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ages or means and their 95% confidence intervals. RESULTS: Of the estimated 8.45 billion outpatient visits in the United States between 2003-2010, approximately 22.3 million (0.3%) and 73.6 million (0.9%) were for schizophrenia and MDD, respectively. Medicare (35.7% [31.2%-40.4%]) and Medicaid (35.2% [31.4%-39.2%]) were most common payers for schizophrenia visits, whereas private insurance was most common for MDD (49.6% [46.3%-53.0%]) and GOP (52.5% [51.1%-53.9%]) visits. During the previous 12-months, there was a higher number of outpatient visits for schizophrenia (11.9 [9.6-14.3]) and MDD (10.9 [9.6-12.1]) than GOP (4.4 [4.3-4.6]). Primary care physician visits accounted for 17.3% [13.4%-22.1%] of schizophrenia, 10.6% [8.2%-13.7%] of MDD, and 46.5% [44.5%-48.5%] of GOP visits. Psychiatrist visits accounted for 79.7% [73.6%-84.7%] of schizophrenia, 89.8% [86.9%-92.1%] of MDD, and 2.0% [1.9%-2.2%] of GOP visits. More medications were prescribed at schizophrenia (3.0 [2.8-3.3]) than MDD (2.5 [2.3-2.6]) or GOP (2.2 [2.1-2.3]) visits. However, medication initiations were less frequent at schizophrenia (16.8% [13.6%-20.6%]) and MDD (19.6% [17.3%-22.1%]) than GOP (36.4% [35.5%-37.4%]) visits. CONCLUSIONS: The NAMCS and NHAMCS data provided a representative characterization of outpatient treatment for schizophrenia across different payers in the United States. Outpatient visits for schizophrenia differed from MDD or GOP visits across multiple characteristics, including payer type, physician specialty, and medication use. PHS104 EFFECT OF INSURANCE COVERAGE ON HEALTH-CARE EXPENDITURES AMONG PATIENTS WITH ARTHRITIS Almasri DM, Noor AO, Lai L Nova Southeastern University, Ft. Lauderdale, FL, USA OBJECTIVES: To compare the effect of insurance coverage on health-care related expenditures among patients with arthritis in the United States. METHODS: A cross-sectional analysis was conducted. Subjects were derived from the National Medical Expenditures Panel Survey (MEPS) for those whom reported having any type of arthritis in 2009. A series of weighted univariate statistics were applied to examine patient’s demographic characteristics (gender, race, age, etc.) and insurance coverage (private, public, and uninsured). We further employed a generalized linear regression model to compare the health-care expenditures (inpatient, emergency room, outpatient, prescription drug) among different insurance status. All analyses utilized SAS PROC SURVEYs’ application to adjust for the complex sampling design employed by MEPS database. RESULTS: There were an estimated 55.99 million arthritis patients from 2009 MEPS, in which 8.5 million (15.1%) had rheumatoid arthritis; 21.2 million (37.7%) had osteoarthritis; and 26.5 million (47.2%) had unspecified arthritis. It is estimated that the majority of the arthritis patients 34.9 million (62.35%) were covered by private insurance, 16.5 million (29.5%) were covered by public plans and about 4.5 million (8%) were uninsured. The total medical expenditure for patients with arthritis in 2009 was $522.6 billion. Total prescription expenditures among arthritis patients were $122.1 billion. Per capita medical care expenditures among private, public and uninsured arthritis patients averaged $8,751, $12,093 and $3,730 respectively (P<0.0001). Also, there is a significant difference (P<0.0001) in the prescription expenditures among private, public and uninsured arthritis patients. Average prescription expenditure is $1982.6, $2991.6 and $748 respectively. CONCLUSIONS: Our findings indicate that uninsured arthritis patients had significant lower costs in total health-care expenditure than insured patients. Consistently with other studies, the uninsured have more unmet health needs than insured Americans. Such undertreated and/or underutilized situation may place uninsured people at risk of a serious disability complication. PHS105 IS OBESITY A SIGNIFICANT PREDICTOR OF ASTHMA, ASTHMA RELATED AND TOTAL HEALTH CARE COSTS AMONG ELDERLY INDIVIDUALS IN THE UNITED STATES? Shah R, Yang Y University of Mississippi, University, MS, USA OBJECTIVES: To investigate whether obesity is associated with asthma, asthma-related and total direct medical costs in elderly individuals in the U.S. using pooled 2006-2010 Medical Expenditure Panel Survey (MEPS) data. METHODS: This study is a retrospective analysis of MEPS data from 2006-2010. Individuals 65 years or older were included in the study. Individuals with asthma were identified by ICD-9-CM code 493 or clinical classification code 128. Individuals with a self-reported body mass index greater than 30 kg/m2 were considered to be obese. A logistic regression model was used to assess the relationship between obesity and asthma. Both asthma-related and total direct medical costs including inpatient, outpatient, prescription medication and office-based physician visit costs were analyzed. All costs were reported in 2010 U.S. dollars,. Generalized linear models with gamma distribution and log link were used to assess the relationship between obesity and direct medical costs. Individual comorbidities and socio-demographic covariates were controlled for in all models. All analyses were conducted using SAS while accounting for the complex survey design of MEPS. RESULTS: Out of 18,305 elderly individuals in MEPS data 2006-2010, 978 were identified as having asthma, of which 595 were obese. Obese elderly individuals were more likely to suffer from asthma as compared to non-obese individuals (odds ratio: 1.649; 95% Confidence Interval:1.306–2.081). Annual asthma-related costs for obese and non-obese asthmatic individuals were $1,585.88 (±94.10) and $1,611.83 (±84.65); annual total (all-cause) costs for obese and non-obese asthmatic individuals were $16,144 (±910.63) and $14,525 (±876.79), respectively. The cost analysis results were not statistically significant. CONCLUSIONS: Elderly obese individuals are at a great risk of suffering from asthma. Although total direct medical cost for obese asthmatic elderly individuals were greater than those of non-obese asthmatics,

obesity is not a statistically significant predictor of asthma-related and total direct medical costs among elderly individuals with asthma. PHS106 GENDER DIFFERENCES IN HEALTH-CARE RELATED EXPENDITURES FOR PATIENTS WITH ARTHRITIS IN THE UNITED STATES Almasri DM, Lai L Nova Southeastern University, Ft. Lauderdale, FL, USA OBJECTIVES: Our study aimed to examine gender differences in Health-related expenditures for patients with arthritis in the US civilian non-institutionalized population. METHODS: A cross-sectional analysis was conducted using the National Medical Expenditures Panel Survey data (MEPS). Study subjects included patients who reported having any type of arthritis in 2009. The dependent variables include total and out of pocket medical expenditures (in-patients, out-patient, emergency department visits); and total and out of pocket prescription drugs expenditures. A series of weighted t-statistics statistics were used to test the effect of gender on health-related expenditures. To provide national estimates, all analyses incorporated sample weights and standard errors corrections to adjust for the complex sampling design employed by MEPS. RESULTS: There were an estimated 55.988 million arthritis patients from 2009 MEPS, in which 8.5 million (15.1%) had rheumatoid arthritis; 21.2 million (37.7%) had osteoarthritis; and 26.5 million (47.2%) had unspecified arthritis. About 85% of the patients were white and 60.4% were females. Female showed significant higher total medical expenditures than male ($9,633 vs. $8,874) (p<0.0001). Female also showed significant higher out of pocket medical expenditures than male. ($1,337 vs. $1,026) (p<0.0001). The results from prescription total expenditures also showed significant difference (p<0.0001) between male ($2,097) and female ($2,235) arthritis patients. Finally, the results of out of pocket prescription expenditures showed a significant difference (p<0.0001) between male ($414) and female ($500). CONCLUSIONS: The study indicates that women have higher medical care service utilization and higher associated charges than men. The findings provide valuable evidence for future implications of women health care services. PHS107 USING PHONE TRIAGE WITH RISK STRATIFICATION TO INITIATE LOW BACK PAIN CARE WITHIN A HEALTH CARE SYSTEM Karlen EK Fairview Health Services, Saint Paul, MN, USA OBJECTIVES: Over 50% of people seeking care for low back pain (LBP) enter through primary care. Primary care physicians (PCPs) often have less training in assessing and treating LBP than physical therapists and medical spine specialists. Nationally, the direct cost to manage LBP has continued to grow and the outcomes have worsened. This pilot initiated LBP care with the highest-value provider type based on the patient’s risk level to determine if higher-value care could be delivered. METHODS: For 2 months, patients calling their primary care clinic to schedule an appointment for new LBP were diverted to a nurse line. After passing a red-flag screen, the patients were risk stratified using the Keele STarT Back tool. Low and medium risk patients immediately received reassure-ance and education in self-management. Those still wanting to see a clinician scheduled with a physical therapist. High risk patients scheduled with medical spine specialists. Patients referred to physical therapy were matched to therapists capable of delivering evidence-based care for their specific risk level. Physical therapists received best-practice guidelines and patient profiles for each of the risk levels. Patient improvement was measured with the Oswestry Disability Index (ODI). RESULTS: Of the 42 LBP patients referred to physical therapy, 90% were matched to physical therapists based on risk level. The cumulative average ODI improvement was 39% in 5.5 visits, a .06 QALY improvement over the previous care model that delivered an average ODI improvement of 27% in 6 visits. Patients receiving care from a medical spine specialist were 56% more likely to have appropriate imaging and 50 times less likely to be prescribed opioids. Estimated direct medical costs savings were 15-31% with 41-61% in total cost savings to the community. CONCLUSIONS: Phone triaging that includes risk stratification delivers higher-value LBP care than traditional care models. PHS108 A QUALITATIVE EXPLORATION OF PERCEPTIONS TOWARDS PHARMACEUTICAL PRICE WAR AMONG COMMUNITY PHARMACIES IN THE STATE OF PENANG, MALAYSIA Tan CS, Hassali MA, Saleem F Universiti Sains Malaysia, Penang, Malaysia OBJECTIVES: To evaluate perceptions of community pharmacists towards medi-cine pricing issues in the model of practice in Malaysia. METHODS: A qualitative approach was adopted. Semi structured interviews were conducted by face to face interview. Purposive sampling technique was used to recruit a convenient sample of full time community pharmacists practising in the State of Penang, Malaysia. All interviews were audio recorded, transcribed verbatim and thematically analysed. RESULTS: A total of 11 community pharmacists were recruited in this study. Thematic content analysis of the interviews identified three main themes: factors causing pharmaceutical price war, potential impact of price war, and recommendations to overcome price war. In general, price war phenomenon has diminished the profit margin of community pharmacists and threatened their survival. Thus the participants were anticipated government could control medicine price. The findings in this study also highlighted participants were dissatisfied with the unethical practise by pharmaceutical company in offering different bonus schemes. The bonus schemes also reported as discriminatory as physician were offered better perks compare to community

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pharmacists. The participants have demanded the Competition Act 2010 should be enforced effectively in current pharmacy practise. CONCLUSIONS: The unreg-ulated pharmaceutical pricing issue had detrimental effect on the profession-alism of community pharmacy practice in Malaysia. The study suggested that a medicine price regulation at the supply chain is needed to be implemented to curtail some unhealthy practice among Malaysian community pharmacists in future. PHS109 PHARMACOECONOMICS IN NEPAL: STAGGERING GROWTH Shrestha (Amatya) S, Shrestha DL Kyungsung University, Busan, South Korea OBJECTIVES: To evaluate and delineate current prominence of pharma-coeconomics in Nepal, and identify the key challenges in gaining effective and economic health care. METHODS: Literatures review of the studies on conceptualization of pharmacoeconomics in Nepal and other developing countries. RESULTS: With escalating applications of economic evaluation of health care cost, majority of the middle-income and few low-income countries have already espoused pharmacoeconomics. While some Asian countries have adopted customized version of Health Technology Assessment (HTA) in reimbursing drug-use and making formulary decisions, Nepal still has an informal HTA programs with decisions made irrespective of cost effectiveness. With total expenditure on health about 5.5% of the GDP and almost non-existing (private) health insurance, large amount of drug-cost is still paid by the public, enforcing them to confront escalating drug-expenses. Two to three universities running pharmacy courses spare only a couple of hours to teach about pharmacoeconomics. CONCLUSIONS: Without much hype, trying to impose pharmacoeconomics model of other countries, into Nepalese health system, may not be justifiable. Poor competencies to deal with inequities, inefficient system due to fragmented resources allocation, limited power to negotiate and passive purchasing practice of the government – the key stakeholder – has impeded the concept of pharmacoeconomics. Moreover, bipolar system of pharmacy education and its practice, and lesser concern of other stakeholders – pharmaceutical companies, research organizations and the payers – are equally responsible for the staggering growth of pharmacoeconomics in Nepal. In addition, scarcity and/or accelerating brain-drain of the specialists, especially pharmacists, has further hindered the use and interpretation of HTA. Ironically, these constraints can be a driving factor to catalyze the need of adopting more formalized approaches to support health care decisions. Technical collab-orations, impelling vigorous research works and funding from the better-of-positioned nations will definitely propel improvements in academic, research and health care, overall sprouting the concept of pharmacoeconomics in Nepal, at a greater speed. PHS110 HEALTH CARE UTILIZATION, SCREENING AND PREVENTIVE PRACTICES AMONG OLDER ADULTS IN THE UNITED STATES McDonald M, Moffatt M, Zhou J, Mardekian J Pfizer, Inc., New York, NY, USA OBJECTIVES: Current knowledge of health care utilization, screening and preventive practices among older adults in the United States are incomplete. This study examines current national estimates for inpatient and outpatient utilization, the receipt of flu and pneumonia shots, colonoscopy/sigmoidoscopy, mammograms, and Pap tests among older adults. METHODS: Cross-sectional observational study design. Analysis of nationally representative data collected from older adults 65 years and older participating in the National Health Interview Survey (NHIS) 2010, 2011. In NHIS 2010, total adults aged 65 years and older, n=5450; men, n=2139; women, n= 3311. In NHIS 2011, total adults 65 years and older, n=6902; men, n=2771; women, n= 4131. RESULTS: Nationally, men and women 65 years and older have similar rates of receiving a flu shot in the past year (66% and 67%, respectively, p=0.4404). Sixty-two percent of elders have ever received a pneumonia vaccine; men have significantly lower vaccine coverage (59%) than women (64%), (p=0.0005). Screening rates for colon cancer are 71% and 68% among older men and women, respectively (p=0.0616). Among older men, 62% had a prostate specific antigen test in the past 2 years. Among older women, 29% and 55% had an annual Pap test and mammogram, respectively. Twenty-three percent of elders had at least 1 emergency room visit in the past year: 22% among men, 24% among women (p=0.0484). In the past year 25% of older men and 19% of women had at least 1 overnight hospital stay (p=0.051). Utilization of outpatient doctor visits between older men and women were similar. CONCLUSIONS: Screening rates for flu shots and for colon cancer are high among US men and women aged 65 years and older. Older men are less likely to receive a pneumonia vaccine. Women are more likely to have had an emergency room visit in the past year. Effective approaches are recommended to increase pneumonia vaccine coverage in men. PHS111 IMPACT OF ADVANCED VERSUS BASIC ELECTRONIC-MEDICAL-RECORD SYSTEMS ON THE QUALITY OF PATIENT CARE: A META-ANALYSIS OF 10 RANDOMIZED CONTROLLED TRIALS Desai VC1, Kelton CM2, Heaton PC1 1University of Cincinnati, Cincinnati, OH, USA, 2University of Cincinnati College of Business, Cincinnati, OH, USA OBJECTIVES: Over the last decade, federal and state initiatives have encouraged the adoption of electronic-medical-record (EMR) systems in hospitals, emergency departments, and physician offices and clinics. These systems may have the potential to prevent adverse drug events, decrease health care costs, as well as improve care itself. Although accumulated evidence suggests that a basic EMR

system with patient demographics and laboratory results improves health care over no system, less evidence is available on the relative advantages, if any, of a more advanced system, which also allows electronic reminders for interventions and screenings. Hence, the objective of the study was to conduct a meta-analysis of the available evidence to measure the impact of an advanced EMR system relative to a basic system on the quality of patient care given by providers. METHODS: Electronic databases, including MEDLINE and Google-Scholar, were searched for randomized controlled trials related to the objective. The composite outcome measure, termed quality of patient care, was defined as whether screening, diagnosis, providing recommended treatment, or counseling were provided during the visit. Sub-group analyses were performed for screening and providing recommended treatment. Studies with large variances were excluded. Heterogeneity was assessed using the I2 statistic. Because I2 exceeded 50%, a random-effects model was used. RESULTS: Ten studies which included 1,867 providers were included. The odds of care were 1.77 (95% CI: 0.98-3.21; p=0.059) times higher for providers with an advanced EMR system compared to those with a basic system. Sub-group analyses showed that the odds of screening patients were 1.07 (95% CI: 1.02-1.13; p=0.005) times higher and providing recommended treatment were 1.11 (95% CI: 0.91-1.35; p=0.32) times higher, compared to the basic system. CONCLUSIONS: Relative to providers with basic EMR systems, those with advanced systems were only slightly more effective in terms of the overall care rate and the screening rate. PHS112 SHORT-TERM RELATIONSHIPS BETWEEN ELECTRONIC HEALTH RECORD SYSTEM INTEGRITY IN EMERGENCY DEPARTMENTS (ED) AND HEALTH CARE RESOURCE UTILIZATION Tang DH1, Warholak TL2 1The University of Arizona, Tucson, AZ, USA, 2University of Arizona, Tucson, AZ, USA OBJECTIVES: To assess emergency department (ED) waiting times, hospitalization rate immediately following ED visits, number of medications prescribed, and length of stay in EDs among practices with various levels of electronic health record (EHR) functionality pertaining to ED visits. METHODS: Data from 2006-2009 Centers for Disease Control and Prevention National Hospital Ambulatory Medical Care Survey Emergency Department files were used for this retrospective, cross-sectional study. EHR use among organizations was sequentially classified as no EHR, some EHR, basic EHR, and fully functional EHR based on the number and level of available features. Negative binomial regression models were applied using patient waiting time and length of visit as outcome variables, while logistic and ordered logistic regression models were applied using hospitalization rate and number of medications prescribed as dependent variables, respectively. Regression analyses adjusted for patient demographics (age, gender, race/ethnicity, region/location, education, income, insurance status), level of triage and comorbidity, and hospital ownership status. To provide national estimates, all results were weighted and used standard errors (SE) calculated via Taylor-series approaches. RESULTS: A total of 496 million ED visits were identified, where 36.1%, 33.5%, and 6.0% of visits were located at EDs with some EHR, basic EHR, and fully functional EHR, respectively. Having some, basic, and fully functional EHR was associated with 12%, 16%, and 14% increased waiting time (pooled p=0.003), and 8%, 12%, and 18% increased length of ED visit (pooled p<0.001). Any EHR use was not associated with number of medications prescribed (pooled p=0.057) and hospitalization (pooled p=0.111). However, basic or fully functional EHR use was associated with greater number of medications prescribed (pooled p=0.035) and hospitalization (pooled p=0.049) as compared with no EHR use. CONCLUSIONS: EHR appeared to increase short-term health care utilization but may benefit patients in the long-term due to early treatment. PHS113 COST-EFFECTIVENESS OF A COMPUTERIZED PROVIDER ORDER ENTRY SYSTEM IN IMPROVING MEDICATION SAFETY: A CASE STUDY IN AMBULATORY CARE Hepp Z1, Forrester SH1, Roth J2, Wirtz HS1, Devine EB1 1University of Washington, Seattle, WA, USA, 2Group Health Cooperative, Seattle, WA, USA OBJECTIVES: The Health Information Technology for Economic and Clinical Health Act is driving electronic health record (EHR) adoption while requiring demonstration of meaningful use. Implementation of computerized provider order entry (CPOE) is integral in meeting meaningful use criteria, and has been shown to improve medication safety and reduce costs in the inpatient setting. However, the cost-effectiveness (CE) of CPOE in ambulatory settings remains uncertain. This study estimates the CE of CPOE in reducing medication errors and adverse drug events (ADEs) in the ambulatory setting. METHODS: We created a decision-analytic model to estimate the cost-effectiveness of CPOE at a large, multidisciplinary medical group over five years. We adopted the medical group’s perspective and conducted our base case analysis using administrative and system costs (2010), changes in efficiency, monetary incentives for CPOE adoption, and changes in number of medication errors and ADEs following CPOE implementation. We evaluated a scenario that accounted for added office time for prescribers and staff to resolve medication errors and treat ADEs, and a scenario that incorporated revenue changes realized by the medical group, which owns four, on-site, retail pharmacies. We used one-way and probabilistic sensitivity analyses to evaluate uncertainty of the model inputs. RESULTS: CPOE dominated paper prescribing, costing $20 million less than paper and resulting in 1.5 million and 15.5 thousand fewer medication errors and ADEs, respectively. The model was robust to uncertainty in all inputs, and CPOE remained dominant in ≥ 99.3% of the simulations in the base case and scenario analyses. The largest drivers of uncertainty in the model were the number of chart pulls, the number of specialty providers and their hourly salaries. CONCLUSIONS: Our findings suggest that provider groups adopting CPOE and eliminating paper prescribing