Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital

Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases. Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED. Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted. Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients. Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

P548 Drug Survival in Patients with Inflammatory Bowel disease: An observational study

Background Although the therapeutic array has significantly widened, over the past decades predicting treatment persistence in IBD patients is still a challenge. In this study we collected longitudinal data to determine drug survival on the medications currently available for IBD. Methods Patients treated in the IBD outpatient clinic of the Goethe University Hospital were retrospectively analyzed. Laboratory parameters and data on treatment adherence were collected via the electronic patient file. We investigated how many patients continued on the respective substances after the induction period and after the 1-year mark. Results A total of 601 patients were included. 321 patients were female (53.4), 280 patients were male (46.6). The median age was 43 (range 19–86). The median disease duration was 14 years (range 1–52). 320 patients (53.2) suffered from CD and 281 (46,8) patients suffered from UC. 95 patients were treated with Infliximab (IFX) with a median duration of 912 days (20–5273). 91 patients (96.8) were still on IFX after the induction period. 73 patients (76.8) patients reached the 1-year mark. At the endpoint of this investigation, 39 patients (41.9) were still on IFX. 172 patients were started on Adalimumab (ADA) with a median of 1054 (48–4458) days on the medication. Of this collective, 172 (100%) patients continued on ADA after the end of the induction period. 136 patients (79.1) reached the 1-year mark. At the endpoint of this investigation, 90 patients (52.3) were still on ADA. Of the entire cohort, 124 patients were treated with Vedolizumab (VDZ) with a median of 745.50 (0-2204) days on the medication. After the induction period for this medication, 123 patients (99.2%) were still on VDZ. 89 patients (71.8%) achieved the 1-year mark. At the endpoint of this investigation, 82 patients (66.1%) were still on VDZ. Lastly, 66 patients were treated with Ustekinumab (UST) with a median duration of 720 days (50–1777). 64 patients (98.5%) achieved clinical remission. 48 patients (72.7%) achieved the 1-year mark. At the endpoint of this investigation, 54 patients (83.1%) were still on UST. As we provided longitudinal data some patients have been exposed to several medications which in part explains the lower patient numbers in the more recently approved drugs. Conclusion Conclusion: The majority of patients were still on the medication after the respective induction in all treatment groups. 1-year treatment persistence was higher for and ADA in comparison to VDZ and UST. Our study provides further evidence on drug survival in IBD and may aid in advising patients in this matter.

Incidence and Causes for Early Ticagrelor Discontinuation: A “Real-World” Dutch Registry Experience

Objectives: The PLATO trial revealed superiority of ticagrelor over clopidogrel for the prevention of atherothrombotic events in patients with acute coronary syndrome. However, adverse events such as bleeding, dyspnea, and bradycardia were frequently reported, potentially leading to excess early ticagrelor discontinuation (ETD), later confirmed in the PEGASUS trial. We here evaluated the incidence and causes for ETD in a real-world patient cohort in a high-volume nonacademic percutaneous coronary intervention center in the Netherlands. Methods: In a retrospective single-center registry, all patients discharged from the hospital with a new ticagrelor prescription were screened for ETD. Follow-up data were obtained using the hospital electronic patient file records and confirmed by telephone contact with the patient and/or general practitioner, if necessary, to complement the data. Results: Ticagrelor was prescribed in 354 patients between December 2011 and December 2012. The follow-up data were available in 301 patients with a mean follow-up duration of 330 days. ETD or switching to another antiplatelet agent occurred in 73 patients (24.3%), mostly due to dyspnea (11.6%), bleeding (3.7%), or planned major surgery (2.7%). Conclusions: Almost one quarter of ticagrelor patients were discontinued prematurely or switched to another antiplatelet agent within 1 year, mostly due to dyspnea or bleeding.

A Case Study On Inter-Organizational Systems and Power

The objective of this article is to show by means of a case study how attempts to develop and implement inter-organizational systems (IOS) can be perceived as power battles, reflections of interests of stakeholders and struggles for domination. The paper shows that IOS is not simply a technical and rational solution but that it involves political processes of articulating interests, building alliances and struggling over outcomes. These issues will be examined through an empirical study of a project to introduce an electronic patient file (EPF) system in The Netherlands. We will seek to expand our knowledge of how inter-organizational systems impact relations among organizations and individuals who use these systems and how such systems affect the division of power inside and between organizations. Such knowledge can be useful when applying an analysis of power during the process of the design and implementation of IOS, which can help managers to implement IOS more effectively.