RESUMEN
Dutch GP's (General Practitioners) take care of people living in homes for the elderly. The population of these homes is selected on the basis of poor functioning on ADL (activities of daily living). We expected to find a group of elderly people within these homes that need more complex primary care. We describe the characteristics of care for an institutionalized elderly population and compare these to the care provided to their independently living peers. The design of this study is a matched case-control study in a Dutch General Practice in the study period 1/1/1998 to 1/7/2004. Our main results show that the rate of cognitive problems is two times, the prevalence of depression even three times higher in older people living in a home for the elderly than in those who live independently. Locomotory problems are a frequent problem in homes for the elderly. Rates of chronic pulmonary problems, atherosclerosis-related diseases and urinary tract infection are higher, whereas no significant differences for CVA, diabetes and cancer were found. Institutionalized older patients use more different types of medication. GP's do not have more contacts with people living in a home for the elderly than with older people living independently. We conclude that people living in homes for the elderly have complex problems, and need special attention for their specific vulnerability. Differences in care are not primarily explained by chronic disease but by problems with mobility, confusion, depression and cognition.
Asunto(s)
Servicios de Salud para Ancianos/normas , Hogares para Ancianos/normas , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Calidad de Vida , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Trastornos del Conocimiento/epidemiología , Depresión/epidemiología , Femenino , Hogares para Ancianos/estadística & datos numéricos , Humanos , Masculino , Países Bajos , Prevalencia , Indicadores de Calidad de la Atención de Salud , Factores de RiesgoRESUMEN
OBJECTIVE: To gain insight into the trends in the prescription ofrofecoxib, the medication and disease histories of rofecoxib users, and the occurrence of cardiac complications during the follow-up. DESIGN: Longitudinal comparative study in family practice. METHOD: Based on the data from family practices (17 family physicians) affiliated with the Registration Network Groningen, a network with about 30,000 patients in the northern part of the Netherlands, the incidence and prevalence ofrofecoxib use were determined per 1000 patients at risk for every quarter during the period 2000-2004. Data on duration, dosage and indications were taken from the rofecoxib prescriptions. Differences in morbidity between rofecoxib users and the users of traditional NSAIDs were compared using logistic regression, and differences between the two groups in the occurrence of cardiac complications were assessed by means of Cox regression analysis. RESULTS: During the period investigated, rofecoxib was prescribed with increasing frequency in family practice; there was a total of 1784 prescriptions for 509 patients. The drug was used increasingly for short durations and for a growing number of indications. Rofecoxib was selectively prescribed to former users of traditional NSAIDs. The occurrence of acute myocardial infarction, stroke or 'transient ischaemic attack' in the follow-up period was associated especially with pre-existing cardiovascular disease, but these complications were also seen more often among patients without pre-existing cardiovascular disease who used rofecoxib than among those who used the traditional NSAIDs (the difference was not significant). CONCLUSION: The observations indicate that, via a process of channelling, rofecoxib was prescribed to a highly-specific population of patients who, paradoxically, were at a higher risk of developing the same cardiac complications with which rofecoxib had been shown to be associated in randomised clinical trials.
Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Lactonas/efectos adversos , Sulfonas/efectos adversos , Anciano , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Bases de Datos Factuales , Relación Dosis-Respuesta a Droga , Medicina Familiar y Comunitaria , Femenino , Humanos , Lactonas/uso terapéutico , Modelos Logísticos , Estudios Longitudinales , Masculino , Países Bajos/epidemiología , Factores de Riesgo , Sulfonas/uso terapéutico , Factores de TiempoRESUMEN
OBJECTIVE: To determine the reliability of identifying patients diagnosed with asthma in general practice and their asthma exacerbation episodes from prescribing data. DATA SOURCE: Automated database from 17 general practitioners (29,805 patients) in the northern Netherlands. STUDY DESIGN: Sensitivity, specificity and predictive values of four criteria for identifying patients diagnosed with asthma and two criteria for identifying asthma exacerbation episodes were calculated using the registered diagnosis as gold standard. RESULTS: Prescription of one or more anti-asthma medications identified 95% of patients with an asthma diagnosis (positive predictive value 0.70), while two or more anti-asthma medications identified 71% (positive predictive value 0.79). A combination of oral corticosteroids or antibiotics identified 55% of exacerbations. CONCLUSIONS: Asthma patients can be identified reliably from prescribing data, but identification of asthma exacerbations was poor. The preference for one criterion over another for identifying patients diagnosed with asthma will depend on the reason for patient selection.