PHS63 Cost-Effectiveness Analysis Of A Pharmacist-Led Intervention On Improving Inhaler Adherence In Patients With Chronic Obstructive Pulmonary Disease

Objectives: The Belgian community pharmacist-led PHARMACOP intervention provided educational inhalation training sessions and motivational interviewing regarding medication use in patients with Chronic Obstructive Pulmonary Disease (COPD). The program significantly improved medication adherence and inhalation techniques compared with usual care. This study aimed to evaluate its costeffectiveness. Methods: An economic analysis was performed from the Belgian health care payer's perspective. A Markov model was constructed in which a cohort of 1,000 patients with COPD receiving the 3-month PHARMACOP-intervention or usual care, was followed. This cohort had a mean age of 70 years, 66% were male, 43% current smokers and patients had a mean Forced Expiratory Volume in 1 second of % predicted of 50. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year (QALY) gained. Follow-up was 1 year in the basecase analysis. Univariate-, probabilistic sensitivity- and scenario analyses (including long-term follow-up) were performed to assess uncertainty. Results: In the basecase analysis, the average overall costs per patient for the PHARMACOPintervention and usual care were € 2,221 and € 2,448, respectively within the 1-year time horizon. This reflects cost savings of € 227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 71 hospital-treated exacerbations (167 for PHARMACOP versus 238 for usual care), i.e. 0.07 (95%CI: 0.04-0.10) incremental hospital-treated exacerbations per patient. In addition, a small (<0.001 QALYs) increase in QALYs was observed. Results showed robust costsavings in various sensitivity analyses. Conclusions: Optimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies

Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) - Sex differences and associations with morbidity and medication use

INTRODUCTION: Multimorbidity in advanced age and the need for drug treatment may lead to polypharmacy, while pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug events (ADEs). OBJECTIVE: The aim of this study was to determine the proportion of subjects using potentially inappropriate medication (PIM) in a cohort of older and predominantly healthy adults in relation to polypharmacy and morbidity. METHODS: Cross-sectional data were available from 1,382 study participants (median age 69 years, IQR 67-71, 51.3% females) of the Berlin Aging Study II (BASE-II). PIM was classified according to the EU(7)-PIM and German PRISCUS (representing a subset of the former) list. Polypharmacy was defined as the concomitant use of at least five drugs. A morbidity index (MI) largely based on the Charlson Index was applied to evaluate the morbidity burden. RESULTS: Overall, 24.1% of the participants were affected by polypharmacy. On average, men used 2 (IQR 1-4) and women 3 drugs (IQR 1-5). According to PRISCUS and EU(7)-PIM, 5.9% and 22.6% of participants received at least one PIM, while use was significantly more prevalent in females (25.5%) compared to males (19.6%) considering EU(7)-PIM (p = 0.01). In addition, morbidity in males receiving PIM according to EU(7)-PIM was higher (median MI 1, IQR 1-3) compared to males without PIM use (median MI 1, IQR 0-2, p<0.001). CONCLUSION: PIM use occurred more frequently in women than in men, while it was associated with higher morbidity in males. As expected, EU(7)-PIM identifies more subjects as PIM users than the PRISCUS list but further studies are needed to investigate the differential impact of both lists on ADEs and outcome. KEY POINTS: We found PIM use to be associated with a higher number of regular medications and with increased morbidity. Additionally, we detected a higher prevalence of PIM use in females compared to males, suggesting that women and people needing intensive drug treatment are patient groups, who are particularly affected by PIM use

Determining Contingencies in the Management of Construction Projects

[EN] This research describes the managerial approaches that contractors follow to determine different types of contingencies in construction project management. Two large Spanish general contractors were selected for an in-depth analysis. Interviews and surveys were conducted with six additional companies to explore the external validity of the findings. Managers constrain time and cost buffers through project objectives, applying heuristics to determine inventory buffers. The management of capacity buffers is entrusted to subcontractors. The contractors take advantage of scope and quality buffers to meet project objectives but rarely share these buffers with the owner, unless the owner is an internal client.Ortiz-González, JI.; Pellicer, E.; Molenaar, KR. (2019). Determining Contingencies in the Management of Construction Projects. Project Management Journal. 50(2):226-242. https://doi.org/10.1177/8756972819827389S226242502Adafin, J., Wilkinson, S., Rotimi, J. O. B., & Odeyinka, H. (2014). Accuracy in Design Stage Cost Estimating through Risk-contingency Analysis: A Theoretical Exploration. Construction Research Congress 2014. doi:10.1061/9780784413517.151Ballard, G., & Howell, G. (1998). Shielding Production: Essential Step in Production Control. Journal of Construction Engineering and Management, 124(1), 11-17. doi:10.1061/(asce)0733-9364(1998)124:1(11)Barraza, G. A. (2011). Probabilistic Estimation and Allocation of Project Time Contingency. Journal of Construction Engineering and Management, 137(4), 259-265. doi:10.1061/(asce)co.1943-7862.0000280Blomquist, T., Hällgren, M., Nilsson, A., & Söderholm, A. (2010). Project-as-Practice: In Search of Project Management Research that Matters. Project Management Journal, 41(1), 5-16. doi:10.1002/pmj.20141Chan, E. H., & Au, M. C. (2009). Factors Influencing Building Contractors’ Pricing for Time-Related Risks in Tenders. Journal of Construction Engineering and Management, 135(3), 135-145. doi:10.1061/(asce)0733-9364(2009)135:3(135)De la Cruz, M. P., del Caño, A., & de la Cruz, E. (2006). Downside Risks in Construction Projects Developed by the Civil Service: The Case of Spain. Journal of Construction Engineering and Management, 132(8), 844-852. doi:10.1061/(asce)0733-9364(2006)132:8(844)Ford, D. N. (2002). Achieving Multiple Project Objectives through Contingency Management. Journal of Construction Engineering and Management, 128(1), 30-39. doi:10.1061/(asce)0733-9364(2002)128:1(30)González, V., Alarcón, L. F., & Molenaar, K. (2009). Multiobjective design of Work-In-Process buffer for scheduling repetitive building projects. Automation in Construction, 18(2), 95-108. doi:10.1016/j.autcon.2008.05.005Guest, G., Bunce, A., & Johnson, L. (2006). How Many Interviews Are Enough? Field Methods, 18(1), 59-82. doi:10.1177/1525822x05279903Günhan, S., & Arditi, D. (2007). Budgeting Owner’s Construction Contingency. Journal of Construction Engineering and Management, 133(7), 492-497. doi:10.1061/(asce)0733-9364(2007)133:7(492)Hällgren, M., & Wilson, T. L. (2008). The nature and management of crises in construction projects: Projects-as-practice observations. International Journal of Project Management, 26(8), 830-838. doi:10.1016/j.ijproman.2007.10.005Harbuck R. H. (2004). Competitive bidding for highway construction projects (pp. ES91–ES94). Morgantown, WV: AACE International Transactions.HORMAN, M., & KENLEY, R. (1998). Process Dynamics: Identifying a Strategy for the Deployment of Buffers in Building Projects. International Journal of Logistics Research and Applications, 1(3), 221-237. doi:10.1080/13675569808962049Horman, M. J., & Thomas, H. R. (2005). Role of Inventory Buffers in Construction Labor Performance. Journal of Construction Engineering and Management, 131(7), 834-843. doi:10.1061/(asce)0733-9364(2005)131:7(834)Howell, G., Laufer, A., & Ballard, G. (1993). Interaction between Subcycles: One Key to Improved Methods. Journal of Construction Engineering and Management, 119(4), 714-728. doi:10.1061/(asce)0733-9364(1993)119:4(714)Howell, G., Laufer, A., & Ballard, G. (1993). Uncertainty and project objectives. Project Appraisal, 8(1), 37-43. doi:10.1080/02688867.1993.9726884Idrus, A., Fadhil Nuruddin, M., & Rohman, M. A. (2011). Development of project cost contingency estimation model using risk analysis and fuzzy expert system. Expert Systems with Applications, 38(3), 1501-1508. doi:10.1016/j.eswa.2010.07.061Laryea, S., & Hughes, W. (2011). Risk and Price in the Bidding Process of Contractors. Journal of Construction Engineering and Management, 137(4), 248-258. doi:10.1061/(asce)co.1943-7862.0000293Leach, L. (2003). Schedule and Cost Buffer Sizing: How to Account for the Bias between Project Performance and Your Model. Project Management Journal, 34(2), 34-47. doi:10.1177/875697280303400205Lee, S., Peña-Mora, F., & Park, M. (2006). Reliability and Stability Buffering Approach: Focusing on the Issues of Errors and Changes in Concurrent Design and Construction Projects. Journal of Construction Engineering and Management, 132(5), 452-464. doi:10.1061/(asce)0733-9364(2006)132:5(452)Oviedo-Haito, R. J., Jiménez, J., Cardoso, F. F., & Pellicer, E. (2014). Survival Factors for Subcontractors in Economic Downturns. Journal of Construction Engineering and Management, 140(3), 04013056. doi:10.1061/(asce)co.1943-7862.0000811Pellicer, E., Sanz, M. A., Esmaeili, B., & Molenaar, K. R. (2016). Exploration of Team Integration in Spanish Multifamily Residential Building Construction. Journal of Management in Engineering, 32(5), 05016012. doi:10.1061/(asce)me.1943-5479.0000438Pellicer, E., & Victory, R. (2006). IMPLEMENTATION OF PROJECT MANAGEMENT PRINCIPLES IN SPANISH RESIDENTIAL DEVELOPMENTS. International Journal of Strategic Property Management, 10(4), 233-248. doi:10.3846/1648715x.2006.9637555Rooke, J., Seymour, D., & Fellows, R. (2004). Planning for claims: an ethnography of industry culture. Construction Management and Economics, 22(6), 655-662. doi:10.1080/014461904200026324Slauson N. P. (2005). The effectiveness of the construction contract (pp. PM121–PM127). Morgantown, WV: AACE International Transactions.Tah, J. H. M., Thorpe, A., & McCaffer, R. (1993). Contractor project risks contingency allocation using linguistic approximation. Computing Systems in Engineering, 4(2-3), 281-293. doi:10.1016/0956-0521(93)90052-xTaylor, J. E., Dossick, C. S., & Garvin, M. (2011). Meeting the Burden of Proof with Case-Study Research. Journal of Construction Engineering and Management, 137(4), 303-311. doi:10.1061/(asce)co.1943-7862.0000283Thal, A. E., Cook, J. J., & White, E. D. (2010). Estimation of Cost Contingency for Air Force Construction Projects. Journal of Construction Engineering and Management, 136(11), 1181-1188. doi:10.1061/(asce)co.1943-7862.0000227Thamhain, H. (2013). Managing Risks in Complex Projects. Project Management Journal, 44(2), 20-35. doi:10.1002/pmj.21325Yeo, K. T. (1990). Risks, Classification of Estimates, and Contingency Management. Journal of Management in Engineering, 6(4), 458-470. doi:10.1061/(asce)9742-597x(1990)6:4(458

Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

Principles for the design and operation of engineer-to-order supply chains in the construction sector

By integrating the approaches of Forrester and Burbidge [Forrester, J. W. 1961. Industrial Dynamics. Pegasus Communications; Burbidge, J. L. 1961. “The “New Approach” to Production.” Production Engineer 40: 769–784], a set of five design principles have emerged which provide a foundation for sound supply chain design. The ‘FORRIDGE’ principles have since been shown to be a powerful guide for effective design of make-to-stock supply chains. However, some have questioned the applicability of generic supply chain thinking, arguing for a tailored approach. Hence, the goal here is to investigate how these principles should be adapted for engineer-to-order (ETO) industries, such as construction, capital goods and shipbuilding. The empirical elements draw on an extensive study of 12 suppliers and two large contractors in the construction industry. Supply chain tactics are identified for this range of companies, which are matched with real world problems, and linked with the FORRIDGE principles. This results in an additional ‘Design for X’ principle being proposed. The contributions made are the adaptation of established principles for the ETO sector, and the framework behind these principles