Medical institutions worldwide strive to avoid adverse medical events, including adverse medication-related events. However, studies on the comprehensive analysis of medication-related adverse events are limited. Therefore, we aimed to identify the error factors contributing to medication-related adverse events using the Human Factors Analysis and Classification System (HFACS) and to develop error models through logistic regression. These models calculate the probability of a medication-related adverse event when a healthcare system defect occurs. Seven experts with at least 12 years of work experience (four nurses and three pharmacists) were recruited to analyze thirty-seven medication-related adverse events. The findings indicate that decision errors, physical/mental limitations, failure to correct problems, and organizational processes were the four factors that most frequently contributed to errors at the four levels of the HFACS. Seven error models of two types (error occurrence and error analysis pathways) were established using logistic regression models, and the relative probabilities of failure factor occurrences were calculated. Based on our results, medical staff can use the error models as a new analytical approach to improve and prevent adverse medication events, thereby improving patient safety.

OBJECTIVES:A daily assessment of the speed of action and effectiveness of treatment of a combination of paracetamol and codeine in patients suffering from intense pain, which has progressed since less than 7 days. METHODS: A multicentre longitudinal observational prospective study carried out in metropolitan France using data collected by general practitioners who agreed to participate. RESULTS: A total of 574 patients treated by a paracetamol-codeine combination (600mg/50mg and 400mg/20mg) were included. The severity of pain measured at inclusion using a visual numeric scale was 7Ϯ1.28. The severity of pain measured after half a day of treatment was 5.61Ϯ1.87 and 5.28 Ϯ 1.86 at the end of the first 24 hours of treatment. A significant improvement in pain was observed from the first half-day (pϽ0.001). The severity of pain on the 2nd, 4th and 7th evenings was respectively 4.08Ϯ1.85; 2.76Ϯ1.76 and 1.79 Ϯ1.69 On D1, 69.7% declared treatment to be effective, 61.04% were satisfied with their treatment and 79.26% did not observe any side effects to the treatment. On D7, 96.15% (D3, 91.3% ) declared treatment to be effective, 87.10% were satisfied with their treatment and 88.96% did not observe any side effects to the treatment. 8 out of 10 patients did not complain about side effects related to the treatment. CONCLUSIONS: A reduction in pain within the first 12 hours showed the pertinence of treatment using a paracetamol-codeine combination. This pertinence was confirmed by two-thirds patients who declared the treatment to be effective from the 1st day, and 91% of them declared this on the 3rd day

A621the effect of perceived financial burden of the co-payment on antihypertensive adherence in patients within the GMS. We recruited community dwelling older adults (N= 1592) from 106 community pharmacies in the Republic of Ireland between March and May 2014, administering a structured telephone interview and following up at 12 months. Dispensing records from the pharmacy were linked to each patient interview. Perceived financial burden was assessed at baseline using a single questionnaire item. Adherence was assessed at 12 months using an 8-item self-report questionnaire and by calculating the proportion of days covered (PDC) from linked dispensing records. Results: At baseline 75.1% (n= 1152) of participants were GMS eligible and 30.1% of GMS participants reported feeling financially burdened by medication costs. In linear regression models adjusted for socio-demographics, medical history, and medication use, financially burdened GMS participants had significantly lower self-reported adherence (β = -0.32, 95% CI -0.51 to -0.14), although this was not evident with refill adherence (β = -0.03, 95% CI -0.08 to 0.02). ConClusions: Further work on the financial barrier to antihypertensive adherence within the GMS is warranted and its potential impact on long-term patient outcomes.

Objectives: To compare treatment persistence and adherence over one year in biologic naïve psoriatic arthritis (PsA) patients initiating apremilast or biologics using a U.S. administrative claims database. MethOds: This retrospective study selected adult PsA patients initiating apremilast or biologics within the January 2013-June 2016 Truven Health MarketScan claims databases. Patients were required to be apremilast/biologic naïve on the index agent in the 12-month pre-index period and have continuous enrollment in the 12-month pre-and post-index periods (index date = initial apremilast or biologic claim). Biologic users were matched 2:1 to apremilast users. Treatment persistence at 12 months was defined as continuous treatment without (1) a > 60-day gap in therapy or (2) a switch to a different PsA treatment and measured during the 12-month post-index period. Patients were adherent if their medication possession ratio (MPR) was ≥ 80% while persistent on the index agent. Results: A total of 381 patients initiating apremilast were matched to 761 patients initiating biologics. Baseline characteristics were similar in both groups (mean age 51 years, 60% female, mean Charlson score 0.6). Treatment persistence at 12 months for apremilast users was similar to biologic users (43% vs 48%; p= 0.082). Average time to non-persistence was 124 days for apremilast users compared to 132 days for biologics users (p= 0.194). Among non-persistent users, apremilast users and biologic users had similar switch rates (7% vs 9%; p= 0.389) and discontinuation rates (93% vs 91%; p= 0.389). Average persistence-based MPR was 0.870 for apremilast users compared to 0.854 for biologic users (p= 0.056), and the adherence rates were 77% and 73%, respectively (p= 0.175). cOnclusiOns: At 12 months, persistence and adherence as well as drivers of non-persistence were similar for biologic naïve patients initiating apremilast or biologics for the treatment of PsA in the U.S.