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2016 Abstracts 0004 - Identification of medication discrepancies and potentially inadequate prescriptions in elderly adults with polypharmacy Juan Franco1 ,2, Sergio Terrasa1 ,2, Karin Kopitowski1 ,2 1Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Abstract: Medication reconciliation is the process of comparing the documented prescriptions in medical records with those actually consumed by the patients. Potentially inadequate prescriptions (PIP) are those significantly associated with adverse drug events. Objectives 1) to describe the frequency and type of medication discrepancies through medication reconciliation 2) to describe the frequency of PIP Method: In a cross-sectional study of randomly selected elderly people (>65 years old) with more than 10 medications recorded in their electronic medical record (EMR), structured telephone interviews were performed in order to identify medications discrepancies and PIP. STOPP criteria were used to identify the latter. Results: Out of 214 randomly selected individuals 150 accepted to participate (70%). 85% were women (average age 78). The average number of medications referred to be consumed by patients was 9.1 (CI 95% 8.6-9.6), and the average number of prescribed medications in their EMR was 13.9 (CI 95% 13.3-14.5). 99% had at least one discrepancy; 46% consumed at least one prescription not documented in their EMR and 93% did not consume at least one of the prescriptions documented in their EMR. In 77% of the patients a PIP was detected, 87% were inadequate use of benzodiazepines, proton pump inhibitors or aspirin. Conclusions: There is a high prevalence of medication discrepancies and PIP within the community of elderly adults affiliated to a Private University Hospital. Additional interventions need to be implemented in order to warrant a safer medication profile among elderly adults. 0006 - Methodological challenges in quantifying overdiagnosis in organized screening for abdominal aortic aneurysm using Swedish registry data Minna Johansson1, John Brodersen2, Bertil Marklund1, Volkert Siersma2, Karsten Juhl Jorgensen3 11. Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 22. Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copehnagen, Denmark, 33. Nordic Cochrane Centre, Copenhagen, Denmark Background: Screening for abdominal aortic aneurysms (AAA) has been implemented in Sweden, the UK and the US based on a relative reduction in disease-specific mortality of about 50% in randomised trials, which translates into a 0.5% absolute reduction. However, no effect on total mortality has been shown.1 Additionally, there are important harms that has not been adequately quantified, such as overdiagnosis of harmless aneurysms, which may result in unnecessary surgery and even death, as well as psychosocial harm.2,3 Based on data from the trials leading to the introduction of AAA screening, we have previously estimated that for every 10,000 men invited, 176 will be overdiagnosed and 37 of them will unnecessarily undergo preventive surgery, two of whom will die from the operation.2 However, these estimates are based on populations with a much higher disease prevalence than today; due to reduced smoking, the prevalence of AAA has dropped by over 70%,4 resulting in reduced absolute benefit and probably a worsened benefit/harm-ratio.2 Objectives: To estimate overdiagnosis in organised AAA screening in Sweden and compare our results to those seen in the randomised trials leading to the introduction of AAA screening. Method: We are conducting a study based on Swedish registry data. The Swedish screening programme has been gradually implemented (2006-2015), which makes it possible to compare a screened versus a non-screened cohort using individual patient data. Results: We will discuss the methodological challenges of our on-going register study and preliminary results will be presented. Conclusions: The balance of benefits and harms of AAA screening today is unknown. The gradual implementation of AAA screening in Sweden presents a unique possibility for evaluation of the screening programme, but substantially declining disease incidence complicates analyses. 1. Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2014; 160: 321-29. 2. Johansson M, Hansson A, Brodersen J. Estimating overdiagnosis in screening for abdominal aortic aneurysm: could a change in smoking habits and lowered aortic diameter tip the balance of screening towards harm? BMJ 2015; 350: h825. 3. Johansson M, Jørgensen KJ, Brodersen J. Harms of screening for abdominal aortic aneurysm: is there more to life than a 0.46% disease-specific mortality reduction?. Lancet 2015 epub ahead of print. DOI: http://dx.doi.org/10.1016/S0140-6736(15)00472-9. 4. Darwood R, Earnshaw JJ, Turton G, et al. Twenty-year review of abdominal aortic aneurysm screening in men in the county of Gloucestershire, United Kingdom. J Vasc Surg 2012; 56: 8-13. 0009 - “Informed choice” in a time of too much medicine - no panacea for ethical dilemmas Minna Johansson1, Karsten Juhl Jørgensen2, Linn Getz3, Ray Moynihan4 1Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2The Nordic Cochrane Centre, Rigshospitalet Department 7811, Blegdamsvej 9, 2100 Copenhagen, Copenhagen, Denmark, 3General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway, 4Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia Abstract: “Informed choice” is increasingly considered as a means to prevent overdiagnosis and resolve the ethical dilemmas arising from preventive medicine, medicalization and “too much medicine”. However, providing information to enable informed choices does not address the many deeper drivers of excessive use of medical interventions and it creates new ethical dilemmas that are under-recognised. We welcome a respect for patient autonomy and are not opposed to involving patients in decisions, but we are concerned with potential downsides of this approach within the context of too much medicine. Objectives: To analyse the limits and potential downsides of trusting “informed choice” and “shared decision making” to resolve the ethical dilemmas associated with “too much medicine”. Method: A narrative review of a topic that is difficult to formally analyse. Results: In modern medicine, the health care system often place citizens in a situation with no possibility to avoid making a choice, this creates ethical dilemmas. Informed choice may transfer responsibility from the health professional to the patient. Additionally, a strong focus on individual autonomy and informed choice may divert attention from some of the underlying, unspoken premises and assumptions that are of fundamental importance to clinical decisions. When considering a patient’s personal preferences we need to take into account that these are influenced by professional presumptions, advocacy groups, financial and political interests, pushing “preferences” in the direction of more medicine. Conclusions: If we fail to analyse and critically reflect on the drivers leading to a new need for “informed choices”, our good intentions may inadvertently enhance medicalization and “too much medicine”. 0010 - Attitudes of Portuguese women concerning breast cancer screening exams - A Population-Based Nationwide Cross-Sectional Study Pedro Pinto1, Maria Esteves1, Carlos Martins2 1USF São João do Porto, Porto, Portugal, 2Faculty of Medicine of Porto University, Porto, Portugal Objectives: Although breast cancer screening may save some women from breast cancer death, it also has important harms like exposing women to false positive results, overdiagnosis and unnecessary treatment. This study aims to assess which breast cancer related medical tests are deemed necessary by adult Portuguese women. Method: This is a cross sectional study. 520 Portuguese women were surveyed by computer-assisted telephone interviewing and randomly selected from national landline telephone lists and NUTS II regions. Proportions and prevalence estimates of the Portuguese population were determined for mammography and breast ultrasonography having women answered on whether they consider they should do, the periodicity they should do it and if they use to do it. Results: 520 women were interviewed; 97.70% (95% CI 94.7 to 99.00) of women aged 50-69 considered they should undergo mammography; 58.4% (95% CI 51.00 to 65.50) of the non-target for screening age group of 18-39 years old having the same opinion. Breast ultrasonography, was referred an intervention they should do by 100.00% of women aged 50-59 years old (N=75), with 79.60% (95% CI 69.70 to 86.80) affirming they usually do it. Obese women were more likely to consider they should undergo mammography. Results were similar when excluding women with personal or familiar history of cancer. Conclusions: A big proportion of Portuguese women consider they should undergo mammography, even younger women, who are not a target in the National Screening Program and most of them say they usually do it. Ultrasonography,
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