Knowledge and health care resource allocation: CME/CPD course guidelines-based efficacy.

BACKGROUND: Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored. OBJECTIVE: This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management. METHODS: Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training. RESULTS: Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p < 0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p < 0.01). CONCLUSION: This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events

Uso di farmaci in un campione di popolazione adulta italiana: cambiamenti temporali ed uso multiplo di farmaci

Obiettivo: darei nformazionis ul trend dell'uso di farmaci,i n un sotto-campiondei popolazione generale,e d identificarei fattori associatai ll'uso multiplo di farmaci. Metodo:166311866s oggetti,s elezionatdi a due campionid i popolazioneg eneralein vestigatin el 1988-1993( baselinee) d inclusi in uno studion ested( personec he avevanor iportatod i assumere farmaci al baselinea, ppaiatic on metodor andoma d un campioned i soggettic he non assumevano farmaci);t ale sotto-campionhea partecipatoa d una indaginet elefonica,c ondottan el 2005 (followup), nella quale sono state raccolte informazioni demografiche, sintomi/malattie respiratorie, comorbidità,u so dei servizi sanitari e assunzioned i farmaci. L'età media del sotto-campionea l baselinee rad i 49.4+14.2a nni,e d al follow-upd i 63.0+13.9. Risultati: la frequenzad i assunzioneo ccasionaled i farmacid iminuisced all'8/% aI 6.10lom, entre l'assunzionea bitualed i farmacia umentad al 46.2%a l70.I%; i tassic umulativid i incidenzas ono risultati di 5.8% e 60.40 , rispettivamente. I farmaci più frequentemente utlhzzati sono i cardiovascolargi,l i psicotropicei d i broncopolmonarCi. irca1 14 7% dell'interoc ampioneu sap iu di un farmaco contemporaneamen(tpeo lypharmacy)D. ai dati dell'intervistat elefonicar isulta che Ia polypharrnacyè significativamentea ssociatac on: età,a nziana( OR 1.83), percezioned i cattiva salute( OR 1.64),v isite specialistiche dal medicod i famiglia, negli ultimi 12 mesi (OR 2.15,, 1.65),p resenzad i malattiec ardiovascolar(iO R 2.34),i pertensione(O R 2.28),d iabete( OR 2.28), depressione/ans(iOaR 2.29)e malattied ello stomaco/intestinlfoe gato( OR 1.88). Conclusioni: questos tudioi ndica che I'età avanzatal,'u so di servizi sanitarie la comorbiditàs ono associatci on l'uso multiplod i farmaci

Clinical vs. Structured interview on anxiety and affective disorders by primary care physicians. Understanding diagnostic discordance

SUMMARY. Aims – To assess in a national sample the ability of GPs to detect psychiatric disorders using a clinical vs. a standardized interview and to characterize the patients that were falsely diagnosed with an anxiety or affective disorder. Methods – This is a national, cross-sectional, epidemiological survey, carried out by GPs on a random sample of their patients. The GPs were randomly divided into two groups. Apart from the routine clinical interview, the experimental group (group A) had to administer the Mini-International Neuropsychiatric Interview (MINI). Results – Data was collected by 143 GPs. 17.2% of all patients had a clinical diagnosis of an affective disorder, and 25.4% a clinical diagnosis of an anxiety disorder. In group A, the number of clinical diagnoses was about twice that of MINI diagnoses for affective disorders and one and a half times that for anxiety disorders. The majority of clinical diagnoses were represented by MINI subsyndromal cases (52.3%). Females showed a higher OR of being over-detected by GPs with anxiety disorders or of not being diagnosed with an affective disorder. Being divorced/separated/widowed increased the OR of over-detection of affective and anxiety disorders. The OR of over-detection of an affective or an anxiety disorder was higher for individuals with a moderate to poor quality of life. Conclusions – In the primary care a gap exists between clinical and standardized interviews in the detection of affective and anxiety disorders. Some experiential and social factors can increase this tendency. The use of a psycho. Declaration of Interest: GlaxoSmithKline provided unrestricted economic and organizational support to the study. No further declarations on other form of financing or any other involvement that might be considered a conflict of interest in connection with the submitted article. KEY WORDS: primary care, detection, affective disorders, anxiety disorders

Clinical vs. structured interview on anxiety and affective disorders by primary care physicians. Understanding diagnostic discordance

SUMMARY. Aims – To assess in a national sample the ability of GPs to detect psychiatric disorders using a clinical vs. a standardized interview and to characterize the patients that were falsely diagnosed with an anxiety or affective disorder. Methods – This is a national, cross-sectional, epidemiological survey, carried out by GPs on a random sample of their patients. The GPs were randomly divided into two groups. Apart from the routine clinical interview, the experimental group (group A) had to administer the Mini-International Neuropsychiatric Interview (MINI). Results – Data was collected by 143 GPs. 17.2% of all patients had a clinical diagnosis of an affective disorder, and 25.4% a clinical diagnosis of an anxiety disorder. In group A, the number of clinical diagnoses was about twice that of MINI diagnoses for affective disorders and one and a half times that for anxiety disorders. The majority of clinical diagnoses were represented by MINI subsyndromal cases (52.3%). Females showed a higher OR of being over-detected by GPs with anxiety disorders or of not being diagnosed with an affective disorder. Being divorced/separated/widowed increased the OR of over-detection of affective and anxiety disorders. The OR of over-detection of an affective or an anxiety disorder was higher for individuals with a moderate to poor quality of life. Conclusions – In the primary care a gap exists between clinical and standardized interviews in the detection of affective and anxiety disorders. Some experiential and social factors can increase this tendency. The use of a psycho. Declaration of Interest: GlaxoSmithKline provided unrestricted economic and organizational support to the study. No further declarations on other form of financing or any other involvement that might be considered a conflict of interest in connection with the submitted article. KEY WORDS: primary care, detection, affective disorders, anxiety disorders

Environmental tabacco smole (ETS): lifetime exposure related to respiratory health in never smoker Italian women

Background: few studies investigated ETS effects on health according to cumulative lifetime exposure. Aim: to assess the associations between ETS lifetime exposure and current respir. dis. Methods: analyses concern 1977 never smoker women (mean age 46). According to duration, frequency, self-reported exposure at work, home or in other places, a cumulative ETS exposure score was computed. Based on tertiles, women were classified in mildly, moderately, heavily exposed. Results: there are dose-response associations between exposure levels and respiratory disorders. OR (95% CI) accounted for age, education, residence, age-residence interaction, and other work-exposure (reference: never exposure

Association between medicine usage and respiratory disorders in Italian general population samples, according to coexisting nonrespiratory diseases

Aim: to assess drug use in subjects with respiratory symptoms/diseases (RD) or airflow obstruction (AO) according to non respiratory diseases (NRD). Methods: Through an interviewer-administered questionnaire, 4010 subjects (8-88 old, 48% males) from two Italian areas, provided information on: chronic use of any or specific (broncho-pulmonary/antiallergic/cardio-vascular/diuretic) drugs, diagnosis of asthma, diagnosis of chronic bronchitis/emphysema (COPD), COPD or chronic cough/phlegm (COPDsx), AO (FEV1/FVC &lt; 70%), NRD. Results: Prevalences of asthma, COPD, COPDsx, and AO were 6.1, 4.7, 21.5, 12.9%, respectively. NRD (especially joint and cardio-vascular) was significantly more prevalent in subjects with RD or AO than in absence of these conditions (73 vs 62, 77 vs 60%, respectively). COPD subjects showed the largest use of drugs (59 for any and 38% for specific), followed by asthmatics (42 and 30%). After accounting for NRD, sex, age, residence, smoking habit, and education, all considered RD and AO resulted significantly related to medicines up-take. The strongest associations were for asthma (OR 1.96, 95%CI 1.40-2.54) and COPD (OR 1.96, 1.40-2.74), as concern any drug, and for asthma (OR 3.48, 2.35-5.16), as regards specific medicines. Except for asthma, the associations were considerably stronger when NRD was not included in analyses. Conclusion: Most people in the general population do not use drugs, in spite of reporting respiratory disorders. Coexistent non respiratory disorders have to be considered to better assess medicine consumption by subjects with respiratory disorders, especially with COPD or AO