Biomedical subjects

Giampiero Mazzaglia

Publications and source records attributed to Giampiero Mazzaglia.

At least 19 recordsLinked to original sources

PubMed2006

Antibiotic prescribing for acute and recurrent cystitis in primary care: a 4 year descriptive study.

OBJECTIVES: To explore the antibiotic prescribing pattern for cystitis and the patient-related variables associated with prescription during a 4 year period among Italian general practitioners (GPs). METHODS: We obtained information from the 'Health Search Database' (HSD), an Italian general practice research database. From a total sample of 457 672 eligible patients aged >16 years registered up to December 2002, we included those whose diagnoses could be classified as acute (uncomplicated and complicated) and recurrent cystitis. Patients' features and prevalence of antibiotic users were assessed. RESULTS: Of 35 129 cases diagnosed during the period 1999-2002, 96.0% of them were acute cystitis (39.2% recorded as uncomplicated). The prevalence of cases with acute complicated and uncomplicated cystitis slightly increased during the 4 year period, whereas it remained stable for recurrent cystitis. Most of the cystitis cases reported no diagnostic tests. More than 70% of patients were prescribed with at least one antibiotic, with a 4-fold increased risk of antibiotic use for acute cystitis throughout the study period. The prevalence of antibiotic users reached 86.2% for both acute uncomplicated and complicated cystitis in 2002, and 81.5% for recurrent cystitis. Fluoroquinolones represented the most common antibiotics being prescribed although they markedly decreased during these years. Fosfomycin trometamol use increased dramatically, becoming the first choice for any type of cystitis. CONCLUSIONS: Data indicate an evident rise in antibiotic use mostly related to fosfomycin trometamol. They also indicate that such a prescriptive trend finds confirmation from the available evidence for acute uncomplicated cystitis, although the management of recurrent cystitis could be further improved.

Acute Disease↗

PubMed2006

Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study.

OBJECTIVES: To compare the ability of five measures of comorbidity to predict mortality and incident disability in basic activities of daily living (BADLs) in unselected older persons. DESIGN: An assessment of the data obtained from the Insufficienza Cardiaca negli Anziani Residenti a Dicomano (ICARe Dicomano) Study, a longitudinal epidemiological survey on heart failure in older people. SETTING: Dicomano, a small, rural town near Florence, Italy. PARTICIPANTS: The entire population aged 65 and older living in Dicomano, Italy, was enrolled in the ICARe Dicomano Study. MEASUREMENTS: At baseline (1995), comorbidity was quantified in 688 participants, based on clinical diagnoses, using disease count (DC), Charlson Comorbidity Index (CCI), Index of Co-Existent Diseases (ICED), and Geriatric Index of Comorbidity (GIC), or on drug use, using Chronic Disease Score (CDS). Incident ADL disability was assessed in 1999 and vital status in 2004. RESULTS: Mortality increased with the severity of comorbidity, with hazard ratios around 2 when comparing the highest and the lowest quartiles of DC, CCI, and ICED in Cox regressions adjusted for age, sex, and physical and cognitive performance. Prediction of mortality with GIC and CDS was only borderline significant. All measures predicted incident ADL disability; the strongest risk gradient (hazard ratio = 8.2 between the highest and lowest quartiles) was observed with ICED. Physical and, to a minor extent, cognitive performance added significantly to predicting mortality and incident BADL disability. CONCLUSION: All the measures of comorbidity predicted death and BADL disability in older community dwellers. DC, CCI, and ICED performed better than GIC and CDS. Physical performance measures are strong, independent contributors to the prediction of these outcomes.

Activities of Daily Living↗

PubMed2005

Antipsychotic prescribing pattern among Italian general practitioners: a population-based study during the years 1999-2002.

OBJECTIVES: To assess the antipsychotic use and the prevalence/incidence of antipsychotic drug users in Italy during the years 1999-2002. To estimate the persistence with antipsychotic medications, and to measure their off-label use. METHODS: We selected 465,061 individuals registered by June 2002 in the lists of 320 general practitioners, homogeneously distributed throughout Italy, from the Health Search Database. We measured the antipsychotic drug consumption, calculated as defined daily dose (DDD) per 1000 inhabitants per day. We also calculated the number of individuals receiving at least one antipsychotic prescription, to estimate the annual prevalence and incidence of antipsychotic users. Among incident users, we evaluated the percentage of patients adherent to drug label indications and the average duration of treatment, estimated as medical possession ratio (MPR). RESULTS: Atypical antipsychotic use has continuously increased from 1999 to 2002. Women, older people and patients affected by psychotic disorders other than schizophrenia were seen to be more likely to receive antipsychotic prescriptions. Persistence with atypical drug treatment (MPR=0.213 in 2002) appeared longer than that of typical drugs (0.169). The percentage of patients adherent to drug label indications was significantly higher among typical antipsychotic users (P<0.001). The most common off-label use for atypical drug was senile dementia. CONCLUSION: Atypical drug use has been continuously expanding over the years 1999-2002, particularly in older people with dementia. The rapidly increasing use of this new class of antipsychotics highlights the need for a better evaluation regarding their safety profile and a better definition of their role in psychiatric treatments.

Adolescent↗

PubMed2005

Adverse drug events in emergency department population: a prospective Italian study.

PURPOSE: There is little evidence concerning adverse drug events (ADEs) in outpatients and related hospital admissions. In Italy, only one investigation was conducted on this important health issue. We therefore carried out a study to determine ADE incidence and ADE-related hospital admissions among emergency department (ED) visits, and to identify the risk factors for serious ADE leading to ED visit. METHODS: During the year 2000, we performed a prospective study in two observational periods of 10 days each in 22 Italian EDs. Demographic, clinical and pharmacological data about all patients admitted to ED were collected by trained and qualified monitors. Records related to ADE were analysed and validated by a specific scientific committee. RESULTS: On 18,854 enrolled patients, 629 (3.3%) were affected by ADE. Among these, 244 (38.8% of ADE patients) reported a serious event. Patients with ADE, accounting for 4.3% (193 cases) of total hospitalisations, were significantly more likely to be hospitalised (30.7% vs. 23.7%; p<0.0001), females (57.2% vs. 46.3%; p<0.0001) and elders, compared with the total sample. Serious ADE resulted significantly associated with male gender and old age. NSAIDs (16.5% of total ADE visits) and antibiotics (12.9%) were the drugs mostly involved in ADE occurrence. ADE affected mostly skin (213 ADE visits) and gastrointestinal system (211). CONCLUSION: Old age and male gender resulted risk factors involved in the development of serious ADE. The high ADE-related hospitalisation incidence highlights the need for prevention strategies targeted to reduce the impact of ADE in the general population.

Adolescent↗

PubMed2005

L-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients.

Scattered reports indicate that L-carnitine may suppress proinflammatory cytokines in sick individuals without renal disease and may improve protein synthesis or nitrogen balance either in patients without renal disease or in maintenance hemodialysis (MHD) or chronic peritoneal dialysis patients. We conducted an experimental study in MHD patients to evaluate the effects of L-carnitine treatment on inflammatory and protein-energy nutritional status. MHD patients were assigned to receive intravenous injections of L-carnitine 20 mg/kg (n = 48) or placebo (n = 65) thrice weekly at the end of each hemodialysis treatment for 6 months. The carnitine-treated group showed a statistically significant decrease in serum C-reactive protein and increase in serum albumin and transferrin, blood hemoglobin, and body mass index. Conversely, in the placebo-treated group, a significant decrease was reported for serum albumin, serum transferrin, and body mass index, whereas the other considered measures did not change significantly. These preliminary findings suggest that in MHD patients, L-carnitine therapy may suppress inflammation, particularly among those patients with C-reactive protein > or =3 mg/dL, and may improve protein-energy nutritional status.

Aged↗

PubMed2005

Incidence of diabetes in a general practice population: a database cohort study on the relationship with haloperidol, olanzapine, risperidone or quetiapine exposure.

The present study aimed to estimate the incidence of diabetes in general practice patients who were treated with haloperidol, olanzapine, risperidone or quetiapine monotherapy and in subjects who were not exposed to antipsychotics. The design was a retrospective, up to 2 years, cohort study, with age-, sex- and length of observation-matching between subjects who were exposed and not exposed to antipsychotic drugs. Data were taken from the Health Search database, which contains information from 550 Italian general practitioners. Participants comprised 2,071 subjects taking haloperidol, 266 taking olanzapine, 567 taking risperidone and 109 taking quetiapine, in addition to 6,026 age- and sex-matched subjects who were not using antipsychotic drugs during the period of observation. Inclusion was limited to initially non-diabetic and antipsychotic drug-free individuals. The main outcome measure was the incidence of drug-treated diabetes. After age and sex correction by Cox regression analysis, the four groups treated with antipsychotics significantly differed from untreated subjects in hazard ratios for diabetes. The ratios for the haloperidol, olanzapine, risperidone and quetiapine groups were 12.4 (95% confidence interval 6.3-24.5), 20.4 (6.9-60.3), 18.7 (8.2-42.8) and 33.7 (9.2-123.6), respectively, with no significant differences when compared to each other.

Adult↗

PubMed2005

Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care.

OBJECTIVE: To describe patterns of persistence and related primary care costs associated with first antihypertensive treatment. DESIGN AND SETTING: Retrospective cohort study during 2000-2001, using information from 320 Italian general practitioners. PARTICIPANTS: We studied 13 303 patients with newly diagnosed hypertension, who received a first single antihypertensive prescription within 3 months after diagnosis. MAIN OUTCOME MEASURES: Persistence with first-line single treatment, categorized as follows: continuers: patients continuing the first-line medication for at least 1 year; combiners: patients receiving an additional antihypertensive drug and continuing the initial medication; switchers: patients changing from the first-line to another class of antihypertensive drug and discontinuing the initial treatment; discontinuers: patients stopping the first-line treatment without having another prescription until the end of the follow-up. Primary care costs were expressed as the cost of hypertension management per person-year of follow-up. RESULTS: In the study cohort, 19.8% were continuers, 22.1% were combiners, 15.4% were switchers, and 42.6% were discontinuers. Continuation was greatest with angiotensin II type 1 receptor blocking agents (25.2%), calcium channel blockers (23.9%) and angiotensin-converting enzyme inhibitors (23.3%). Severe hypertension [hazards ratio 1.30; 95% confidence interval (CI) 1.18 to 1.43] and severe health status (hazards ratio 1.22; 95% CI 1.15 to 1.30) increased the risk of discontinuation. The likelihood of needing an additional antihypertensive drug was associated with mild-to-severe baseline blood pressure, diabetes (hazards ratio 1.20; 95% CI 1.06 to 1.36), and familial history of cardiovascular disease (hazards ratio 1.24; 95% CI 1.10 to 1.39). Discontinuers accounted for 22.4% of the total primary care cost. Initial treatment with angiotensin II type 1 receptor blocking agents and beta-blockers resulted in incremental primary care costs of 145.2 and 144.2, respectively, compared with diuretics. Combiners and switchers increased the primary care cost by 140.1 and 11.7, compared with continuers. CONCLUSION: Persistence with first-line single antihypertensive drugs is extremely low during the first year of treatment. Potential cost saving should be possible by reducing the high frequency of discontinuation. Diuretics represent the least expensive therapeutic option, although further investigations in the long-term are needed to analyse the effects of persistence on therapeutic effectiveness and related costs.

Adult↗

PubMed2005

Cholesterol control in stroke prevention in Italy: a cross-sectional study in family practice.

BACKGROUND: Stroke represents worldwide the second and seventh cause of death and invalidity, respectively. Patients with ischaemic stroke or transitory ischaemic attack (TIA) are at high risk of recurrence, therefore requiring intensive treatment. Hypercholesterolaemia is a modifiable risk factor for stroke. The general practitioners attitude towards detection and treatment of dyslipidaemia among patients with stroke or TIA in Italy is unknown; we therefore aimed to address this issue taking advantage of the database of The Italian College of General Practitioners. METHODS: Prevalence of the monitored factors (lipid levels, statin prescription, and lipid level control with hypolipidaemic agents prescription) were analysed on a patient population of 465 061. RESULTS: A total of 2555 (49% women and 51% men) patients with a diagnosis of stroke and 2755 patients (52% women and 48% men) with a diagnosis of TIA were included in the study. Total plasma cholesterol (TC) was reported in more than 60% of the patients and low-density lipoprotein cholesterol (LDLc) and high-density lipoprotein cholesterol (HDLc) in less than half. Total plasma cholesterol and LDLc were controlled in 70.3 and 72.8% of the patients, respectively. The percentage of controlled patients decreased to 64% when both LDLc and TC were considered. Statins and fibrates were prescribed in a small proportion of patients (16.9 and 3.5%, respectively). An acceptable control of blood lipids was achieved in a majority of those patients (60.2%). However a relatively large number of patients (646) with high plasma lipids remained untreated. CONCLUSIONS: Monitoring and intervention strategies on plasma lipid levels in patients with a diagnosis of stroke or TIA need to be improved.

Age Distribution↗

PubMed2005

Computerized general practice databases provide quick and cost-effective information on the prevalence of angina pectoris.

BACKGROUND: The aim of this study was to compare the prevalence of angina pectoris (AP) using self-reported information and primary care databases. METHODS: A comparison between the prevalence of AP in 730,586 subjects from the Health Search Database (HSD) and 119,799 individuals from a Health Interview Survey (HIS) was performed. The age-specific prevalence was calculated by dividing the detected cases by the total number of individuals in each age group. The age-standardized prevalence was estimated by direct standardization performed using the Italian standard population. RESULTS: The HSD reported a higher crude prevalence of AP than the HIS, both in males (1374/100,000 vs 1006/100,000) and females (1449/100,000 vs 1007/100,000). In the HSD the age-specific prevalence was lower for patients aged <65 years, whilst higher estimates were reported for older patients. Age standardization slightly reduced the prevalence in both samples, although the HSD always reported higher estimates. CONCLUSIONS: Prescription data from general practice databases may be a valid, simple, and cost-effective method to evaluate and serially monitor the prevalence of AP.

Adolescent↗

PubMed2005

The database of Italian general practitioners allows a reliable determination of the prevalence of myocardial infarction.

BACKGROUND: To plan preventive intervention after myocardial infarction (MI) the disease prevalence and the age and time from acute event of the index population should be known. METHODS: We identified all the living patients with MI coded diagnosis in the database of the Italian College of General Practitioners (Health Search Database-HSD). The years from the first acute MI were also determined. RESULTS: 3588 subjects with MI diagnosis were identified (2698 males and 888 females, for 2 gender not recorded). Based on the distribution of our population and on that reported by the Italian Institute of Statistics, stratified by gender and age (segments of 10 years), the estimated number of subjects with MI in Italy (age-standardized rates x 10000) was 309284 for men and 102343 for women. CONCLUSIONS: The prevalence of MI diagnosis in the HSD is very close to that obtained by other epidemiological methods. Querying the database can provide a simple and inexpensive way to estimate and monitor the prevalence of MI in Italy.

Adult↗

PubMed2005

Homecare for patients with heart failure in Italy.

UNLABELLED: BACKGROUND; Heart failure (HF) represents an important health issue in western countries, especially for the elderly, frail population. A number of HF patients must usually be assisted at home. No information is available about the usual care of HF patients in Italy. The aim of this study was to describe the characteristics of HF patients receiving homecare in the Italian general practice. METHODS: A questionnaire was sent to 320 general practitioners (GPs) involved in the Health Search project. Among these, 148 (46.2%) answered and 376 home-ridden HF patients (60.3% women, median age 85 years) were identified. RESULTS: 257 (57%) patients were in NYHA class III or IV. Multiple relevant concomitant diseases occurred in 326 (86.7%) subjects. Only 140 (37.2%) patients were able to take their pills without any help; caregivers, mainly family members, were required 24 hours a day in 78.7% of cases. The length of homecare was > 1 year in 84.5% of cases. CONCLUSIONS: According to our data, thousands of HF patients are usually assisted at home for long periods in Italy. This is a very old group of subjects with heavy co-morbidity and a high need for continuous, prolonged assistance. Studies specifically aimed at the care of HF patients are needed.

Aged↗

PubMed2004

Oral anticoagulant therapy in Italy: prescribing prevalence and clinical reasons.

BACKGROUND: Oral anticoagulants (OAs) are recommended for many clinical problems and their use requires organised and knowledgeable medical support. Up to our knowledge, there is no data about both the reasons of treatment among OAs' users and the number of patients prescribed with OAs in Italy. OBJECTIVES: To describe the OA use, and the reasons of prescribing among Italian General Practitioners. METHODS: We used the Health Search Database owned by the Italian College of General Practitioners to identify the clinical records of patients > or =20 years who had at least one prescription of OAs during the year 2002. RESULTS: Among a study population of 448,495 patients, 3,649 subjects (0.81%) had received at least one OAs prescription. Applying such a proportion to the overall Italian population, on the basis of data from Italian Office for National Statistics (ISTAT), we estimated that 376,882 patients would have used OAs during the year 2002 in Italy. The most frequent clinical problem related to the use of OAs was atrial fibrillation (45.6%), followed by cardiac valve disease (14.6%), deep vein thrombosis (12.2%) and peripheral artery embolism (7.7%). CONCLUSIONS: Approximately 370,000 patients are prescribed with OAs in Italy and for more than 50% of them life-long therapy is recommended. Atrial fibrillation is the most frequent reason for prescription.

Administration, Oral↗

PubMed2004

Management of patients with suspected angina, but without known myocardial infarction: a cross-sectional survey.

BACKGROUND: Although several studies describing the diagnostic and therapeutic management of patients with myocardial infarction (MI) by general practitioners have recently been published, little information exists about patients with angina without MI. AIM: To describe the management of patients with angina without known MI in general practice. DESIGN: A cross-sectional survey. SETTING: Italian general practitioners providing data to the Health Search Database. METHOD: Prevalent cases of angina, using the prescription of nitrates as a 'proxy' for disease status, in patients without known MI were selected from the Health Search Database. Data on patient demographics, clinical information, established therapies and cardiology visits were collected. A binomial logistic regression analysis was performed to test which variable made prescription more or less likely. RESULTS: There were 10 455 patients with angina. Blood pressure readings were available for 73.8% of patients; in this group 58.9% had inadequate (> or = 140/90 mmHg) blood pressure control. Total cholesterol was recorded in 61.6% of cases (mean value = 5.5 mmol/L). Antiplatelet or oral anticoagulant agents were used by 67.8% of the patients, while 24.1% of patients received lipid-lowering agents, 61% received ACE-inhibitors or angiotensin-II receptor antagonists, and 25.2% received beta-blockers. CONCLUSIONS: In patients treated with nitrates the monitoring of modifiable risk factors and the use of preventive drugs is lower than expected. New strategies aimed at improving secondary cardiovascular prevention among these easily identifiable high-risk subjects are needed.

Adolescent↗

PubMed2003

Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care.

OBJECTIVE: To assess patient- and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice. METHODS: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database. Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness. RESULTS: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold. Significant associations with antibiotic use were found for geographic location and number of patients under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. CONCLUSIONS: There is still excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.

Acute Disease↗

PubMed2003

Secondary prevention of stroke in Italy: a cross-sectional survey in family practice.

BACKGROUND: Hypertension control and antiplatelet or oral anticoagulant drugs are the basis for secondary prevention of cerebrovascular events. Family physicians (FPs) are usually involved in both aspects of prevention, but no research has been carried out in Italy to evaluate the behavior of FPs in this field of prevention. METHODS: Data concerning 318 Italian FPs and 465,061 patients were extracted from the Health Search Database. Patients with coded diagnoses of stroke and transient ischemic attack (TIA) were selected. Demographic records and information regarding presence of concurrent disease and medical records were also obtained. Logistic regression analyses were carried out to assess whether conditions exist that make appropriate control of blood pressure (BP) and prescription of antiplatelet or anticoagulant drugs more likely. RESULTS: We selected 2555 patients with diagnosis of stroke and 2755 with TIA. Among all of the subjects, 32.6% had no BP recorded. Among the remaining subjects, 58.7% reported uncontrolled BP. Isolated systolic hypertension has been shown in 68.8% of patients with uncontrolled BP. Antiplatelet and anticoagulant drugs were prescribed in 72% of these cases. Factors that made the prescription significantly more unlikely were diagnosis of TIA (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.41 to 0.54), total invalidity (OR, 0.66; 95% CI 0.56 to 0.78), and time from event of 5 years or more (OR, 0.81; 95% CI, 0.70 to 0.94). CONCLUSIONS: Italian FPs could improve secondary prevention of cerebrovascular accidents. The primary target of intervention should be the control of systolic BP, and the group of patients with unacceptably high BP should be given priority. All of these patients should have been prescribed antiplatelet drugs or anticoagulant agents, except in cases of extremely short life expectancy or substantial contraindications.

Aged↗

PubMed2003

Effects of manidipine and nifedipine on blood pressure and renal function in patients with chronic renal failure: a multicenter randomized controlled trial.

Several studies suggest the distinctive advantages of ACE-inhibitors and calcium-channel blockers in protecting the residual renal function in hypertensive patients. Pre-clinical and clinical studies have shown rare adverse events in the treatment with manidipine, which is commonly used as antihypertensive drug. We therefore decided to compare the effects of manidipine and nifedipine, on blood pressure, and renal function. One hundred and one hypertensive patients with chronic renal failure were randomly assigned to receive either manidipine 20 mg daily or nifedipine 60 mg daily, respectively. Patients were assessed every two weeks during the active treatment period with the final follow-up after three months. The primary endpoint was the achievement of DBP < or = 90 mmHg or a 10 mmHg DBP reduction from the baseline values, whilst the secondary endpoints was the improvement of the renal function assessed through the creatinine clearance, creatinine blood levels, protein and sodium urine excretion. Significant reduction in SBP (p < 0.001) and DBP (p < 0.001), compared to the baseline values, was reached in both treatments. Creatinine blood levels (p < 0.05) and creatinine clearance (p < 0.01) significantly increased in the manidipine group. Protenuria did not significantly change in the manidipine group but increased in the nifedipine group (p < 0.05). The number of patients with severe adverse reactions differed significantly (p < 0.01) between the groups with the highest frequency for nifedipine (14.5%) compared to manidipine (8.5%). The withdrawal rate was not significantly different between the groups. Manidipine is equally safe and effective as nifedipine and it may have more activity on renal function and less severe side effects compared to nifedipine.

Adult↗

PubMed2003

Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases.

BACKGROUND: The aim of this study was to describe population and primary care morbidity and to examine how the differences vary across the diseases and are influenced by patients' demographic characteristics. METHODS: A comparison of the prevalence of four chronic conditions for 432747 patients from the Health Search Database (HSD) and 119799 individuals from a Health Interview Survey was carried out. A linear regression was performed to study the associations between age and difference in morbidity. RESULTS: Similar prevalence was found for diabetes and hypertension, whereas for chronic obstructive pulmonary disease (COPD) and gastroduodenal ulcer lower HSD prevalence was reported. Among females, age was always associated with morbidity difference. Among males, significant associations were found only for COPD (R2 = 0.81; p = 0.001) and gastroduodenal ulcer (R2 = 0.93; p < 0.001). CONCLUSIONS: The difference between population and primary care morbidity is affected by disease under investigation and patients' demographic characteristics. Therefore, in choosing the more cost-effective approach to collect data such evidence should be taken into account, and results should be interpreted with great caution.

Adolescent↗

PubMed2003

Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behavior among Italian general practitioners in diabetic patients: an intervention trial.

OBJECTIVE: To evaluate whether an electronic reminder integrated into a routine computer system increases the use of antiplatelet drugs for diabetic patients among Italian general practitioners (GPs). RESEARCH DESIGN AND METHODS: A randomized controlled trial was carried out among 300 GPs and their patients selected from the Health Search Database. Among these, 150 GPs (intervention group) received instructions to activate an electronic reminder plus a letter summarizing the beneficial effects of antiplatelet drugs in diabetic patients with at least one additional cardiovascular risk factor ("high risk"), whereas the other 150 GPs (control group) received only the letter. The electronic reminder, integrated into a standard software system for the management of the daily clinical practice, was displayed when every participating GP opened the medical record of diabetic patients aged > or =30 years. Only high-risk diabetic patients were included in the analysis. Patients were considered under antiplatelet treatment if they received two or more prescriptions at baseline and during the follow-up. RESULTS: We selected 15,343 high-risk diabetic patients, 7,313 belonging to GPs of the control group and 8,030 belonging to GPs of the intervention group. Overall, 1,672 patients (22.9%) of the control group and 1,886 (23.5%) patients of the intervention group received antiplatelet drugs at baseline (P = N.S.). At the end of the follow-up, the number of treated patients was significantly increased in the intervention group (odds ratio 1.99, 95% CI 1.79-2.22) versus the control group. The effect of the electronic reminder was more relevant among those patients with one or more cardiovascular risk factors but without previous cardiovascular diseases (CVDs), compared with those with CVDs. CONCLUSIONS: These findings provide evidence for the effect of an electronic reminder in affecting the prescriptive behavior of GPs.

Adult↗