Ischemic heart disease and primary care: identifying gender-related differences. An observational study

Background: Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods: Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results: There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion: Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis

Ús de fàrmacs antidepressius i antipsicòtics per part de la població immigrant i autòctona de la regió sanitària de Lleida. Anàlisi de les desigualtats en l’exposició i en l’adherència al tractament

L'estrès i el dol associats a la migració, així com la manca d'equitat en l'accés als serveis sanitaris influeixen negativament en la salut mental. Aquesta tesi té com objectiu determinar si l'exposició i l'adherència a antidepressius i antipsicòtics és diferent entre autòctons i immigrants d'una regió espanyola. S'han realitzat quatre estudis entre 2007 i 2009 a partir de les dispensacions de fàrmacs a la població de la regió. Tots els grups immigrants reben menys antidepressius i antipsicòtics que la població autòctona d'igual edat i sexe, amb diferències entre grups. El risc relatiu d'abandonament dels antidepressius és un 28% major en els immigrants; el 36,8% abandona el primer mes i només el 29,5% manté una bona adherència, davant el 38,8% dels autòctons. L'adherència als antipsicòtics és bona en el 19,1% dels immigrants i el 40,4% dels autòctons. Les diferències trobades indiquen la necessitat d'aprofundir en les causes per establir les polítiques d'actuació necessàries.El estrés y el duelo asociados a la migración y la falta de equidad en el acceso a los servicios sanitarios influyen negativamente en la salud mental. El objetivo de esta tesis es determinar si la exposición a antidepresivos y antipsicóticos es diferente entre inmigrantes y autóctonos de una región española. Se realizaron cuatro estudios entre 2007 y 2009 a partir de las dispensaciones de fármacos. Todos los grupos inmigrantes recibieron menos antidepresivos y antipsicóticos que la población autóctona de igual edad y sexo, con diferencias entre grupos. El riesgo relativo de abandono de los antidepresivos fue un 28% mayor en los inmigrantes; el 36,8% abandonó durante el primer mes y solo el 29,5% mantuvo una buena adherencia, frente al 38,8% de autóctonos. La adherencia a antipsicóticos fue del 19,1% y 40,4% para inmigrantes y autóctonos respectivamente. Las diferencias encontradas indican la necesidad de profundizar en las causas para establecer las políticas de actuación adecuadas.Immigration is a stressful process and a risk factor for mental illness. Inequality in health care access can worsen this situation. The aim of this study is to determine if there are differences between immigrants and non-immigrants in the use of and compliance with antidepressant and antipsychotic treatment in a Spanish region. It includes four studies on pharmaceutical dispensing done between 2007 and 2009. All immigrant groups have lower antidepressant and antipsychotic consumption than the native population of the same age and sex, with differences between groups. The relative risk of abandoning treatment is 28% higher in immigrants; 36,8% filled only one prescription and 29,5% presented good compliance compared with 38,8% of natives. Antipsychotic adherence was appropriate for 19,1% of immigrants and 40,4% of native. More research is needed to understand the causes of these differences and to ensure adequate access and use of mental health services

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

Background: Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region. Methods: Population-based (n = 206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4 months and when patients withdrew more than 80% of the packs required. Results: 5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives = 3 months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42). Conclusions: In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group

Comparative exposure to antipsychotic medications in immigrant and native-born populations of a Spanish health region

Background: Raised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences. Objective: To compare exposure to antipsychotic medications in immigrant and native-born populations in Spain. Method: Descriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008. Results: 1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant. Conclusions: All immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population