RESUMEN
OBJECTIVE: To analyze the prescribing patterns of antidiabetic and cardiovascular medications among diabetics in the most highly populated Italian Region, from 2000 to 2008. METHODS: Data were obtained from the Lombardy Region administrative health databases. The standardized prevalence of antidiabetic and cardiovascular drugs use was calculated within each study year. The prescription trends of initial treatment with antidiabetic drugs were also analyzed. RESULTS: From 2000 to 2008 there was an increase in the proportion of patients treated with biguanides (from 53.4% to 66.5%; p<0.0001) while those receiving sulfonylurea decreased (from 78.6% to 56.4%; p<0.0001). A sharp increase of metformin (as monotherapy) as initial treatment was also observed (from 15.2% to 48.8%; p<0.0001). The percentage of patients receiving renin-angiotensin system inhibitors, lipid-lowering drugs and antiplatelets increased between 2000 and 2008, from respectively 45.1% to 63.3%, 13.6% to 43.2% and 21.6% to 40.9 (p<0.0001). Multivariate analyses indicated that changes in prescriptions were statistically significant for both antidiabetic and cardiovascular drugs. CONCLUSION: This study documents progressive changes in the prescription of antidiabetic and cardiovascular drugs in accordance with guidelines. However, the use of metformin as first line therapy was still suboptimal and cardiovascular preventive strategies were only partially implemented in community practice.
Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Humanos , Hipoglucemiantes/uso terapéutico , Hipolipemiantes/uso terapéutico , Italia , Metformina/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Compuestos de Sulfonilurea/uso terapéuticoRESUMEN
OBJECTIVE: To investigate the prescribing patterns and the prevalence of polypharmacy in community-dwelling elderly people, and to analyze the association of chronic medications and number of drug prescriptions with age and sex. METHODS: All prescriptions for people aged 65 years or older reimbursed by the Italian National Health Service (NHS) and dispensed by retail pharmacies of the 15 local health units (LHU) in the Lombardy Region during 2005 were analyzed. Logistic regression analysis was used to assess the association between drug prescription (overall, chronic drugs, and polypharmacy) and age, sex, and LHU of residence. RESULTS: Eighty-eight percent of the 1 ,767 ,239 analyzed elderly received at least one drug prescription. The overall prescription rate was slightly higher for women than men (odds ratio [OR] 1.20; 95%CI 1.19-1.21). Seventy-six percent of the elderly received at least one chronic drug, 46% were exposed to polypharmacy, and 20% to chronic polypharmacy. At multivariate analysis, age and LHU residence of the elderly were the main determinants of drug exposure. A significant correlation was found between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy (r(s) = 0.79, p < 0.0005 and r(s) = 0.84, p < 0.0001, respectively). CONCLUSIONS: Our findings indicate that age and LHU residence of the elderly are the main determinants of drug prescribing, and there is evidence of a significant correlation between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy.
Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Revisión de la Utilización de Medicamentos/estadística & datos numéricos , Polifarmacia , Factores de Edad , Anciano , Bases de Datos Factuales , Femenino , Humanos , Italia , Modelos Logísticos , Masculino , Casas de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Factores SexualesRESUMEN
OBJECTIVES: To assess the pharmacological treatment and the control of major modifiable cardiovascular risk factors in everyday practice according to the patients' cardiovascular risk level. METHODS: In a cross-sectional study general practitioners (GPs) had to identify a random sample of their patients with cardiovascular risk factors or diseases and collect essential data on the pharmacological treatment and control of hypertension, hyperlipidemia, and diabetes according to the patients' cardiovascular risk level and history of cardiovascular disease. Participants were subjects of both sexes, aged 40-80 years, with at least one known cardiovascular risk factor or a history of cardiovascular diseases. RESULTS: From June to December 2000, 162 Italian GPs enrolled 3120 of their patients (2470 hypertensives, 1373 hyperlipidemics, and 604 diabetics). Despite the positive association between the perceived level of global cardiovascular risk and lipid-lowering drug prescriptions in hyperlipidemic subjects (from 26% for lowest risk to 56% for highest risk p < 0.0001) or the prescription of combination therapy in hypertensives (from 41% to 70%, p < 0.0001) and diabetics (from 24% to 43%, p = 0.057), control was still inadequate in 48% of diabetics, 77% of hypertensives, and 85% of hyperlipidemics, with no increase in patients at highest risk. Trends for treatment and control were similar in patients with cardiovascular diseases. CONCLUSIONS: Even in high-risk patients, despite a tendency towards more intensive treatment, pharmacological therapy is still under used and the degree of control of blood pressure, cholesterol level and diabetes is largely unsatisfactory.
Asunto(s)
Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus/tratamiento farmacológico , Hiperlipidemias/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Hipolipemiantes/uso terapéutico , Adulto , Anciano , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Prescripciones de Medicamentos/estadística & datos numéricos , Quimioterapia Combinada , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Adhesión a Directriz , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Italia/epidemiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the appropriate prescription of antiplatelets according to patients' global cardiovascular risk level in everyday practice. METHODS: In a cross-sectional study, general practitioners (GPs) identified a random sample of 10% of patients at cardiovascular risk among all subjects coming to the surgery and collected data on cardiovascular risk factors and history of atherosclerotic cardiovascular diseases (CVD). GPs were asked to do a physical examination and record the results of laboratory tests to define the global cardiovascular risk. The use of antiplatelet drugs in patients with established CVD and in healthy subjects at high risk of developing symptomatic atherosclerotic disease was evaluated. RESULTS: A total of 162 GPs from all over Italy recruited 3,120 subjects (51% female, mean age 64 years). Of the 949 with an indication for antiplatelet treatment for secondary prevention of CVD, 442 (47%) were receiving it. Among the 2,071 without CVD, 11% were taking an antiplatelet drug. In this group, antiplatelets were prescribed in 6, 10, 16 and 23%, respectively, of patients perceived by GPs to be at mild, moderate, high and very high cardiovascular risk. CONCLUSIONS: Prescription of antiplatelets still seems to be far from what is recommended in virtually all patients with a history of CVD. In subjects with cardiovascular risk factors but without CVD antiplatelet prescription increases in relation to global cardiovascular risk but is still low in patients at high or very high risk of cardiovascular events.
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Enfermedades Cardiovasculares/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pautas de la Práctica en Medicina , Adulto , Anciano , Anciano de 80 o más Años , Aspirina/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Estudios Transversales , Utilización de Medicamentos , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Médicos de Familia , Prevención Primaria , Medición de Riesgo , Ticlopidina/uso terapéuticoRESUMEN
BACKGROUND: Although risk assessment charts have been proposed to identify patients at high cardiovascular risk, in everyday practice general practitioners (GPs) often use their knowledge of the patients to estimate the risk subjectively. DESIGN: A cross-sectional study aimed to describe how GPs perceive, qualify and grade cardiovascular risk in everyday practice. METHODS: General practitioners had to identify in a random sample of 10% of their contacts the first 20 consecutive patients perceived as being at cardiovascular risk. For each patient essential data were collected on clinical history, physical examination and laboratory tests, for the qualification of risk. At the end of the process GPs subjectively estimated the overall patient's level of risk. General practitioners grading was compared with the risk estimate from a reference chart. RESULTS: Over a mean time of 25 days 3120 patients perceived as being at cardiovascular risk were enrolled. According to the inclusion scheme each GP had contact with more than 200 patients at cardiovascular risk every month. Thirty percent of these patients had atherosclerotic diseases. Up to 72% of patients without any history of atherosclerotic diseases but perceived to be at risk could be classified according to a reference chart as being at moderate to very high risk. Comparing GPs' grading of risk with a chart estimate there was agreement in 42% of the cases. Major determinants of GPs' underestimation of risk were age, sex and smoking habits, while obesity and family history were independently associated with overestimation. CONCLUSIONS: On the basis of their perception GPs properly identify patients at cardiovascular risk in the majority of cases. General practitioners subjective grading of risk level only partially agreed with that given by a chart.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Médicos de Familia/psicología , Pautas de la Práctica en Medicina , Factores de Edad , Anciano , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Complicaciones de la Diabetes , Femenino , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Italia , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/genética , Obesidad/complicaciones , Proyectos Piloto , Estándares de Referencia , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversosRESUMEN
UNLABELLED: Objectives 1. To assess if record linkage of two different databases could improve the quality and understand the epidemiology of diabetes and its complications. 2. To analyse how hospitalization relates to the natural history of the disease and to its pharmaceutical management. 3. To document how pharmacoepidemiology could be a challenging tool for clinicians. 4. To identify critical areas where improvement of care would be specifically important. METHODS: Data came from two large databases, the drugs prescription and the hospital discharge forms of the Local Health Unit of Rovigo, Italy, collected through 2000. A casecontrol design was adopted to compare two cohorts identified by prescription of antidiabetic vs any other drugs and the linkage to their hospitalizations over the index period. The study was focused on people > or = 50 year in order to concentrate the attention on NIDDM. A population of 5.603 patients were identified as diabetic and 63.155 were the controls. The prevalence of diabetes was 3.6% in the general population and 8.1% in 50 year and older. The hospitalizations analysis revealed differences between cases and controls in term of longer duration of stay (10.1 vs 8.4 days), higher in-hospital mortality (5.5% vs 5%) and higher presence of cardiovascular complications. Of the 2.922 hospitalizations registered for diabetics, 43% did not report the specific ICD-9-CM code for diabetic disease (250.x). Record linkage of these administrative databases offers new opportunities to improve the comprehension of the natural history of diabetic disease. The identification of diabetic patients from prescription data allows a more reliable picture of the hospitalization than the simple analyses of hospital discharge forms. Up to 43% of hospitalizations in the diabetic cohort did not report the specific diabetic disease diagnosis, compared to the 25% reported in a previous observation where linkage was not applied. The lack of this code registration during hospitalization can reflect a scant perception of the importance of diabetes as the major determinant of complications and could open a discussion table with other clinicians, general practitioners and health care professionals.