No / This paper aims to estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/ health board and corresponding National Health Service (NHS) costs in the UK. This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients’ characteristics, wound-related health outcomes and health-care resource use were quanti ed for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any speci c diagnosis. The prevalence of acute, chronic and unspeci ed wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates. Declaration of interest: The study’s sponsors had no involvement in the study design, the collection, analysis and interpretation of the data, the writing of this manuscript and the decision to submit this article for publication. The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute for Health Research (NIHR), the Department of Health, or any of the other sponsors. / NIHR Wound Prevention and Treatment Healthcare Technology Co-operative (National Institute for Health Research WoundTec HTC), Bradford Institute For Health Research, Bradford, West Yorkshire, UK, following an open tendering process. Additional funding was provided by: 3M Health Care Limited, Loughborough, Leicestershire, UK; Activa Healthcare Limited, Burton On Trent, Staffordshire, UK; Brightwake Limited, Kirkby In Ashfield, Nottinghamshire, UK; KCI Medical Limited, Crawley, West Sussex, UK; Longhand Data, Welburn, North Yorkshire, UK; Medira Limited, Cambridge, Cambridgeshire, UK; Mölnlycke Health Care Limited, Dunstable, Bedfordshire, UK; Park House Healthcare Limited, Elland, West Yorkshire, UK; Perfectus Biomed Limited, Daresbury, Warrington, UK; Pulsecare Medical LLC, North Andover, Massachusets, US; Smith & Nephew Medical Limited, Hull, East Riding Of Yorkshire, UK; Sozo Woundcare Limited, Harrogate, North Yorkshire, UK; Systagenix Wound Management Limited, Gatwick Airport, West Sussex, UK; Trio Healthcare, Great Missenden, Buckinghamshire, UK; Urgo Limited, Loughborough, Leicestershire, UK; Willingsford Limited, Southampton, Hampshire, UK.

Yes / Direct oral anticoagulants (DOACs) uptake for stroke prevention in atrial fibrillation has been slow.[1] This study aimed to profile the prescribing of DOACs over three years to identify factors associated with DOAC prescribing in a Clinical Commissioning Group (CCG) without restrictions to DOACs use. The objectives were to identify: - Characteristics of patients prescribed oral anticoagulant (OAC) in a sample of general practices; - Who initiated the prescribing of OAC; - Recorded reasons for prescribing a DOAC rather than warfarin;

Yes / Background and Objective In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fbrillation has been slow and varied across diferent Clinical Commissioning Groups (CCGs). This study aimed to profle the prescribing of oral anticoagulants for stroke prevention in patients with atrial fbrillation over 3 years in a CCG without restrictions to DOACs use to understand more about organisational and/or individual barriers to the early uptake of DOACs. Methods Data were collected from nine general practices between 1 April 2012 and 31 March 2015 of patients who were initiated on the oral anticoagulant therapy. Data were analysed descriptively and with independent Student’s t test and Chi square test to explore if there was an association between type of oral anticoagulant initiated and sex, age, type of prescriber and prior aspirin use. Results The early uptake of DOACs signifcantly increased over the study period (p<0.0001; medium size efect φc=0.372). There was no statistically signifcant diference between sex or age and type of oral anticoagulant initiated. Primary-care prescribers were responsible for initiating the majority of oral anticoagulants (71%; N=257) and driving the use of DOACs (72%, N=71). Patients switched from aspirin to an oral anticoagulant were more likely to be initiated on warfarin than a DOAC. Conclusions The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers in this particular CCG. / Bayer Pharmaceuticals via an unrestricted educational grant.