P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England

Background/Aims NICE publishes guidance underpinned by act of Parliament and legally enforceable, on the use of biological therapies in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) which should allow harmonisation of access independent of region. However, sufficient guidance is not provided on the use of sequential biologics nor is a numerical cap placed on the number of biologics a patient can attempt if they have had an inadequate response. We have previously reported that in a limited sample, Clinical Commissioning Groups (CCGs) interpret NICE guidance variably and restrict access to NICE approved treatments depending on geography, the so-called “postcode lottery”. We determined the variability of biologics pathways in all CCG’s in England to examine whether a potentially unfair postcode lottery exists for sequential biologics use. Methods All 135 England CCGs covering over 55 million people, were sent Freedom of Information requests, for their biologic pathways for RA, PsA and AS. Where CCGs did not have this information, the relevant acute trusts were contacted, with responses recorded under that CCG. For every CCG the local biologics pathways were examined for detail on the number and type of biologics commissioned before an Individual Funding Request was needed. “No Cap” was recorded if CCG’s responded with no restriction on the number of biologics. Results Responses were obtained from 124/135 CCG’s for RA, 122/135 for PsA and AS, all covering an estimated population in excess of 45 million people. For RA, 55% CCG’s had no cap on the number of commissioned RA biologics. 45% had a variable cap from 3 to 6 commissioned biologics. For PsA, the figures were 54% with no cap and 46% with variable capping between 2-5 biologics allowed, for AS the figures were 51% and 49% respectively. In total this represented 41 different local pathways for RA, 29 different pathways for PsA and in AS where fewer biologics choices exist, 25 different pathways depending on CCG and location. Conclusion There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patient care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriate biologic. The results of this national study demonstrate the variability of biologics pathways in many areas of England ensuring a postcode lottery still exists in many regions. Disclosure J. Mistry: None. D. Hill: None. A. Bosworth: None. A. Kaul: None.

Individual Funding for People With Mental Health Issues

This chapter outlines the key features of individual funding programs and examines their suitability for people with mental illness. This is a contested area with some writers concerned that mental illness is different from other types of disability and unsuitable for individual funding. The recovery model and the episodic nature of mental illness are seen as conflicting with individual funding eligibility criteria for consistent and permanent disability. The counter view is that flexible individual funding is ideally suited to meeting the fluctuating needs of people with mental illness: its key principles of empowerment and self-direction being consistent with the recovery paradigm. Evidence from Australian and international studies is reviewed, suggesting that successful outcomes can be achieved if the necessary supports and resources are available to meet people's needs.

Financial and Analytical Aspects of Making Decisions on Determining the Roles of Participants in Partnership Projects

The article is aimed at forming an analytical basis for making decisions on determining the optimal role played by participants in financing partnership projects for the economic development of a state. The paper outlines the importance of distributing financial support efficiently in order to address problems related to the lack of funding and low efficiency of socially important projects implemented on a partnership basis. Statistical data testifying to the development of projects implemented in Ukraine on a partnership basis are considered. The most common forms of partnership agreements and financial support mechanisms used in partnership projects in Ukraine are also identified. The regions of Ukraine that are leaders and outsiders as for the number of partnership agreements concluded and / or implemented on their territory are identified. The effectiveness of various financial participation forms used by various parties to partnership projects is analyzed. To fulfill the task, the participation of potential investors is generalized by three sources of funding: state budget funds, local budget funds and other sources that include all extrabudgetary financial resources (own resources of program participants, businesses and individuals related to project implementation results, international organizations, as well as sponsorship and charitable funds, borrowed funds, etc.). Regression models have been constructed to determine the impact of the funding sources involved on the successful implementation of partnership projects in different areas (programs in economic, social and environmental areas are considered separately). Based on the modelling results, the elasticity coefficient has been calculated, which shows the extent to which the attraction of an individual funding source influences the success of the program. Conclusions are made on the extent to which the increase (or decrease) of the share of funding from a single source affects the success of the program in a certain area

Implementation of Integrative Arabic Grammar (Nahwu & Sharaf) Curriculum in Islamic Boarding School

Learning Nahwu & Sharaf is considered a frightening subject by students in Islamic boarding schools and informal Islamic boarding schools. One of the reasons is that the institution's existing curriculum has not been planned and presented correctly. One of the institutions with an integrative curriculum to teach Nahwu & Sharaf subjects considered acceptable is the Darul Uluum Islamic Boarding School.This study aimed to describe Nahwu & Sharaf curriculum development concepts and models at Daarul Uluum Islamic boarding school at Majalengka supporting and inhibiting implementing the curriculum. The method used in this study was qualitative research. Data collection used interviews, the teacher's approach to teaching Nahwu & Sharaf, and the Islamic boarding school syllabus.The results showed that Nahwu & Sharaf curriculum development model was a central de-central, which combined two administrative approaches and the grassroots approach. The supporting factors were: 1) Motivation of leaders of Islamic boarding school; 2) Commitments of leaders of Islamic boarding schoolto develop curriculum, 3) Professional competence of Nahwu & Sharaf teachers, and 4) Input of students who have an initial understanding of the material to be obtainable. The inhibiting factors were: 1) the lack of individual funding allocations; 2) the teacher has not been able to properly teach students the material in Nahwu & Sharaf syllabus; 3) the unequal ability of teachers to teach in class Nahwu & Sharaf subjects; and 4) students feel bored while studying in class.

Concentration of Danish research funding on individual researchers and research topics: Patterns and potential drivers

The degree of concentration in research funding has long been a principal matter of contention in science policy. Strong concentration has been seen as a tool for optimizing and focusing research investments but also as a damaging path towards hypercompetition, diminished diversity, and conservative topic selection. While several studies have documented funding concentration linked to individual funding organizations, few have looked at funding concentration from a systemic perspective. In this article, we examine nearly 20,000 competitive grants allocated by 15 major Danish research funders. Our results show a strongly skewed allocation of funding towards a small elite of individual researchers, and towards a select group of research areas and topics. We discuss potential drivers and highlight that funding concentration likely results from a complex interplay between funders’ overlapping priorities, excellence-dominated evaluation criteria, and lack of coordination between both public and private research funding bodies.

Concentration of Danish research funding on individual researchers and research topics: Patterns and potential drivers

The degree of concentration in research funding has long been a principal matter of contention in science policy. Strong concentration has been seen as both a tool for optimizing and focusing research investments, but also as a damaging path towards hypercompetition, lacking diversity and conservative research topic selection. While several studies have documented high funding concentration linked to individual funding organisations, few have looked at funding concentration from a systemic perspective. In this article, we examine nearly 20,000 competitive grants allocated by fifteen major Danish research funders. Our results show a strongly skewed allocation of funding towards a small elite of individual researchers, and toward a very select group of research areas and topics. We discuss several potential drivers, and highlight that strong funding concentrations likely result from a complex interplay between funders’ overlapping priorities, excellence-dominated evaluation criteria, and lack of coordination between both public and private research funding bodies.