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Objective Opioids are frequently used in spine surgeries despite their adverse effects, including physical dependence and addiction. Gender difference is an important consideration for personalized treatment. There is no review assessing the prevalence of opioid use between men and women before spine surgeries. Design We compared the prevalence of preoperative opioid use between men and women. Setting Spine surgery. Subjects Comparison between men and women. Methods PubMed, Embase, and Cochrane were searched from inception to November 9, 2018. Clinical characteristics and prevalence of preoperative opioid use were collected. Where feasible, data were pooled from nonoverlapping studies using random-effects models. Results Four studies with nonoverlapping populations were included in the meta-analysis (one prospective, three retrospective cohorts). The prevalence of preoperative opioid use was 0.64 (95% CI = 0.40–0.83). Comparing men with women, no statistically significant difference in preoperative opioid use was detected (relative risk [RR] = 0.99, 95% CI = 0.96–1.02). Surgery location (cervical, lumbar) and study duration (more than five years or five years or less) did not modify this association. All involved open spine surgery. Only one secondary analysis provided data on both pre- and postoperative opioid use stratified by gender, which showed a borderline significantly higher prevalence of postoperative use in women than men. Conclusions The prevalence of opioid use before spine surgery was similar between men and women, irrespective of surgery location or study duration. More studies characterizing the pattern of opioid use between genders are still needed.

A283a specialty or traditional drug depending on its inclusion in the largest pharmacy benefit managers' specialty drug lists. We estimated the population health gain if 50% (range 10-90%) of eligible patients switched from the current standard of care to the new drug. We used Mann-Whitney U test to compare population health gains for specialty versus traditional drugs. Results: FDA approved 279 NMEs from 1999-2011. We identified QALY gain estimates for 101 NMEs (36% of approved drugs), including 57 specialty drugs and LY gain estimates for 50 NMEs (18%), including 35 specialty drugs. The median estimated population QALY gain for specialty drugs was 27,809 (IQR= 150,713) [range 5,562 to 50,506] and for traditional drugs was 3,798 (IQR= 193,409) [range 760 to 6,838]. The median estimated population LY gain for specialty drugs was 38,559 (IQR= 195,801) [range 7,712 to 69,406], and for traditional drugs was 9,439 (IQR= 1,939,730) [range 1,888 to 16,990]. We did not find a statistically significant difference between specialty and traditional drugs in the estimated population QALY (p= 0.138) and LY gains (p= 0.721) in the 12 months following their approval. ConClusions: Despite tending to be indicated for diseases of lower prevalence we found a trend towards specialty drugs offering larger population health benefits than traditional drugs, particularly when measured in terms of QALY (p= 0.138).

Background: Medication therapy management (MTM) is a set of services that have proven to optimize therapeutic outcomes and be extremely beneficial to patients. However, evidence suggests that pharmacists are not providing MTM services at the rate that they could be. While studies have elucidated on the facilitators and barriers for pharmacists when providing MTM, few have offered a comprehensive explanation that encompasses both physical and psychosocial factors. The Theory of Reasoned Action can be used to assess the attitudes, self-efficacy, and intent of pharmacists in the provision of MTM services (MTMS). Methods: This is a cross-sectional, survey-based study. The survey contains five sections and 48 items that measure constructs relating to a modified Theory of Reasoned Action (TRA). The survey was administered via the web-based platform Qualtrics. From a list obtained from the Ohio State Board of Pharmacy, 12,140 registered pharmacists were emailed the electronic survey. Descriptive statistics will be used and composite scores will be calculated for the constructs in the TRA. Pearson's correlations and binary logistic regression analyses will be done to address the third iv objective. Lastly, a qualitative analysis was conducted for three open-ended survey questions. Results: A total of 487 responses were retained for analysis. The majority of participants had positive attitudes (71.4%), subjective norm (60.3%), and self-efficacy (75.2%) toward the provision of MTMS. Of MTMS providers, most intended to continue providing MTMS (91.3%). A lesser percentage (40.6%), intended to provide additional MTMS to their current selection of services. Of non-MTMS, only 30.0% intended to begin providing such services. All TRA constructs were found to relate to each other among MTMS providers and a supporting supervisor (p=0.010), easy billing (p=0.032), and high confidence (p=0.21) were predictive of intention. Qualitative analyses identified that many participants consider time, access to a billing platform, training materials, and managerial support as the main facilitators for the provision of MTMS. Lack of time, inadequate staff, and lack of managerial support were identified as the main barriers. Conclusion: Managerial support and self-efficacy is vital to the successful incorporation of MTMS in pharmacy practice. To cement the value of pharmacist-provided MTM to administration, its financial value must be proven. Providers' status is key to address this. Additionally, pharmacists must be well-equipped and trained to effectively provide MTMS when providers' status is granted to be able to quickly transition into a more clinical role. Access to MTM-specific training materials in the pharmacy can help better equip pharmacists to provide these services. I would like to acknowledge the support and guidance of my committee members, Dr. Pinto, Mrs. Puffer, and Dr. Khuder, without which I may not have successfully completed my first independent research project. Additionally, I would like to express my sincere gratitude for...