[Evaluation of therapeutical appropriateness in psychiatric treatment of schizophrenia, by integrating computer data records with clinical audit results]

The aim is to evaluate prescriptive patterns of atypical antipsychotic drugs for the treatment of schizophrenia in the LHU Caserta in 2011-2013, and to indicate potentially inappropriate therapy; to plan or schedule corrective/preventive activities to support the continuous improvement of health services

The Burden of Nephrotoxic Drug Prescriptions in Patients with Chronic Kidney Disease: A Retrospective Population-Based Study in Southern Italy

Background: The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients. Aim: To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011. Methods: The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated. Results: Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used. Conclusions: Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration

The burden of nephrotoxic drug prescriptions in patients with chronic kidney disease: A Retrospective population-based study in Southern Italy

Background: The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients. Aim: To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011. Methods: The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated. Results: Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used. Conclusions: Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration

COVID-19 Patient Management in Outpatient Setting: A Population-Based Study from Southern Italy

: Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients' management in Southern Italy in the period February 2020-January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27-58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice

Flow chart of CKD patients included in the study.

<p>Flow chart of CKD patients included in the study.</p

Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of NSAIDs.

<p>Proportion of CKD patients (N = 1,989) who received at least one prescription of individual NSAIDs within one year prior or after the first CKD diagnosis and within one year after the entry in dialysis (N = 112). Others (<5%): tenoxicam, meloxicam, aceclofenac, ibuprofen, dexibuprofen, tiaprofenic acid, naproxen, lornoxicam, acetylsalicylic acid, acetylsalicylic acid and ascorbic acid, niflumic acid, diclofenac sodium plus misoprostol. Coxib: celecoxib, etoricoxib.</p

Crude and Cluster-adjusted analysis of CKD patients’ CND prescription by GP.

<p>Distribution (%) of CKD patients who received at least one prescription of contraindicated nephrotoxic drugs (CND) within the year prior (A) and after (B) first CKD diagnosis, clustered by GP. The distribution was clustered by GP and the was adjusted also by sex and age. CND: contraindicated nephrotoxic drug.</p

Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of CND, stratified by classes.

<p>Proportion of CKD patients (N = 1,989) who received at least one prescription of contraindicated nephrotoxic drugs, stratified by drug classes, within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112) within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112). Others: zoledronate, lithium, antineoplastic agents (methotrexate, interferon alfa-2B), gold preparations (auranofin), hydrochlorothiazide. Low dosage acetylsalicylic acid was not included among NSAIDs, but it was analysed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089072#pone-0089072-g005" target="_blank">Figure 5</a>, separately. CND: contraindicated nephrotoxic drug.</p

Proportion of incident CKD patients (N = 1,989) who received at least one prescription of nephrotoxic drug.

<p>Proportion of incident CKD patients (N = 1,989) who received at least one prescription of nephrotoxic drug within one year prior or after first CKD diagnosis, and within one year after dialysis entry (N = 112).</p

Characteristics of incident CKD patients, stratified by cumulative use of NSAIDs during the follow-up, and results from ordinary and cumulative logistic regressions.

<p>SD =  standard deviation; 95% CI  =  confidence interval; adj. OR =  adjusted OR; mean duration of follow-up (years): mean follow-up between date of incident CKD diagnosis (i.e. index date) and end of the follow-up.</p><p>*The analysis was adjusted by sex and age.</p><p>¹ Co-morbidities and concomitant drugs have been evaluated any time prior to the index date and they are not mutually exclusive.</p>†<p>Combination therapy consisting of vitamin A and D (ATC: A11CB) or vitamin D/vitamin D analogues (ATC: A11CC).</p