Evidence from some studies suggest that osteoarthritis (OA) patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) that are not in accordance with their cardiovascular (CV) or gastrointestinal (GI) risk profiles. However, no such study has been carried out in the United States. Therefore, we sought to examine the prevalence and predictors of potentially inappropriate NSAIDs use in older adults (age > 65) with OA using machine learning with real-world data from Optum De-identified Clinformatics® Data Mart. We identified a retrospective cohort of eligible individuals using data from 2015 (baseline) and 2016 (follow-up). Potentially inappropriate NSAIDs use was identified using the type (COX-2 selective vs. non-selective) and length of NSAIDs use and an individual’s CV and GI risk. Predictors of potentially inappropriate NSAIDs use were identified using eXtreme Gradient Boosting. Our study cohort comprised of 44,990 individuals (mean age 75.9 years). We found that 12.8% individuals had potentially inappropriate NSAIDs use, but the rate was disproportionately higher (44.5%) in individuals at low CV/high GI risk. Longer duration of NSAIDs use during baseline (AOR 1.02; 95% CI:1.02–1.02 for both non-selective and selective NSAIDs) was associated with a higher risk of potentially inappropriate NSAIDs use. Additionally, individuals with low CV/high GI (AOR 1.34; 95% CI:1.20–1.50) and high CV/low GI risk (AOR 1.61; 95% CI:1.34–1.93) were also more likely to have potentially inappropriate NSAIDs use. Heightened surveillance of older adults with OA requiring NSAIDs is warranted.

A447and optimise the reporting of such evaluations. To our knowledge, there are no such published guidelines in Spain. Methods: This guidance was designed with the main aim of providing authors with recommendations, in the form of a checklist, to optimise design and reporting of EE and BIA to be submitted to the Catalan Health System (CatSalut) within its harmonization program for pharmaceutical innovation. Results: For a given evaluation, two separate guidelines with corresponding checklists assess its methodology, quality, and reporting based on several dimensions. ConClusions: The steps outlined in this first guidance in Spain, although not compulsory, will provide useful practical tips for how to go about designing and reporting of an EE or a BIA for pharmaceuticals in Catalonia (Spain).

Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient's sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5–97.5%) and high trust (95.4–99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed.

Background The association between poor oral health and diabetes is well documented. Therefore, preventive oral health is strongly indicated for individuals with diabetes. The purposes of this study were 1) to determine if there were a difference in preventive dental care utilization among older adults with diabetes from 2002 and 2011, and 2) to compare preventive dental care utilization of older adults with and without diabetes from 2002 and 2011. Methods The data were from the Medicare Current Beneficiary Survey. The sample included older, fee-for-service Medicare beneficiaries (ages 65 years and above). The key outcome was self-reported preventive dental care. In 2002, there were 8,725 participants; in 2011, there were 7,425 participants. Chi square and logistic regressions were conducted. Results In 2002, 28.8 % of participants with diabetes had preventive dental care. In 2011, this percentage increased to 36.0%. Similar results were seen among individuals without diabetes (42.9% in 2002 and 45.5% in 2011). The increase in preventive dental care was statistically significant for individuals with and without diabetes. The participants with diabetes, as compared with participants without diabetes, remained statistically less likely to have preventive dental care in adjusted logistic regression analysis with and without considering the interaction between observation year and diabetes (adjusted odds ratios= 0.73, and 0.86, respectively). Conclusion While the increase in preventive dental care is welcoming, older adults with diabetes continue to have significant preventive dental care need. Practical Implication Additional efforts are needed to encourage individuals with diabetes to obtain preventive dental care.