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BackgroundAntifibrotic medications are prescribed for Idiopathic Pulmonary Fibrosis (Pirfenidone or Nintedanib) and Progressive Fibrosing ILD (Nintedanib) with the aim of slowing disease progression. Unfortunately, side effects of these medications can be significant.AimTo understand if regular ILD nurse/pharmacist (RN/RPh) telephone contact with patients taking antifibrotic medication can positively impact therapeutic tolerance.MethodsRetrospective antifibrotic prescribing data was collected from October 2020 to October 2024 from our ILD specialist centre. We analysed patient demographics, duration on antifibrotic therapy and number of RN/RPh telephone contacts.ResultsData from 859 patients prescribed antifibrotics was analysed with 462 patients (54%) still on treatment in October 2024. During the study period, a total of 140 patients (16% of cohort) and 35% of patients who discontinued treatment died. Mean duration on treatment (days) in 2021 was 141 vs 305 in 2024; a 116% increase with an average annual rise of 33%. Longest use (days) was at 3192 for Nintedanib and 3127 for Pirfenidone. Since inception, RN/RPh-led monitoring has increased from 769 total contacts in 2021 to 1483 in 2024, an average annual rise of 25%.ConclusionOur preliminary ILD data demonstrates an annual increase in length of antifibrotic treatment since 2020, which could be related to the initiation of virtual RN/RPh-led monitoring. A comparative analysis of pre-initiation data would provide further insights into the role of RN/RPh in improving antifibrotic tolerance, as well as explore other variables that may influence sustained therapy maintenance.

Abstract BACKGROUND The Age Friendly Health Systems (AFHS) initiative promotes use of the 4Ms Framework: We sought to evaluate provider adherence to protocols addressing the medication M of the framework. METHODS The project was conducted among patients > 65years treated in the inpatient (IP), outpatient (OP) and emergency departments (ED) of Grady Memorial Hospital (GMH). We implemented 2 approaches to improve provider prescribing among older adults 1) Using a clinical decision support tool via the electronic health record Epic Systems®, a best practice advisory (BPA) offered individual provider feedback regarding potentially inappropriate medications (PIMs) ordered and offered safer alternative medications. 2)A pharmacist-led daily medication review with provider feedback on PIMs in the Acute Care for Elderly (ACE) Unit. Primary outcome: Percentage of PIMs discontinued. Secondary outcomes: Percentage of BPA vs pharmacist recommendations accepted, discharge PIMs, Length of Stay (LOS), mobility, delirium and Katz scores, 30-day readmission rate. RESULTS: 8270 BPA alerts fired for 3291 patients, mean age 73.7, with 5709 BPAs in IP, 1462 in ED & 1083 in OP settings. Providers responded to alerts by overriding BPA (10.2%), canceling BPA (60.4%), removing alerted PIM (20.6%), ordering alternative medication (3.5%).. With the pharmacist led intervention, ACE Unit providers accepted 47.2% recommendations, discontinued 17.9% PIMs . 19% of ACE and 1.1% of GMU patients were discharged without PIMs. 30-day readmission rate was 19.1% (ACE) vs 27% (GMU) (P = 0.31). Conclusion There was a higher provider acceptance rate with the pharmacist led intervention but no significant difference in PIM discontinuation rate