PubMed | 08903 Lhospitalet Of Llobregat, Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol, Autonomous University of Barcelona and CIBER ISCIII
Type: | Journal: Journal of diabetes research | Year: 2016
To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer.Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination.Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) < 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR < 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure.Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM.
PubMed | Aragon Health science Institute IACS, RTI Health Solutions, Leibniz Institute for Prevention Research and Epidemiology BIPS, Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol and Karolinska Institutet
Type: | Journal: Pharmacoepidemiology and drug safety | Year: 2017
To describe the characteristics of new users of cilostazol in Europe with the aim to support the evaluation of its benefit/risk as used in regular clinical practice before the implementation of labeling changes recommended by the European Medicines Agency.New users of cilostazol were identified in populations enrolled in five European health automated databases in the UK (The Health Improvement Network [THIN]), Spain (EpiChron cohort and Information System for the Improvement of Research in Primary Care [SIDIAP]), Sweden (National Registers), and Germany (German Pharmacoepidemiological Research Database [GePaRD]) between 2002 and 2012. New users were characterized according to the prevalence of cardiovascular disease and other comorbidities, concurrent use of interacting medications, new contraindications, duration of use, and potential off-label prescribing.We identified 22593 new users of cilostazol. The median age was between 68.0 (THIN) and 73.7 (Sweden) years. More than 78% of users had concomitant cardiovascular disease, and between 78.8% (GePaRD) and 91.6% (THIN) were treated with interacting medications. Prevalence of new cardiovascular contraindications ranged from 1.5% (THIN) to 11.6% (GePaRD), and concurrent use of two or more antiplatelet drugs ranged from 6.3% (SIDIAP) to 13.5% (EpiChron cohort). Between 39.4% (Sweden) and 52.9% (THIN) of users discontinued cilostazol in the first 3months. Between 41.0% (SIDIAP) and 93.4% (THIN) were considered to have received cilostazol according to the European Medicines Agency labeling.In this collaborative European study, most cilostazol users were elderly patients with a high prevalence of cardiovascular diseases and other comorbidity and concurrent use of interacting drugs, indicating that this is a vulnerable population at high risk of complications, especially cardiovascular events. 2017 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.
PubMed | Institute Investigacion Biomedica Of Malaga Ibima, University of Castilla - La Mancha, Consultora, Research and Development Unit and 5 more.
Type: | Journal: Health expectations : an international journal of public participation in health care and health policy | Year: 2017
Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities.To identify proposals to approach HP in the context of primary care according to health-care users aged 45-75years, key community informants and primary care centre (PCC) workers.Descriptive-interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out.Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person-centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness.According to a socio-ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.
Multicentric randomized clinical trial to evaluate the long-term effectiveness of a motivational intervention against smoking, based on the information obtained from spirometry in primary care: the RESET study protocol
PubMed | Rovira i Virgili University, Idiap Research Institute and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: | Journal: BMC family practice | Year: 2016
Spirometry is the recommended method of evaluating pulmonary function when respiratory disease is suspected in smokers. Nonetheless, no evidence exists of the usefulness of information obtained from this test as a motivational strategy for smoking cessation. The primary objective of this study is to evaluate the effectiveness of a motivational intervention based on spirometry results in achieving long-term smoking cessation.We propose a multicenter randomized clinical trial in the primary care setting.We will recruit active smokers of both sexes, aged 35-70 years, with a cumulated smoking habit exceeding 10 packs/year and who consult for any reason with their primary care physician in the 20 health centers in the province of Tarragona (Spain). Patients with a history of lung disease or who have undergone exploratory measures of pulmonary function in the preceding 12 months will be excluded. All patients who agree to participate will provide signed informed consent prior to their inclusion. A total of 1000 smokers will be consecutively randomized to a control or intervention group (1:1).Participants in both groups will receive brief (5-minute) health counseling, in accordance with usual clinical practice. In a consultation lasting about 15 minutes, participants in the intervention group will also receive detailed, personalized information about the results of a spirometry test and about their lung age compared with their chronological age. Both groups will be followed up for 12 months. Main variables and analysis: The main variable will be sustained smoking abstinence at 12 months after the intervention, as confirmed by CO breath testing and urine cotinine test. Results will be analyzed based on intention to treat, using the chi-square test and logistical regression if necessary to adjust for confounding variables.We expect the rate of prolonged smoking abstinence in the intervention group will be at least 5% higher than in the control group. If this strategy proves effective, it could easily be included in the health promotion activities offered in primary care settings.ClinicalTrials.gov Identifier: NCT02153047 . Registered on 28/05/2014.
PubMed | Rovira i Virgili University, Idiap Research Institute and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: Journal Article | Journal: BMC pulmonary medicine | Year: 2016
The aim of this study was to assess the association of key adiposity markers with lung function in smokers without respiratory disease in a Mediterranean population.We performed a cross-sectional study with baseline data from a representative sample of the ESPITAP study in Spain. Participants were 738 smokers (52.3% men) without respiratory disease, aged 35 to 70, selected from 12 primary health care centres. We assessed weight, height, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). The pulmonary functional parameters were forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and FEV1/FVC ratio.In this cohort of smokers, 22.2% of individuals had central obesity. FVC% was inversely associated with all anthropometric measures (BMI, WC and WHtR) in the overall population and in men; in women, only BMI was associated with FVC%. FEV1% was inversely associated to BMI and WC in the overall population, and to all anthropometric measures in men. Furthermore, both BMI and obesity were positively associated with FEV1/FVC ratio overall and when stratified by sex; this suggests a restrictive pattern explained by the altered ventilator mechanics experienced by people with obesity.In a Mediterranean population of smokers without respiratory symptoms, abdominal obesity, evaluated not only by BMI and WC but also WHtR, is inversely associated with lung function. Fat distribution appears more strongly related to pulmonary function parameters in men than in women. In smokers with high values for WC, WHtR and BMI, assessment of lung function is recommended.Current Controlled Trials NCT01194596 . Registered 2 September 2010.
PubMed | Institute Catala Of La Salut, Laboratori Clinic lHospitalet, Hospital Universitari Of Bellvitge and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: Journal Article | Journal: Revista espanola de geriatria y gerontologia | Year: 2016
This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijn test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.
PubMed | Servicio de farmacia, Servicio Of Urgencias Del Hospital Universitari Arnau Of Vilanova, Institute Catala Of La Salut and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: Journal Article | Journal: BMC cardiovascular disorders | Year: 2017
The prevalence of ischemic heart disease is high. Few recent studies have investigated the periods of sick leave of these patients. Our aim is to determine the length of sick leave after an acute coronary syndrome, its costs, associated factors and to assess the use of antidepressants and/or anxiolytics.An observational study of a retrospective cohort of patients on sick leave due to ischemic heart disease in a health region between 2008-2011, with follow-up until the first return to work, death, or end of the study (31/12/2012).length of sick leave, sociodemographic variables and medical prescriptions.Four hundred and ninety-seven patients (mean age 53years, 90.7% male), diagnosed with acute myocardial infarction (60%), angina pectoris (20.7%) or chronic form of ischemic heart disease (19.1%). Thirty-seven per cent of patients took anxiolytics the year after diagnosis and 15% took antidepressants. The average duration of sick leave was 177days (95% CI: 163-191 days). Patients diagnosed with acute myocardial infarction returned to work after a mean of 192days, compared to 128days in cases with angina pectoris. Patients who took antidepressants during the year after diagnosis returned to work after a mean of 240days. The mean work productivity loss was estimated to be 9,673 euros/person.The mean duration of sick leave due to ischemic heart disease was almost six months. Consumption of psychotropic medication doubled after the event. Older age, suffering an acute myocardial infarction and taking antidepressants were associated with a longer sick leave period.
PubMed | Idiap Research Institute, Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol and University of Girona
Type: Journal Article | Journal: Journal of clinical lipidology | Year: 2016
To describe real-life patterns of statin use and cholesterol goal attainment in a retrospective cohort of patients with high cardiovascular risk.Retrospective cohort study of 21,636 individuals, 18.34% women, mean age 63.30 years (standard deviation 6.29). New statin users aged 35 to 74 years at high cardiovascular risk and with no previous cardiovascular disease in primary care electronic medical records (2006-2011). Patterns of statin use were based on statin type, potency, and 1-year statin switches.Relative mean reductions over 1 year and probability of goal attainment (<3.3 mmol/L). Natural patterns of statin use were identified using multiple correspondence analysis; general linear and logistic models were used to estimate low-density lipoprotein cholesterol (LDL-C) reductions and goal attainment probability.Three patterns of statin use were defined: low (3.82% of the population), moderate (71.94%), and high intensity (24.24%). After 1 year, potency decreased 42.74%, 64.16%, and 50.94%, respectively, and 37.41%, 29.47%, and 30.16% of the population stopped taking statins in low, moderate, and high patterns, respectively. Relative reductions in LDL-C: low intensity, 15.7% (95% confidence interval [CI]: -22.96 to 54.36); moderate intensity, 29.72% (95% CI: 29.12-30.32); and high intensity, 24.20% (95% CI: -8.08 to 40.32). There was a direct relationship between higher intensity patterns and greater probability of goal attainment.Three real-life patterns of statin use were identified. Lipid management strategies in primary care should focus on improving adherence to treatment. People starting at low potency should switch to a moderate pattern; more intensive therapies should be considered in who require a larger LDL-C reduction to reach therapeutic targets, patients with good treatment adherence who do not achieve the goal with a moderate pattern of therapy or patients at very high risk.
PubMed | Institute Catala Of La Salut and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: Journal Article | Journal: PloS one | Year: 2016
To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain).This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73 m2 and/or urine albumin to creatinine ratio (UACR) 30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy.CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4-1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values 10 mg/g, and increased considerably with UACR values 300 mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6-2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73 m2 [OR], 95% confidence interval [CI], 1.3 (1.1-1.6).These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population.
PubMed | Avedis Donabedian Research Institute FAD, Radboud University Nijmegen, Autonomous University of Barcelona and Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol
Type: Journal Article | Journal: The International journal of health planning and management | Year: 2016
To explore the added value of community-orientated programmes aimed at enhancing healthy lifestyles associated with the key components of cardiovascular risk management (CVRM) in coronary heart disease (CHD) patients.Observational study in Spain, including 36 practices, 36 health professionals, and 722 CHD patients (mean (SD) age 72 (11.73)). Our predictor variable of interest was reported deliveries from primary care practices (PCPs) concerning community-orientated programmes such as physical exercise and smoking cessation groups. Data were obtained through structured questionnaires administered to PCP health professionals. Our CVRM outcome measures were as follows: recorded risk factors, drug prescriptions, and intermediate patient outcomes (blood pressure levels, low-density lipoprotein cholesterol, and body mass index).Thirty practices delivered community programmes: most delivered one [17 (47.2%) practices] or two [11 (30.5%) practices]. These educational programmes aimed to encourage enhanced healthy lifestyles through group counselling sessions, mailed print material, and one-to-one counselling. In PCPs delivering community programmes, more patients received antihypertensives (89.7%), antiplatelet therapy (80.5%), and statins (70.8%) than those PCPs without programmes, although there were no statistically significant differences between them.No evidence was found for the added value of community-orientated CVRM programmes that could help health professionals refine criteria when including CHD patients in preventive programmes.