Anti-asthmatics prescriptions in the paediatric population in the Lazio Region of Italy: association with socio-demographic children’s and physician’s characteristics

  Background Asthma is the most common chronic disease in childhood; inItaly its prevalence is estimated to be 9% in children (0-14 years old). Objective Estimate the use of anti-asthmatics prescriptions in the paediatric population and to evaluate its association with children’s and physician’s characteristics. Methods The study was conducted in 728,830 children 1-14 years old residing in the Lazio region,Central Italy. Individual data on AA (ATC R03) prescriptions during 2009 were used. Prevalence was calculated according to children’s gender, age and area of residence. The association, in terms of rate ratio (RR), between AA prescription with children’s and physicians’ characteristics was estimated by multi level Poisson models. Results Overall, 404,239 AA prescriptions were given to 178,850 (25%) children with the highest frequency in the 1-2 age group (39%). Boys were more likely to receive a prescription than girls. Beclomethasone was the most prescribed active ingredient (34%), followed by salbutamol (24%); 44% of children ³6 years old had only 1 box prescription in the year, 48.9% of these subjects were treated with inhaled corticosteroids alone. Children’s gender, age and area of residence were the major determinants in drug prescription while, as far as physicians’ level,  gender and number of patients in charge were associated to a greater probability of getting an AA prescription. Conclusion Prescription data provide useful information to measure prevalence use and consumption of AA drugs. Variability between age groups as well as differences in doctors’ characteristics suggests that specific strategies to optimise resource use of AA are needed

Can we use the pharmacy data to estimate the prevalence of chronic conditions? a comparison of multiple data sources

<p>Abstract</p> <p>Background</p> <p>The estimate of the prevalence of the most common chronic conditions (CCs) is calculated using direct methods such as prevalence surveys but also indirect methods using health administrative databases.</p> <p>The aim of this study is to provide estimates prevalence of CCs in Lazio region of Italy (including Rome), using the drug prescription's database and to compare these estimates with those obtained using other health administrative databases.</p> <p>Methods</p> <p>Prevalence of CCs was estimated using pharmacy data (PD) using the Anathomical Therapeutic Chemical Classification System (ATC).</p> <p>Prevalences estimate were compared with those estimated by hospital information system (HIS) using list of ICD9-CM diagnosis coding, registry of exempt patients from health care cost for pathology (REP) and national health survey performed by the Italian bureau of census (ISTAT).</p> <p>Results</p> <p>From the PD we identified 20 CCs. About one fourth of the population received a drug for treating a cardiovascular disease, 9% for treating a rheumatologic conditions.</p> <p>The estimated prevalences using the PD were usually higher that those obtained with one of the other sources. Regarding the comparison with the ISTAT survey there was a good agreement for cardiovascular disease, diabetes and thyroid disorder whereas for rheumatologic conditions, chronic respiratory illnesses, migraine and Alzheimer's disease, the prevalence estimates were lower than those estimated by ISTAT survey. Estimates of prevalences derived by the HIS and by the REP were usually lower than those of the PD (but malignancies, chronic renal diseases).</p> <p>Conclusion</p> <p>Our study showed that PD can be used to provide reliable prevalence estimates of several CCs in the general population.</p

Physician and patient characteristics associated with prescriptions and costs of drugs in the Lazio region of Italy

Objective Prescribing medications is one of the most important therapeutic activities of a general practitioner (GP) and the quality of such practices is a relevant issue. Our objective was to use regional administrative databases to assess the following: (a) the prevalence of prescription drug use by patient age and gender, (b) different GPs' prescription volumes and average drug expenditure, and (c) how GPs' socio-demographic variables may be considered as predictive factors in their prescribing practices.Methods An observational cross-sectional study was carried out in the primary care setting (GPs and paediatricians only) on drug utilization in the period 1st January-31st December 2007. Poisson regression models were run to estimate the incidence rate ratio (IRR) of prevalence adjusted by patients' age. Linear regression models (for GPs and paediatricians separately) were performed to test the possible association between average drug expenditure and physicians' characteristics.Results The overall prevalence of drug utilization was approximately 65% of the total population and this finding is coherent with other studies. Age was a predictive determinant of average drug expenditure that was significantly higher for the elderly. Younger physicians were more likely to prescribe medications, independent of the presence of any chronic condition in their beneficiaries. Female GPs, those practicing in a group and those practicing in central Rome had a higher average drug expenditure. Results for paediatricians showed that there was a very strong geographical effect that influenced average expenditure.Conclusions Prescribing decisions are subject to a myriad of external factors. The present study shows how physicians' characteristics might affect drug prescription in terms of prevalence of use, costs and consumption. Using regional administrative databases it has been possible to analyse the association between doctors' prescribing habits, their socio-demographic factors and characteristics of their catchments areas. However, the variability in age groups in terms of prevalence, consumption and expenditure suggests that a sophisticated method of analysis will be needed in order to implement strategies and interventions able to optimise resource use in the health care sector.Drug use Drug consumption and prevalence GPs' characteristics Pharmaceutical expenditure