbidities. Central nervous system, pulmonary, and disseminated cryptococcosis were most common overall (60%, 14%, and 11%, respectively). The incidence of cryptococcosis fluctuated throughout the study period. PWH accounted for over 50% of cases from June 2017 to June 2019, but this proportion decreased to 47% from July to December 2019. Among the 52% of patients requiring hospitalization, 61% were PWH and 35% were NHNT patients. PWH had longer hospital stays. In-hospital mortality at 90 days was significantly higher in NHNT patients (22%) compared to PWH (7%) and transplant recipients (0%). One-year mortality remained lowest among PWH (8%) compared to NHNT patients (22%) and transplant recipients (13%).

Conclusion

In this study, most cases of cryptococcosis were PWH. Interestingly, while the incidence remained relatively stable in PWH, it slightly increased in those without HIV by the end of the study period. Mortality was highest in NHNT patients.

Community pharmacists' naloxone counseling: A theory-informed qualitative study

BACKGROUND

Opioid-related overdose (ORO) deaths have reached a record high in the United States. Naloxone is an opioid antagonist that can rapidly reverse an opioid overdose. Pharmacists are in an ideal position to provide naloxone and related counseling, given their accessibility and expertise. However, minimal research is available on community pharmacists' naloxone counseling.

OBJECTIVES

The aim of this study was to investigate Georgia community pharmacists' naloxone counseling as well as explore their attitudes, subjective norms, and perceived behavioral control toward counseling.

METHODS

Semi-structured telephone interviews were conducted to elicit pharmacists' beliefs and practices regarding naloxone counseling. The interviews were guided by open-ended questions based on the theory of planned behavior (TPB). Thematic analysis was performed to identify the modal salient beliefs expressed by the pharmacists. The Consolidated Criteria for Reporting Qualitative Research was used to report the study findings.

RESULTS

A total of 12 community pharmacists participated. Pharmacists held mixed attitudes toward naloxone counseling. While they recognized it as a vital part of their profession to prevent ORO deaths, they also expressed concerns about offending patients. Regarding normative beliefs, pharmacists identified several groups, including regulatory agencies (e.g., Board of Pharmacy, CDC), managers, news/media, patients, and doctors, influencing their provision of naloxone counseling. Facilitators to counseling included receiving naloxone training and having access to counseling guidelines and resources. Reimbursement issues, high costs of naloxone, and lack of patient awareness were the most commonly cited barriers. Pharmacists reported participating in counseling and providing information on identifying signs of opioid overdose and administering naloxone.

CONCLUSIONS

The TPB is a useful framework for understanding community pharmacists' beliefs and practices regarding naloxone counseling. Capitalizing on facilitators and targeting barriers related to pharmacists' reimbursement issues, high costs of naloxone, and increasing patients' awareness of naloxone use and benefits may enhance pharmacists' naloxone counseling.

Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data

Introduction

In general, racial and ethnic differences exist in antipsychotic prescription practices. However, little is known about such differences between individual long-acting injectable (LAI) antipsychotic formulations, specifically. This study's primary objective was to determine racial and ethnic differences among LAI antipsychotic use. Secondary objectives were to identify if discontinuation rates differed between agents and by race or ethnicity.

Methods

International Classification of Diseases, 10th edition (ICD-10) codes were used to identify patients with schizophrenia and related disorders (18-64 years) who received an LAI antipsychotic between 2016 and 2020 using Merative Multi-State Medicaid databases. Using National Drug Code numbers for LAI antipsychotics, pharmacy claims were identified and data analyzed. Cochran-Mantel-Haenszel tests and odds ratio estimators were used to investigate conditional association between race or ethnicity and medication, while controlling for age, sex, health plan, and prescription year. Kaplan-Meier survival curves were examined, and stratified log-rank tests were conducted to compare the time until discontinuation distributions by race or ethnicity.

Results

The analysis included 37 712 patients. Blacks received an LAI first-generation antipsychotic more often than Whites (OR: 1.64, 95% CI: [1.56, 1.73], Hispanics (OR: 1.46, 95% CI: [1.21, 1.75]) and others (OR: 1.44, 95% CI: [1.20, 1.73]). Aside from fluphenazine decanoate showing earlier discontinuation rates for Whites over Blacks (P = .02), no significant differences in discontinuation across race or ethnicity were identified.

Discussion

Despite no significant differences in second-generation antipsychotic LAI discontinuation rates between Blacks and other racial or ethnic groups, Blacks received second-generation antipsychotic LAIs significantly less often than other groups. Further studies are needed to determine why differences may be occurring.

Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US

Importance

Daily preexposure prophylaxis (PrEP) use can prevent up to 99% of HIV infections; however, PrEP uptake is low due to poor access to PrEP-prescribing locations for populations at increased risk for HIV, especially in the southeastern US. Pharmacies are a feasible option to increase PrEP access, but little is known about how they could complement current PrEP-prescribing locations.

Objective

To examine geographic distributions of current PrEP-prescribing locations compared with pharmacies and the facility to need ratios (PFNRs) according to HIV risk in the Southeast and describe the potential reach of pharmacies to expand PrEP access.

Design, Setting, and Participants

Data for this cross-sectional study of PrEP-prescribing locations and pharmacies were compiled from January 1 to December 31, 2021. States or specific counties in the Southeast included in this study were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative.

Exposure

Expansion of HIV prevention services to pharmacies.

Main Outcomes and Measures

Choropleth maps of 5-year HIV risk per 100 000 persons were developed for EHE jurisdictions in the southeastern US. PrEP-prescribing locations (obtained from a national database of PrEP prescribers) and pharmacies (obtained from state pharmacy boards) were overlayed on HIV risk maps. The PFNRs by state were calculated as number of facilities (PrEP-prescribing locations or pharmacies) divided by 5-year HIV risk per 100 000 persons. Lower PFNRs indicated lower geographic availability of locations to meet the needs of the population at risk for HIV. The PFNRs for current PrEP-prescribing locations vs pharmacies were compared.

Results

Among the 2 southeastern states and 13 counties in 4 southeastern states included, PrEP-prescribing locations were unequally distributed across EHE areas, with substantially fewer in areas at high risk for HIV. Pharmacies were evenly dispersed across areas regardless of HIV risk. The mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]); for pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]). The PFNRs were at least 20.3 times higher for pharmacies compared with PrEP-prescribing locations. States with the greatest potential increase in PFNRs with expansion to pharmacies included Kentucky, South Carolina, and Tennessee.

Conclusions and Relevance

The findings of this cross-sectional study suggest that expanding HIV prevention services to pharmacies in EHE areas in the Southeast could significantly increase capacity to reach individuals at increased risk of HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services may be an important next step in ending the HIV epidemic.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Examining pharmacies' ability to increase pre-exposure prophylaxis access for black men who have sex with men in the United States

BACKGROUND

Pre-exposure prophylaxis (PrEP) has not effectively reached black men who have sex with men (BMSM). Using innovative, nontraditional health care settings-such as community pharmacies-may improve PrEP uptake among BMSM.

OBJECTIVE

To examine correlates of patient willingness to be screened for PrEP (via human immunodeficiency virus [HIV] testing and risk assessment) in pharmacies among BMSM in the United States.

METHODS

Data from the 2020 American Men's Internet Survey were analyzed. Using a modified Poisson regression method with robust variance estimates, we examined differences in willingness to screen for PrEP in pharmacies among BMSM. A 95% confidence interval (95% CI) was calculated for each estimated prevalence ratio (PR).

RESULTS

Of 826 respondents, 637 (77%) were willing to be screened for PrEP in pharmacies. Having a high school degree (PR 0.76 [95% CI 0.62-0.95]), willingness to use PrEP (1.70 [1.41-2.05]), and comfort speaking with pharmacy staff about PrEP (2.5 [1.86-3.51]) were significantly associated with willingness to screen for PrEP in a pharmacy setting. Importantly, there were no observed differences in willingness by age, employment status, annual household income, or insurance status.

CONCLUSION

Pharmacy-based PrEP access may be an effective strategy to end inequities in HIV, given that our results indicate that most BMSM are willing to be screened for PrEP in pharmacies. Future studies should examine whether willingness to use pharmacy-based HIV prevention services is associated with subsequent uptake of these services among BMSM.

Abstract P604: Acceptability of a Newly Developed Southern Dietary Approaches to Stop Hypertension Diet Among Heart Failure Patients in the South: A Sensory Evaluation

Introduction: Despite known benefits of the DASH diet on cardiometabolic outcomes, adherence rates have been low among heart failure (HF) patients in the Southern US.

Objective: To 1) use sensory evaluation methods to assess the acceptability of a newly developed Southern DASH diet among HF patients in the South, and 2) assess its associations with participants’ demographic and health characteristics.

Methods: Through collaborative efforts with dietetics and culinary experts, and by using qualitative data on dietary preferences among HF patients in the South, we developed a new 14-day Southern DASH diet meal plan. Each day of the meal plan met NHLBI standards for DASH diet serving sizes based on 2000 kcals/day and limited sodium to 2300 mg/day. The study assessed acceptability of 4 days’ worth of breakfasts, lunches, snacks, and dinners. Using a 9-point hedonic scale, participants rated the overall liking (OL), appearance, flavor, texture, and preparation intent (PI) for each recipe. Demographic and health characteristics were obtained by survey. We conducted Kruskal-Wallis tests with a Bonferroni adjustment to assess acceptability differences between Southern DASH diet days. Mann-Whitney U tests were performed to assess relationships between acceptability and participants’ characteristics.

Results: Sample size calculations were met (n = 35 participants enrolled). The mean (SD) age was 67.2 (9.5) years, 37.1% were female, and 14.3% African American. Using industry standards (OL ≥7), 3 out the 4 evaluated days were highly accepted. Day 3’s OL, flavor, texture, and PI, and Day 4’s ratings for flavor were rated significantly higher than those for Day 2 (Table 1). Day 3’s OL rating was significantly higher among those who received nutrition education for managing HF than those who did not ( U = 213.0, p-value = 0.009). No significant differences were determined between OL and race.

Conclusions: A newly developed Southern DASH diet was largely accepted among HF patients in the South and supports targeted HF management efforts.

Abstract P400: Effectiveness and Acceptability of Dietary Telehealth Interventions Targeting Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis

Introduction: Dietary telehealth interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic.

Objective: To examine (1) effectiveness of dietary telehealth interventions in improving diet-related CVD risk factors and (2) their acceptability among CVD patients.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the effect of dietary telehealth interventions on CVD risk factors (Table 1) among adult CVD patients. Two investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms, and included English language RCTs published before July 2022. Pooled data for each CVD outcome were assessed using a random effects model, and mean difference (MD), standardized MD (SMD), or risk ratio (RR) were calculated using R software.

Results: A total of 15 RCTs with 3,751 participants were included in the analysis. Participants had a mean age (SD) of 60.9 (3.6) years, 23.3% were women. Most RCTs were conducted in the US (33.3%) and in urban areas (93.3%). Interventions involved either phone calls, apps, texts, or websites, and follow-up durations ranged from 4 to 56 weeks. Of the 15 studies, 4 were of high quality, 10 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD: -3.01 [95% CI: -4.75 to -1.28]) and low-density lipoprotein cholesterol (SMD: -0.11 [95% CI: -0.19 to -0.03]) to significantly favor dietary telehealth interventions compared to usual care among CVD patients. There was no significant difference between the acceptability of dietary telehealth interventions and usual care. Significant I 2 indicated moderate to considerable heterogeneity.

Conclusions: Dietary telehealth interventions show promise in addressing CVD risk factors.

Pharmacists' naloxone services beyond community pharmacy settings: A systematic review

BACKGROUND

Pharmacists' provision of naloxone services in community pharmacy settings is well-recognized. Recently, studies describing pharmacists' naloxone services in settings other than community pharmacies have emerged in the literature. There is a need to synthesize evidence from these studies to evaluate the scope and impact of pharmacists' naloxone services beyond community pharmacy settings.

OBJECTIVES

The objectives of this systematic review were to a) identify pharmacists' naloxone services and their outcomes, and b) examine knowledge, attitudes, and barriers (KAB) related to naloxone service provision in non-community pharmacy settings.

METHODS

Eligible studies were identified using PubMed, Web of Science, and CINAHL. Inclusion criteria were as follows: peer-reviewed empirical research conducted in the U.S. from January 2010 through February 2022; published in English; and addressed a) pharmacists' naloxone services and/or b) KAB related to the implementation of naloxone services. PRISMA guidelines were used to report this study.

RESULTS

Seventy-six studies were identified. The majority were non-randomized and observational; only two used a randomized controlled (RCT) design. Most studies were conducted in veterans affairs (30%) and academic medical centers (21%). Sample sizes ranged from n = 10 to 217,469, and the majority reported sample sizes <100. Pharmacists' naloxone services involved clinical staff education, utilization of screening tools to identify at-risk patients, naloxone prescribing and overdose education and naloxone dispensing (OEND). Outcomes of implementing naloxone services included improved naloxone knowledge, positive attitudes, increased OEND, and overdose reversals. Pharmacists cited inadequate training, time constraints, reimbursement issues, and stigma as barriers that hindered naloxone service implementation.

CONCLUSION

This systematic review found robust evidence regarding pharmacist-based naloxone services beyond community pharmacy settings. Future programs should use targeted approaches to help pharmacists overcome barriers and enhance naloxone services. Additional research is needed to evaluate pharmacist naloxone services by using rigorous methodologies (e.g., larger sample sizes, RCT designs).

Impact of patient-centered prescription medication labels on adherence in community pharmacy

BACKGROUND

Prescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients' understanding and improve medication use.

OBJECTIVE

To examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards.

METHODS

This study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes.

RESULTS

Findings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma controllers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods.

CONCLUSION

We report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.

Demographic and socioeconomic correlates to buprenorphine access in pharmacies

BACKGROUND

Research has focused on buprenorphine prescribing with limited attention to the role of pharmacy access to buprenorphine for opioid use disorder.

OBJECTIVE

This study examines demographic and socioeconomic correlates to buprenorphine access in Georgia pharmacies.

METHODS

A 5-question (12 potential subqueries) telephone administered survey was used to investigate access and stocking patterns of specific dosages and formulations of buprenorphine in Georgia pharmacies (n = 119). Descriptive statistics characterized physician and pharmacy demographics and buprenorphine stocking practices. Correlations between various factors including buprenorphine stocking practices, geographic, and sociodemographic characteristics were identified using nonlinear regression models.

RESULTS

The majority of pharmacies stocked the most commonly prescribed 8/2 mg dosage strength of buprenorphine/naloxone films and tablets (69.0% and 63.0%, respectively). Other strengths were less likely to be readily available. Pharmacies in Suburban Census tracts were 77.0% more likely to stock any type of buprenorphine monotherapy [odds ratio (OR) = 1.77, t = 2.37, P < 0.05] and 58.1% more likely to stock the 8 mg buprenorphine monotherapy formulation [OR = 1.58, t = 2.15, P < 0.05] than Urban tracts. Pharmacies in areas with above-average non-White populations were 29.6% more likely to stock a monotherapy product [OR = 1.30, t = 2.16, P < 0.05], and those in areas with above-average poverty rates were more likely to stock the 8 mg/2 mg buprenorphine/naloxone tablets [OR = 1.04, t = 2.02, P < 0.05]. There were no additional differences across the sample in formulation or dosage strengths. Pharmacists who endorsed challenges dispensing buprenorphine (23.3%) cited issues around insurance coverage, payment difficulty, prior authorization issues, and low stock of specific formulations.

CONCLUSIONS

Results suggest that low availability of certain dosages or formulations of buprenorphine in local pharmacies could obstruct access for patients. Future research should address barriers to supplying buprenorphine and collaborative measures between pharmacists and prescribers to improve access.

Distribution of age, sex, race, and ethnicity in COVID-19 clinical drug trials in the United States: A review

BACKGROUND

COVID-19 quickly overwhelmed the world, but disproportionately affects certain communities, particularly minority groups. Despite overrepresentation among COVID-19 cases and death, minority groups were underrepresented in some of the early COVID-19 clinical trials.

OBJECTIVE

To assess and compare the demographic characteristics of COVID-19 clinical trial participants to national COVID-19 data.

METHODS

PubMed was searched from December 1, 2019 to November 24, 2020, for randomized controlled trials evaluating a pharmacologic treatment for COVID-19 patients from one or more U.S. sites written in the English language following the PRISMA checklist. Descriptive statistics were calculated to characterize patient demographics enrolled in the included clinical trials, as well as for comparison with national COVID-19 data.

RESULTS

A total of 4472 records were identified, of which 16 studies were included. The median number of participants was higher in studies of nonhospitalized patients compared to those of hospitalized patients (n = 452 [range 20-1062] vs n = 243 [152-2795]). Ten (63%) studies reported mean or median ages of 50 years or older among all study arms. Males comprised more than half of the study cohort in ten (63%) studies. Race and ethnicity were reported separately in four (25%) studies but were combined when reported in five (31%) studies, while six (38%) reported only race or ethnicity. Proportional representation based on age, sex, race, and ethnicity was evident in some trials, but not in others, when compared to national data.

CONCLUSION

Overall, participants often did not reflect the actual population with COVID-19 and demographic characteristics were inconsistently reported.

Antihypertensive Use and the Risk of Alzheimer's Disease and Related Dementias among Older Adults in the USA

BACKGROUND

Epidemiological evidence on different classes of antihypertensives and risks of Alzheimer's disease and related dementias (ADRD) is inconclusive and limited. This study examined the association between antihypertensive use (including therapy type and antihypertensive class) and ADRD diagnoses among older adults with hypertension.

METHODS

A retrospective, cross-sectional study was conducted, involving 539 individuals aged ≥ 65 years who used antihypertensives and had ADRD diagnosis selected from 2013 to 2018 Medical Expenditure Panel Survey (MEPS) data. The predictors were therapy type (monotherapy or polytherapy) and class of antihypertensives defined using Multum Lexicon therapeutic classification (with calcium channel blockers [CCBs] as the reference group). Weighted logistic regression was used to assess the relationships of therapy type and class of antihypertensives use with ADRD diagnosis, adjusting for sociodemographic characteristics and health status.

RESULTS

We found no significant difference between monotherapy and polytherapy on the odds of ADRD diagnosis. As to monotherapy, those who used angiotensin-converting enzyme inhibitors (ACEIs) had significantly lower odds of developing AD compared to those who used CCBs (OR 0.36, 95 % CI 0.13-0.99).

CONCLUSIONS

Findings of the study suggest the need for evidence-based drug therapy to manage hypertension in later adulthood and warrant further investigation into the mechanism underlying the protective effect of antihypertensives, particularly ACEIs, against the development of AD among older adults with hypertension.

COVID-19 vaccination among pregnant people in the United States: a systematic review

OBJECTIVE

Pregnant people are at increased risk of COVID-19–related morbidity and mortality, and vaccination presents an important strategy for preventing negative outcomes. However, pregnant people were not included in vaccine trials, and there are limited data on COVID-19 vaccines during pregnancy. The objectives of this systematic review were to identify the safety, immunogenicity, effectiveness, and acceptance of COVID-19 vaccination among pregnant people in the United States.

DATA SOURCES

Four databases (PubMed, Web of Science, CINAHL, and Google Scholar) were used to identify eligible studies published from January 1, 2020 through February 6, 2022.

STUDY ELIGIBILITY CRITERIA

Inclusion criteria were peer-reviewed empirical research conducted in the United States, publications in English, and research addressing 1 of the following topics: safety, immunogenicity, effectiveness, and acceptance of COVID-19 vaccination among pregnant people.

METHODS

A narrative synthesis approach was used to synthesize findings. Critical appraisal was done using the JBI (formerly Joanna Briggs Institute) tool.

RESULTS

Thirty-two studies were identified. Most studies (n=24) reported the use of Pfizer and Moderna COVID-19 vaccines among pregnant people; only 6 reported the Janssen vaccine. Of the 32 studies, 11 examined COVID-19 vaccine safety, 10 investigated immunogenicity and effectiveness, and 11 assessed vaccine acceptance among pregnant people. Injection-site pain and fatigue were the most common adverse events. One case study reported immune thrombocytopenia. COVID-19 vaccination did not increase the risk of adverse pregnancy or neonatal outcomes compared with unvaccinated pregnant people. After COVID-19 vaccination, pregnant people had a robust immune response, and vaccinations conferred protective immunity to newborns through breast milk and placental transfer. COVID-19 vaccine acceptance was low among pregnant people in the United States. African American race, Hispanic ethnicity, younger age, low education, previous refusal of the influenza vaccine, and lack of provider counseling were associated with low vaccine acceptance.

CONCLUSION

Peer-reviewed studies support COVID-19 vaccine safety and protective effects on pregnant people and their newborns. Future studies that use rigorous methodologies and include diverse populations are needed to confirm current findings. In addition, targeted and tailored strategies are needed to improve vaccine acceptance, especially among minorities.

Relationships between Key Functions of Patient-Provider Communication, Trust, and Motivation across White, African American, and Hispanic/Latino Patients with Asthma

Patient-provider communication is essential for providing effective care for asthma patients. However, little is known about key functions of communication and their relationships with outcomes in asthma patients across racial/ethnic groups. This study assessed asthma patients' perceptions of key functions of patient-provider communication, and examined associations between key functions, trust, and motivation across racial/ethnic groups. In this study, a sample of 470 US adults responded to an assessment of patient-provider communication, trust, and motivation through an electronically administered survey. Key functions of patient-provider communication included: exchanging information, responding to emotions, making decisions, enabling self-management, managing uncertainty, and fostering relationships. Results showed no differences in the mean scores of key functions of communication across racial/ethnic groups. The key function fostering relationships was positively associated with trust and motivation in both Whites and African Americans. However, the key function making decisions was associated with trust, and the key function managing uncertainty was associated with motivation only for Hispanic/Latinos. Results suggest different cultures may place different values on key functions of communication which may engender trust and motivation. Practical implications and suggestions for future research are discussed.

Integrating and Disseminating Pre-Exposure Prophylaxis (PrEP) Screening and Dispensing for Black Men Who Have Sex With Men in Atlanta, Georgia: Protocol for Community Pharmacies

BACKGROUND

Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 99% among men who have sex with men, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP, including inconvenient locations of PrEP-prescribing physicians, distrust of physicians, and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in low-income, underserved neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (eg, vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM.

OBJECTIVE

We aim to develop a sustainable pharmacy PrEP delivery model for BMSM that can be implemented to increase PrEP access in low-income, underserved neighborhoods.

METHODS

This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model's feasibility, acceptability, and safety and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed-methods approach will be performed, including three study phases: (1) a completed formative phase with qualitative interviews from key stakeholders; (2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and (3) a planned pilot intervention phase which will test the delivery model in 2 Atlanta pharmacies in low-income, underserved neighborhoods.

RESULTS

Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists, and pharmacy staff. Important factors were identified to facilitate the implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase.

CONCLUSIONS

Pharmacies have proven to be a feasible source for offering PrEP for White men who have sex with men but have failed to reach the most at-risk, vulnerable population (ie, BMSM). Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/35590.

Clinical Severity on Hospital Admission for COVID-19: An Analysis of Social Determinants of Health From an Early Hot Spot in the Southeastern U.S

INTRODUCTION

Disparities in COVID-19 infection, illness severity, hospitalization, and death are often attributed to age and comorbidities, which fails to recognize the contribution of social, environmental, and financial factors on health. The purpose of this study was to examine relationships between social determinants of health (SDOH) and COVID-19 severity.

METHODS

This multicenter retrospective study included adult patients hospitalized with COVID-19 in Southwest Georgia, U.S. The primary outcome was the severity of illness among patients on hospital admission for COVID-19. To characterize the effect of biological and genetic factors combined with SDOH on COVID-19, we used a multilevel analysis to examine patient-level and ZIP code-level data to determine the risk of COVID-19 illness severity at admission.

RESULTS

Of 392 patients included, 65% presented with moderate or severe COVID-19 compared to 35% with critical disease. Compared to moderate or severe COVID-19, increasing levels of Charlson Comorbidity Index (OR 1.15, 95% CI 1.07-1.24), tobacco use (OR 1.85, 95% CI 1.10-3.11), and unemployment or retired versus employed (OR 1.91, 95% CI 1.04-3.50 and OR 2.17, 95% CI 1.17-4.02, respectively) were associated with increased odds of critical COVID-19 in bivariate models. In the multi-level model, ZIP codes with a higher percentage of Black or African American residents (OR 0.94, 95% CI 0.91-0.97) were associated with decreased odds of critical COVID-19.

CONCLUSION

Differences in SDOH did not lead to significantly higher odds of presenting with severe COVID-19 when accounting for patient-level and ZIP code-level variables.

Access and Utilization of Asthma Medications Among Patients Who Receive Care in Federally Qualified Health Centers

OBJECTIVES

To describe access to and use of prescription asthma medications, and to assess factors associated with asthma exacerbation, healthcare utilization, and health status among asthma patients treated at Federally Qualified Health Centers.

METHODS

This is a retrospective cross-sectional study. We analyzed data from the 2014 National Health Center Patient Survey. This data is publicly available from the Health Resources and Services Administration. Data was collected from patients receiving face-to-face care from health centers funded under Section 330 of the Public Health Service Act. Data from patients was collected between October 8, 2014, and April 17, 2015. We included adult participants who reported having a diagnosis of asthma and confirmed that they still have asthma. Association between explanatory variables (access to prescription medications and use of asthma controller medications) and outcome variables (asthma exacerbations, asthma hospitalizations or emergency department visits, and self-rated health) was assessed using multivariable regression analyses while adjusting for demographics.

RESULTS

A total of 919 participants with asthma were included. Approximately 32% of the participants experienced delays in getting prescription medications, 26% were unable to get them, 60% experienced an asthma exacerbation last year, 48% rated their health as fair/poor, and 19% visited a hospital or an emergency department last year. Multivariable results showed that participants who were currently taking controller medications were more likely to have experienced an asthma exacerbation (OR = 4.02; 95% CI 1.91 to 8.45; P < .01), or visited a hospital or an emergency department (OR = 3.07; 95% CI 1.39 to 6.73; P < .01) in the last year compared with those who had never taken controller medications. Experiencing difficulties in accessing asthma medications was associated with lower self-rated health (β  = -.51; 95% CI -0.94 to -0.08; P = .02).

CONCLUSIONS

Future interventions should seek to improve asthma patient care and health outcomes using innovative strategies that act at multiple levels of the healthcare system (eg, individual, interpersonal, community levels).

Emergency Contraception Access and Counseling in Metropolitan and Nonmetropolitan Pharmacies in Georgia

Background: Emergency contraception (EC) efficacy is dependent on timing of administration. Adequate pharmacy stock information and accurate patient counseling are important to ensure timely access. Objective: This study evaluates pharmacist reported availability and counseling for levonorgestrel (LNG) and ulipristal acetate (UPA), and identifies differences between caller type and pharmacies in metropolitan vs nonmetropolitan areas of Georgia. Methods: This prospective, randomized, telephone-based study included 25% of Georgia community pharmacies, stratified by geographic location. Calls were made by investigators, first posing as a mystery shopper inquiring about EC stock and efficacy, then 3-6 weeks later as a researcher inquiring about EC stock. Analysis utilized descriptive statistics, chi Square, and logistic regression. Results: Of 600 pharmacies, the mystery shopper caller reached 86%: 74% of pharmacists initially discussed LNG, 57.1% had it stocked, more often in metropolitan areas (OR 1.7, 95% CI 1.08-2.6). Ulipristal acetate was discussed by 1.9% and reported in-stock < 1%. Of those who discussed window of efficacy, 79% indicated LNG would either not work 4 days after intercourse or they were unsure. The research caller successfully completed a second call for 64% of pharmacies: 57% stocked LNG, 3% stocked UPA, and UPA was more likely to be stocked in metropolitan pharmacies. Conclusion: In Georgia, UPA availability is poor, and nonmetropolitan pharmacies were less likely to stock LNG and UPA. A minority of pharmacists correctly indicated that LNG may work up to 120 hours after intercourse. Strategies are needed to overcome barriers to EC availability in community pharmacies and support pharmacists' EC counseling.

463. Factors of Social Determinants of Health Associated with Length of Stay in COVID-19 Patients with Multimorbidity in Southwest Georgia, United States

Background

Previous studies have observed that multimorbidity, defined as two or more comorbidities, is associated with longer lengths of stay (LOS) and higher mortality in patients with COVID-19. In addition, inequality in social determinants of health (SDOH), dictated by economic stability, education access and quality, healthcare access and quality, neighborhoods and built environment, and social and community context have only added to disparities in morbidity and mortality associated with COVID-19. However, the relationship between SDOH and LOS in COVID-19 patients with multimorbidity is poorly characterized. Analyzing the effect SDOH have on LOS can help identify patients at high risk for prolonged hospitalization and allow prioritization of treatment and supportive measures to promote safe and expeditious discharge.

Methods

This study was a multicenter, retrospective analysis of adult patients with multimorbidity who were hospitalized with COVID-19. The primary outcome was to determine the LOS in these patients. The secondary outcome was to evaluate the role that SDOH play in LOS. Poisson regression analyses were performed to examine associations between individual SDOH and LOS.

Results

A total of 370 patients were included with a median age of 65 years (IQR 55-74), of which 57% were female and 77% were African American. Median Charlson Comorbidity Index was 4 (IQR 2-6) with hypertension (77%) and diabetes (51%) being the most common, while in-hospital mortality was 23%. Overall, median length of stay was 7 days (IQR 4-13). White race (-0.16, 95% CI -0.27 to -0.05, p=0.003) and residence in a single-family home (-0.28, 95% CI -0.38 to -0.17, p< 0.001) or nursing home/long term care facility (-0.36, 95% CI -0.51 to -0.21, p< 0.001) were associated with decreased LOS, while Medicare (0.24, 95% CI 0.10 to 0.38, p=0.001) and part-time (0.35, 95% CI 0.13 to 0.57, p=0.002) or full-time (0.25, 95% CI 0.12 to 0.38, p< 0.001) employment were associated with increased LOS.

Conclusion

Based on our results, differences in SDOH, including economic stability, neighborhood and built environment, social and community context, as well as healthcare access and quality, have observable effects on COVID-19 patient LOS in the hospital.

Disclosures

All Authors: No reported disclosures

298. Examining the Relationship Between Excess Weight and In-Hospital Mortality in COVID-19 Patients in Southwest Georgia, U.S

Background

There are multiple mechanisms for the interconnection between obesity and adverse outcomes in COVID-19. Body mass index (BMI) has historically been used to delineate body fatness, but does not include age, which could influence the relationship between body fat and BMI. Ideal body weight (IBW) equations predict a single IBW, which could allow improved recognition of adults with excess weight at increased risk of death from COVID-19. The purpose of our study was to determine whether an association exists between excess weight and in-hospital mortality in COVID-19 patients.

Methods

This was a multicenter, retrospective chart review of hospitalized patients with COVID-19. Patients were separated in two groups based on the difference between actual body weight (ABW) and IBW (ABW/IBW ≤ 120% and ABW/IBW &gt; 120%) to compare rates of in-hospital mortality and length of stay (LOS). A subgroup analysis of patients with ABW/IBW &gt; 120% was conducted to compare in-hospital mortality between patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%.

Results

A total of 445 patients were included of which 71% were in the ABW/IBW &gt; 120% group. Patients in the ABW/IBW ≤ 120% group had higher median age (71 [IQR 64-80.5] vs 60 [IQR 50-70] years) compared to those in the ABW/IBW &gt; 120% group. Fewer African Americans and females were in the ABW/IBW ≤ 120% than in the ABW/IBW &gt; 120% group (65% vs 86% and 35% vs 64%, respectively). There was no difference in the rate of in-hospital mortality between patients in the ABW/IBW ≤ 120% and ABW/IBW &gt; 120% group (26% vs 20%, p=0.174). Average LOS was 10.5 days (SD 9.2) for patients in the ABW/IBW ≤ 120% and 9.3 days (SD 9.5) for those in the ABW/IBW &gt; 120% group (p=0.227). Among those in the ABW/IBW &gt; 120% group, in-hospital mortality was 14%, 23%, and 22% in patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%, respectively (p=0.192).

Conclusion

In-hospital mortality and LOS were not significantly higher among COVID-19 patients with excess weight, defined by ABW/IBW &gt; 120%, when compared to those with ABW/IBW ≤ 120%. Further research is needed to compare COVID-19 outcomes when BMI and ABW/IBW are used to define excess weight.

Disclosures

All Authors: No reported disclosures

460. Disproportionalities in COVID-19 Clinical Drug Trials in the United States: A Systematic Literature Review

Background

To combat higher rates of COVID-19 infection, hospitalization, and death among minorities, it is crucial to identify safe, efficacious, and generalizable treatments. Therefore, the purpose of this systematic literature review was to assess the demographic characteristics of COVID-19 clinical trial participants.

Methods

A literature search was performed according to the PRISMA checklist using PubMed from December 1, 2019 to November 24, 2020 with the following search terms: 2019-nCoV, COVID-19, SARS-CoV-2, clinical trial, randomized controlled trial, observational study, and veterinary. To capture additional results, keyword searches were performed using various versions and plural endings with the title/abstract field tag. Randomized controlled trials evaluating a pharmacologic treatment for COVID-19 patients from one or more U.S site written in the English language were eligible for inclusion. Descriptive statistics were calculated to characterize age, gender, race, and ethnicity of patients enrolled in the included COVID-19 clinical trials, as well as for comparison with national COVID-19 data.

Results

A total of 4472 records were identified, of which 16 were included. Most were placebo-controlled (69%) and included hospitalized patients with COVID-19 (69%). Demographic data were reported for each study arm in 81% of studies. Median number of participants was higher in studies of nonhospitalized patients (n=452 [range 20-1062] vs n=243 [range 152-2795]). Nine (56%) studies reported mean or median ages of 50 years or older amongst all study arms. Males comprised more than half of the study cohort in 50% of studies. Race and ethnicity were reported separately in five (31%) studies, reported in combination in four (25%), while six (38%) reported only race or ethnicity. White or Caucasian patients made up most participants across all arms in 75% of studies. Based on national COVID-19 data, hospitalizations were similar between White persons and African American persons, but higher than other race or ethnic groups, and evenly distributed among males and females.

Conclusion

Lack of heterogeneously reporting demographic characteristics of COVID-19 clinical trial participants limits the ability to assess the generalizability of pharmacologic treatments for COVID-19.

Disclosures

All Authors: No reported disclosures

Evaluation of quality measure attainment with pharmacist-delivered Medicare annual wellness visits

BACKGROUND

Medicare is required to fully cover annual wellness visits (AWVs) to increase access to preventive care. As health care converts to pay for performance models, clinical quality measures have increasing importance. Few studies have investigated the effect of pharmacist-delivered AWVs on clinical quality measure attainment in a rural family medicine (FM) clinic setting.

OBJECTIVES

The primary objective of this study was to evaluate attainment of clinical quality measures for pharmacist-delivered AWVs compared with physician-delivered AWVs (usual care). Secondary objectives included assessment of the number and type of drug therapy problems (DTPs) identified by pharmacists during AWVs.

METHODS

This single-center retrospective cohort study was conducted within an FM clinic located in southwest Georgia. Two cohorts were created according to the provider of AWVs during 2017: pharmacist or physician-usual care. Data on quality measure eligibility, attainment, and DTPs (for the pharmacist group only) were collected through electronic chart review. Descriptive statistics were used to characterize variables, and chi-square (or Fisher exact where appropriate) tests to compare the proportion of clinical quality measures attained between groups.

RESULTS

Among 334 delivered AWVs, pharmacists performed 68.6%. Approximately 62% of pharmacist and usual care visits were female with mean ages of 72 (SD +/- 9.1) and 62 (SD +/- 13.9) years, respectively. Pharmacist-delivered AWVs had statistically significant greater quality measure attainment in the following categories: advance care planning, osteoporosis cardiovascular screenings, and Tdap vaccinations compared with usual care (P < 0.05). Usual care had statistically significant greater quality measure attainment for diabetes screening. Seventy-five DTPs were identified in the pharmacist group, with the majority being related to adherence (39%).

CONCLUSION

Pharmacist-delivered AWVs had greater quality measure attainment in several areas than usual care. Furthermore, increased quality measure attainment may assist in meeting benchmarks set by payers to ensure ongoing reimbursement of these services.

Information versus influence: An analysis of educational, relational, and identity rewards present in direct-to-consumer prescription drug advertising

BACKGROUND

Pharmaceutical companies have rationalized rapid increases in spending on direct-to-consumer advertising (DTCA) by highlighting the educational potential that such efforts have for patients. Others have argued that profits and influence, not educational benefits, are the true motivators for the expansion of DTCA. It is critical that pharmacists be aware of the content of direct-to-consumer advertisements to best counsel patients on proper medication expectations.

OBJECTIVES

This study investigated the ways in which drug information is being presented to patients and whether such rewards may act as a form of education regarding a greater emphasis on the product or the condition the drug is designed to treat.

METHODS

This study conducted a content analysis of 60 broadcast prescription drug advertisements appearing over a 12-week primetime programming period across 4 major news networks to determine which types of educational, relational, and identity rewards were present across the textual, verbal, and visual modalities.

RESULTS

Findings indicated a greater overall presence of relational and identity rewards than educational rewards. Most of the educational rewards served to promote a particular drug rather than educate consumers about a condition. There was a statistically significant relationship between reward type and modality, such that there were greater relational and identity rewards within the visual modality and greater educational rewards in the textual modality than expected.

CONCLUSION

Findings showed that educational rewards in the service of promoting a particular drug were included more than 2.5 times as often as educational rewards about the condition treated. This lack of information about the condition suggests that DTCA may be aiming to increase profits by encouraging conversation between patients and providers about the advertised medications. As a result, a patient may demonstrate an increased desire to discuss a particular drug with a pharmacist or a provider rather than discussing information about the condition itself.

Using a theoretical approach to predict college students' non-medical use of prescription drugs - a survival analysis

This study assesses students' non-medical use of prescription drugs (NMUPD) from college entrance to graduation, and examines factors that predict NMUPD. Participants: The study was conducted between May 2011 and September 2015 with 338 students. Methods: Longitudinal cohort study design was used to examine NMUPD across time, and NMUPD-related attitudes and subjective norms. Five yearly interviews were conducted to collect data. Cox proportional hazards regression analysis was used to examine time to NMUPD. Results: Thirty-five percent of study participants reported NMUPD; the majority of those initiated non-medical use before their third year in college. Analyses indicated that more positive attitudes towards NMUPD (HR = 1.73, p < 0.001), increased subjective norms regarding NMUPD (HR = 1.01, p < 0.01), and gender (male) (HR= 1.89, p < 0.001) were significantly associated with sooner NMUPD. Conclusions: Findings suggest that NMUPD prevention efforts that target mutable factors such as attitudes and subjective norms should be implemented early during students' college careers.

Incidence and utility of follow-up blood cultures in cancer patients with gram-negative bacteremia

Benefit of follow-up blood cultures (FUBC) in cancer patients with gram-negative bacteremia (GNB) is unknown. Multicenter, retrospective review was performed in adult cancer patients with GNB between January and December 2018. Primary outcome was FUBC incidence. Chi-square, t-tests/Wilcoxon rank-sum, and bivariate regression (logistic/Poisson) analyses compared secondary outcomes (catheter removal, ID consultation, antibiotic duration, length stay, mortality) between patients with versus without FUBC. Of 52 patients with GNB, majority (35/52; 67%) received ≥1 FUBC (mean per patient 3.6, SD 4.3, range 0-29). Majority FUBC had no growth (157/173; 90.8%). Rates of catheter removal and ID consultation were similar between groups (P > 0.05). Patients with FUBC had greater LOS (mean 21 vs 15 days; coefficient = 0.31, CI 0.17-0.45), longer duration of antibiotics (mean 13 vs 11 days, coefficient 0.19, P = 0.013), but no mortality difference (P = 1). FUBC are frequently performed yet infrequently positive in cancer patients with GNB, but were associated with increased LOS and antibiotic duration.

The relationship between health-related quality of life, perceived social support, and social network size in African Americans with aphasia: a cross-sectional study

Stroke significantly impairs health-related quality of life (HRQL). Stroke survivors with aphasia (SWA) experience lower HRQL than stroke survivors without aphasia (SSA) as a result of poorer communication and social functioning. The extent to which aphasia influences HRQL in African-Americans and the components of social functioning that are most important to HRQL warrants further exploration.There were two main objectives of this paper. The first was to survey HRQL domains of communication, physical, mental/emotional, role, and social functioning in African American SWA and SSA. The second was to examine if social support and social network predicted HRQL in SWA.A total of 39 African American adults (62.4 ± 11.10) participated in this descriptive cross-sectional case control study. Patient-reported outcome measures were used to assess HRQL, perceived social support, and social network in SWA, SSA, and normal-aging healthy controls (NAH). Data analysis included an ANOVA and moderator regression to determine if social support or social network predicted HRQL in SWA.SWA reported a significantly lower overall HRQL (p = <.000) than NAH adults. Communication HRQL was the hallmark difference found between SWA and SSA (p = <.000). Social support and social network were relatively similar among all three groups. However, social support and social network did not predict HRQL in SWA.Findings from this study suggest that social HRQL continues to be significantly lower in SWA; however, social support and social network factors do not drive differences among African-Americans. Moreover, communication HRQL remains the hallmark difference between SWA and SSA.

1022. Impact of Hospitalization on Antiretroviral Therapy for People Living with HIV

Background

Persons living with HIV (PLWH) are frequently hospitalized for reasons often unrelated to HIV. Transitioning of antiretroviral therapy (ART) while inpatient may not always be an immediate priority due to lack of knowledge, formulary restrictions, and patient status. This could lead to medication errors and gaps in therapy, which can persist at discharge, and could lead to viral rebound and disease progression. The purpose of this study was to identify effects of hospitalization on ART for PLWH.

Methods

This was an IRB approved, multi-center, retrospective cohort study of patients with HIV and/or AIDS based on ICD codes. Patients were included if they were at least 18 years old, receiving outpatient ART prior to admission, and hospitalized between March 2016 and March 2018. Patients were excluded if they were pregnant and only received intravenous zidovudine during their hospitalization. The primary objective was to determine the rate of ART restarted during hospitalization. Secondary objectives included rate at which inpatient ART was modified compared to outpatient regimen, and risk factors associated with regimen modification.

Results

Of 400 patients screened, 295 (74%) patients were on an outpatient ART regimen and were included in the study. Approximately half, 51%, were on a single tablet regimen (STR) outpatient. This population was majority male (59%) and of black race (87%). Median age was 49 years. Median CD4 count was 160 cells/mm3, while median HIV RNA for those with detectable viral load was 57,095 copies/mL.

236 of 295 patients (80%) received ART during their inpatient stay. However, 70 (30%) of these patients received a regimen that differed from their outpatient ART regimen. 69% of regimens were modified for reasons other than to optimize therapy. Patient sex, place of admission, and receipt of a STR or multi-tablet regimen (MTR) as an outpatient did not significantly impact rate of regimen modification.

Conclusion

Ensuring appropriate transition of ART during hospitalization remains an area in need of improvement. No one specific factor was associated with whether outpatient ART was appropriately and accurately restarted during hospitalization. Thus, there are many opportunities to improve transitions of care and antiretroviral stewardship.

Disclosures

All Authors: No reported disclosures

364. Baseline characteristics, comorbidities, and outcomes of COVID-19 patients hospitalized in Southwest Georgia, U.S. – an interim analysis of an early hot spot

Background

Understanding the spectrum of disease severity and death are critical for identifying unrecognized risk factors associated with morbidity and mortality from coronavirus disease 19 (COVID-19). The purpose of this study was to describe the baseline characteristics, clinical presentation, and outcomes among patients hospitalized with COVID-19 in a major hotspot in the U.S. Southeast.

Methods

This multicenter retrospective chart review included adult patients hospitalized with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia. The primary outcome was mortality, which was assessed through discharge or June 14, 2020, whichever occurred first. Secondary outcomes included comorbidities, laboratory and radiographic findings, as well as clinical course.

Results

A total of 120 patients were included with a median age of 61 years (IQR 50–72). The majority were African American (73%) and female (56%). Comorbidities on admission were present in 88% of patients; most prevalent were hypertension (76%), diabetes mellitus (55%), and chronic pulmonary disease (27%). Median Charlson comorbidity index was 4 (IQR 2–6) and BMI was 32.8 kg/m² (IQR 26.2–39.5). On presentation, patients most often complained of dyspnea (69%), fever (63%), and cough (53%), with a median SOFA score of 2 (IQR 2–4). Most patients were admitted to the general ward (71%), of which 17% were subsequently transferred to ICU. During hospitalization, 27% were mechanically ventilated for a median 11 days (IQR 5–13.5), 18% developed ARDS, and 43% developed AKI. Median length of stay was 9.5 days (IQR 3.75–14). Overall mortality was 20%, which was significantly higher among patients with comorbidities (p = 0.047), as well as those who developed ARDS (p < 0.001) or AKI (p = 0.027).

Conclusion

Most reports of COVID-19 have focused on large urban settings. However, early during the pandemic, we identified a large cluster of cases with a high-case fatality rate in a semirural setting in Southwest Georgia in the U.S.

Disclosures

All Authors: No reported disclosures

Support and perceived barriers to implementing pre-exposure prophylaxis screening and dispensing in pharmacies: Examining concordance between pharmacy technicians and pharmacists

OBJECTIVES

Recent legislation to expand pre-exposure prophylaxis (PrEP) screening and dispensing in pharmacies may significantly improve PrEP access for people at a high risk of human immunodeficiency virus (HIV) transmission. Studies have shown that pharmacists show wide support for PrEP expansion in pharmacies. However, pharmacy technicians are often the first point of contact for patients in pharmacies and are required to implement many of the tasks to ensure patients of a pharmacy receive adequate services. The purpose of this study was to assess pharmacists' and pharmacy technicians' perspectives regarding the implementation of PrEP screening and dispensing.

METHODS

We qualitatively examined whether pharmacy technicians' (n = 6) support and perceived barriers to screening and dispensing PrEP in pharmacies were concordant with those of pharmacists (n = 7). Pharmacy staff were recruited from high-risk HIV neighborhoods in Atlanta, GA using AIDSVu (Atlanta, GA). Two independent coders used MAXQDA (Berlin, Germany) and performed thematic data analysis and unitization to determine agreement.

RESULTS

Pharmacists and pharmacy technicians expressed strong willingness and support for screening and dispensing PrEP in pharmacies. Both groups expressed concerns about the time and the resources needed to perform PrEP screening and dispensing. Technicians, however, also reported concerns about privacy for patients, the need for community support and awareness of pharmacy-based PrEP screening, and recommended scheduling of PrEP screening activities during a limited part of the day to facilitate screening. Pharmacists reported fewer barriers but reported a need for more training of pharmacy staff to assist with PrEP screening and dispensing implementation.

CONCLUSION

Pharmacy technicians discussed more barriers compared with pharmacists who were largely centered around practical considerations (i.e., logistics and workflow) that may affect the success of PrEP screening and dispensing. Given technicians' pivotal role in the pharmacy, implementation of pharmacy-based PrEP services should address technicians' perceived barriers in addition to those of pharmacists.

Factors associated with health psychology use in pediatric type 1 diabetes

AIMS

Identify the prevalence of health psychology use in children with type 1 diabetes (T1D) and evaluate how individual and contextual characteristics are associated with use.

METHODS

Children ages 8-16 years with T1D and their parents were recruited from two tertiary diabetes clinics. Cross-sectional data included parent and adolescent surveys and hemoglobin A1c. Parents self-reported the child's use of health psychology in the last year along with individual factors (e.g., predisposing factors including demographics, enabling factors including health insurance type, evaluated need including mental health diagnoses and perceived need including self-management barriers). Association of health psychology use with individual (e.g., demographics, enabling factors, evaluated and perceived need) and contextual (e.g., clinical site) characteristics was evaluated using logistic regression.

RESULTS

Of 363 eligible participants, 267 (74%) participated. Health psychology use was reported by only 8.2% (n = 22) of participants and was significantly associated with evaluated need factor of mental health diagnosis (OR 5.8; p < 0.001) and perceived need factor of parent-reported self-management barriers. Use was not associated with other individual or contextual factors.

CONCLUSIONS

Though infrequent, health psychology use was positively associated with mental health diagnoses and self-management barriers.

Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men

OBJECTIVE

To understand the perceptions and support for pharmacy-based pre-exposure prophylaxis (PrEP) delivery among pharmacists and men who have sex with men (MSM).

DESIGN

A qualitative study from April 2017 to December 2018.

SETTING AND PARTICIPANTS

The researchers used purposive sampling to identify MSM participants and AIDSVu to identify pharmacists in high-human immunodeficiency virus (HIV) zip codes in the metropolitan Atlanta area. Eight MSM and 6 pharmacists consented to participate in the study.

OUTCOME MEASURES

Perceptions and support for PrEP delivery in pharmacies.

RESULTS

Both MSM and pharmacists expressed strong support for in-pharmacy PrEP screening and dissemination. MSM reported that pharmacies were more convenient and accessible compared with physician's offices. However, they also noted that privacy and training of pharmacy staff were important for them to consider being screened for PrEP in a pharmacy. Pharmacists also believed training was important and felt comfortable counseling on HIV prevention for their current patients.

CONCLUSION

These data support early evidence that pharmacies are a promising venue to improve PrEP access for MSM. To implement PrEP screening in pharmacies, proper training of pharmacy staff and a designated space to ensure privacy are critical. Future studies should test the feasibility of screening for PrEP in pharmacies for black MSM.

1306. Evaluation and Predictors of Antiretroviral (ART)-Related Medication Errors in Hospitalized People Living with HIV (PWLH)

Background

As HIV has become a chronic condition, management of the disease and preventing resistance is paramount to improving patient outcomes. Medication errors can lead to suboptimal therapy and potential development of resistance. The purpose of this study was to identify the rate of antiretroviral (ART)-related medication errors in hospitalized people living with HIV (PWLH).

Methods

This was a multi-center, retrospective cohort study of patients diagnosed with HIV and/or AIDS based on International Classification of Diseases codes. Patients were included if they were at least 18 years old and hospitalized between March 2016 and March 2018. Patients were excluded if they were pregnant and only received intravenous zidovudine during their hospitalization. Of the patients eligible for inclusion, 400 were randomly selected and included in this study. The primary objective was to determine the rate of inpatient ART-related medication errors. Secondary objectives included the type of errors and rate of error resolution prior to discharge.

Results

A total of 203 ART-related medication errors occurred during the study period (mean 0.9 ± 1.2 errors per patient). Incorrect schedule was the most common type of error followed by incorrect or incomplete regimen. More errors occurred in male patients (P = 0.01), those known to be infected with HIV on admission (P < 0.05), and in patients with an undetectable viral load (P = 0.01). Approximately 30% of ART-related medication errors were resolved prior to discharge, of which pharmacists were responsible for 25%. Incorrect schedule, incorrect or incomplete regimen, and clinically significant drug-drug interaction (DDI) were the most common medication errors that persisted at discharge. Among resolved errors, resolution of clinically significantly DDI or incorrect/incomplete ART were the most common interventions.

Conclusion

ART-related medication errors continue to occur in hospitalized PLWH and frequently persist at discharge. Interventions should be developed to reduce rates of ART-related medication errors on admission. Antimicrobial stewardship programs serve as an ideal platform to incorporate ART stewardship into routine activities to help minimize errors while inpatient and during transitions of care.

Disclosures

All authors: No reported disclosures.

Testing Young Adults' Reactions to Facebook Cues and Their Associations with Alcohol Use

Background: Alcohol cues on social media may influence young adults' drinking patterns, these cues may be pro-social or pro-alcohol in nature. The influence of individual Facebook cues on young adults' drinking intentions and behaviors remains unknown. Objectives: The purpose of this study was to assess how Facebook cues influence intention to drink, and how intention was associated with Theory of Reasoned Action constructs including alcohol-related attitudes and norms, and future behavior. Methods: Incoming university students completed a pre-college and a 2-year follow-up phone interview. A vignette presented individual Facebook cues representing "pro-social" or "pro-alcohol" sentiments. Participants indicated intention to drink alcohol and their rationale for this intention after each cue. Additional measures included TRA constructs of alcohol-related attitudes and norms, and problem alcohol use. Analyses included a qualitative approach to examine rationales for intention to drink in response to Facebook cues, and linear mixed effects models. Results: Of 338 participants, 56.1% were female, 74.8% were Caucasian. Alcohol-related attitudes and norms were positively associated with intention to drink in response to pro-social and pro-alcohol Facebook cues. Participants' intention to drink in response to pro-alcohol cues was positively associated with problem alcohol use two years later. Conclusions/importance: Findings illuminate the influence of social media on alcohol-related behaviors and highlight potential future screening approaches.

1926. Evaluation of Safety and Effectiveness of Continuous Infusion Ceftolozane/Tazobactam as Outpatient Parenteral Antimicrobial Therapy

Background

Ceftolozane/tazobactam (C/T) is indicated for complicated intra-abdominal infections and complicated urinary tract infections (cUTI). Its spectrum of activity extends to most Gram-negative bacteria including multidrug-resistant (MDR) Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing enterobacteriaceae. Current dosing requires 8-hour intervals in order to meet appropriate concentrations above the MIC, making outpatient delivery logistically difficult. C/T is stable up to 24 hours at room temperature, allowing for potential continuous infusion. This study evaluated patients who received this novel dosing regimen at an outpatient infusion center.

Methods

This study was a nonrandomized, retrospective chart review of adult patients who received C/T August 2016–January 2018 for any indication, including off-label, in the outpatient setting as a continuous infusion. Primary outcome evaluated was symptom resolution at the end of therapy documented in outpatient records. Secondary outcomes were microbiologic resolution at the end of therapy, if available, and patient satisfaction via a modified patient satisfaction survey assessed from follow-up phone call to patient.

Results

Seven patients received C/T in the outpatient setting and were included in the study. Infections treated varied and included pneumonia (three), cUTI (two), skin and soft tissue (one), and bacteremia (one). Most patients received 4.5 g (with one receiving 9 g) C/T over 24 hours mixed with normal saline via an ambulatory infusion pump refilled each day at an outpatient infusion center. All seven patients were infected with P. aeruginosa (four being MDR) with one patient co-infected with E. coli. Susceptibility testing was performed on three P. aeruginosa isolates (two susceptible and one intermediate). Six of seven patients reported symptom resolution at the end of therapy. Three patients were microbiologically evaluable at the end of therapy and all three demonstrated microbiologic resolution. Three of seven patients completed the satisfaction survey with all three reporting overall satisfaction. No adverse events were documented from any patients.

Conclusion

Ceftolozane/tazobactam administered as a continuous infusion in the outpatient setting is a safe, effective, and convenient way to treat complicated P. aeruginosa infections.

Disclosures

B. M. Jones, Merck: Grant Investigator, Grant recipient. C. Bland, Merck: Grant Investigator and Speaker’s Bureau, Grant recipient and Speaker honorarium.

Race and Time to Receipt of Androgen Deprivation Therapy Among Men With Metastatic Prostate Cancer

BACKGROUND

The Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT.

METHODS

The purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare.

RESULTS

A total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region.

CONCLUSION

Considering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.

Social Media Posts by Recreational Marijuana Companies and Administrative Code Regulations in Washington State

IMPORTANCE

Recreational marijuana use was legalized in the state of Washington in 2012, and the Washington Administrative Code (WAC) 314-55-155 was implemented to limit the exposure of youths to marijuana advertisements.

OBJECTIVES

To evaluate the content of social media posts by marijuana companies and to assess the compliance of these posts with WAC regulations.

DESIGN, SETTING, AND PARTICIPANTS

In a cross-sectional study, a content analysis of 1027 social media posts was conducted to identify and assess compliance of WAC regulations with the business pages of recreational marijuana companies located on Facebook and Twitter platforms in the state of Washington from December 1, 2015, through November 30, 2016.

MAIN OUTCOMES AND MEASURES

Application of coding based on WAC regulations to focus on the prohibition of language that promoted the overconsumption of marijuana, that described its curative or therapeutic benefits, or that was designed to appeal to youths; and the requirements for warnings about intoxication, driving, health risks, and age restrictions for marijuana.

RESULTS

Of the 1027 posts on Facebook and Twitter from business pages of 6 marijuana companies, Facebook followers ranged from 342 to 1592 persons and Twitter followers ranged from 374 to 2915 persons per company. Findings for WAC regulations included 17 posts (1.7%) that encouraged overconsumption; 137 posts (13.3%) that promoted therapeutic benefits; and 9 posts (0.01%) that appealed to youths. Requirements for warnings addressing intoxication, driving, health risks, and age restrictions were present on 110 posts (10.7%). Some businesses repeatedly violated particular regulations; 7 of 17 (41.2%) posts encouraging overconsumption derived from 1 marijuana company.

CONCLUSIONS AND RELEVANCE

Most social media posts by marijuana companies were consistent with WAC regulations that prohibit particular messages, but few companies provided required warning messages. Findings can be used toward implementation strategies for marijuana prevention to address these influential media messages.

The relationship of Type 1 diabetes self-management barriers to child and parent quality of life: a US cross-sectional study

AIM

Families of children and adolescents with Type 1 diabetes experience self-management challenges that negatively impact diabetes control. This study assesses whether self-management challenges are also associated with quality of life (QOL) for children and adolescents with Type 1 diabetes and their parents.

METHODS

Children aged 8-12 years (n = 135), adolescents aged 13-16 years (n = 132) and their parents completed QOL assessments (diabetes-specific QOL from the PedsQL Diabetes Module or the Family Impact Module, both scaled 0-100) and a validated survey of up to six self-management barriers [PRISM; scaled 1 (low) to 5 (high)]. Regression coefficients were calculated to assess the association of self-management barriers with child and adolescent diabetes-specific QOL or parent QOL, including interaction effects to assess the stability of the associations.

RESULTS

Mean duration of diabetes was 4.7 years for children and 6.1 years for adolescents. The majority of children and adolescents did not meet target values for glycaemic control. All barriers but one (Healthcare Team Interactions) were associated with lower diabetes-specific QOL for children and adolescents, as well as lower QOL for parents (all P < 0.05). Barrier scores that were 1 unit higher were associated with diabetes-specific QOL that was 3.7-5.1 points lower for children and 5.8-8.8 points lower for adolescents, as well as QOL that was 6.0-12.6 points lower for parents. Diabetes-specific QOL was most strongly associated with 'Denial of Disease and Its Consequences' for children and with 'Regimen Pain and Bother' for adolescents. Parent QOL was most strongly associated with 'Understanding and Organizing Care'. Associations were stable across numerous demographic and disease factors.

CONCLUSIONS

Single-unit differences in self-management barrier scores are associated with clinically meaningful differences in QOL for children and parents. Interventions specifically tailored to address individual self-management barriers may improve both diabetes control and QOL.

Evaluation of affective domain elements in a new pharmacy practice course

INTRODUCTION

In 2016, new Accreditation Standards were implemented that required integration of affective domain elements (ADEs) into the Doctor of Pharmacy (PharmD) curriculum and admissions interview process. The purpose of this study is to analyze the relationship between admissions variables and performance in a new course, and to analyze the relationship between student self-assessment and faculty evaluation of their development and performance in ADEs.

METHODS

Pre-pharmacy admission variables were evaluated for correlations with student performance in ADEs. Student self-assessments and faculty evaluations of performance in ADEs were also analyzed.

RESULTS

Statistically significant positive correlations were found between student age and completion of at least a bachelor's degree with student self-assessment in communication and leadership. When evaluating faculty assessment, significant positive correlations were found for female performance in the areas of leadership and team readiness. There was a positive association between the Pharmacy College Admission Test (PCAT) quantitative score and performance in professionalism; while negative associations were seen between the PCAT comprehensive score and student self-assessment in self-awareness and professionalism, and between the PCAT quantitative score and student self-assessment in self-awareness (p < 0.05 for all). Median evaluation ranks by faculty members were significantly lower than the median self-evaluation ranks done by students.

DISCUSSION AND CONCLUSION

This study suggests careful analysis of admissions variables in relation to ADEs may offer PharmD programs insight into how they design educational activities related to the affective domain. Additionally, evaluating multiple observations by both students and faculty members may identify patterns of growth and development in ADEs.