Prevalence of severe atopic dermatitis in adults in 3 areas of Spain

The study was sponsored by Sanof

Utilización de recursos sanitarios y costes asociados al diagnóstico y tratamiento de cada episodio de trombosis venosa profunda y sangrado en pacientes intervenidos de cirugía ortopédica de cadera o rodilla

Objective: To determine the use of healthcare resources and costs associated with the diagnosis and treatment of thrombosis and bleeding patients who have undergone elective hip or knee replacement surgery, in routine clinical practice conditions. Patients and methods: This multicentre observational and retrospective study extracted data from the medical records of three Spanish public hospitals (2010). Patients ≥40 years who had received prophylaxis-anticoagulation were included. They were randomised into three groups: (a) control (no hospital complications), (b) bleeding, and (c) thrombosis. General variables, use of resources and costs were analysed. Statistical analysis: logistic regression and ANCOVA for model correction (P < .05) was included. Results: A total of 141 patients (control: 60; bleeding: 60; and thrombosis: 21), with a mean age 68.7 (SD: 10.4) years, and 68.1% females were identified. Hip arthroplasty was more frequent (71.6%). The bleeding risk was associated with age (OR = 1.1) and thrombosis with COPD (OR = 1.8); P < .05). The average length of stay for the thrombosis, bleeding and control groups was 13.9, 11.5 and 7.4 days, respectively; P < .001). The total costs for each group were D10,484.3; D8766.4 and D6496.1 respectively; P < .05. All grouped results were comparable between them according to the hospital analysed and the type of replacement. Conclusions: Costs were higher for thrombosis and bleeding patients, respectively. Costs were associated with length of stay and hospital-acquired infections.Objetivo: Conocer la utilización de recursos sanitarios y los costes asociados al diagnóstico y tratamiento de la trombosis y sangrado en pacientes intervenidos de artroplastia primaria total de cadera (ATC) o rodilla (ATR), durante 3 meses de seguimiento. Pacientes y método: Estudio observacional de carácter multicéntrico y retrospectivo, realizado a partir de los registros médicos de pacientes pertenecientes a 3 centros hospitalarios-públicos espanoles ˜ (ano˜ 2010). Se consideraron aleatoriamente 3 grupos de pacientes: a) control (sin complicaciones hospitalarias); b) sangrado, y c) trombosis. Se incluyeron variables generales, de utilización de recursos y sus costes. Análisis estadístico: regresión logística y ANCOVA, p < 0,05. Resultados: Se incluyeron pacientes ≥ 40 anos ˜ y que hubieran recibido profilaxis anticoagulante. Se incluyó un total de 141 pacientes (control: 60; sangrado: 60; y trombosis: 21). La edad media fue de 68,7 (DE: 10,4) anos ˜ y el 68,1% fueron mujeres. La ATR fue la técnica más frecuente (71,6%). El riesgo de sangrado se relacionó con la edad (OR = 1,1) y el de trombosis con la EPOC (OR = 1,8), p < 0,05. El promedio de días de estancia de los grupos de trombosis, sangrado y control fue de 13,9; 11,5 y 7,4 días, respectivamente, p < 0,001). Los costes totales fueron: 10.484,3 D; 8.766,4 D, y 6.496,1 D, respectivamente, p < 0,05. Todos los resultados agrupados fueron comparables entre ellos según el hospital analizado y el tipo de artroplastia. Conclusiones: Los costes más elevados se producen en los pacientes que habían desarrollado una trombosis y sangrado, respectivamente. Los costes se relacionaron con la prolongación de los días de estancia y las infecciones intrahospitalariasMedicin

Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain

<p>Abstract</p> <p>Background</p> <p>This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP).</p> <p>Methods</p> <p>This is a retrospective, observational study including patients ≥18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance.</p> <p>Results</p> <p>A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7–80.5%) in PP and 20.9% (95% CI: 18.2–23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4–22.2%) in PP and 60.8% (95% CI: 57.6–64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00–1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03–1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06–1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22–1.89); p = 0.000] were covariates associated to the use of aspirin in PP.</p> <p>Conclusion</p> <p>Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved.</p

Use of metformin and vildagliptin for treatment of type 2 diabetes in the elderly

Antoni Sicras-Mainar,1 Ruth Navarro-Artieda2 1Direcci&oacute;n de Planificaci&oacute;n, Badalona Serveis Assistencials SA, 2Documentaci&oacute;n M&eacute;dica, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Background: The aim of this study was to describe the clinical (treatment adherence, metabolic control, hypoglycemia, and macrovascular complications) and economic (resource use and costs) consequences of using a combination of metformin + vildagliptin to treat type 2 diabetes in elderly patients seen in daily clinical practice. Methods: We conducted a multicenter, retrospective, observational study that included patients aged &ge;65 years treated with metformin who started a second oral antidiabetic therapy during the years 2008&ndash;2009. There were two groups of patients: a study group receiving metformin + vildagliptin and a reference group receiving metformin + other oral antidiabetics (sulfonylureas or glitazones). The main measures were comorbidity, compliance/persistence, metabolic control (glycosylated hemoglobin &lt;7%), complications (hypoglycemic, macrovascular), and total costs. The patients were followed for 2 years. Results: We recruited 987 patients (49.1% male) of mean age 74.2 years. There were 270 (27.4%) patients in the metformin + vildagliptin group and 717 (72.6%) in the reference group. Vildagliptin-treated patients had significantly (P&lt;0.05) improved compliance (68.3% versus 62.5%, respectively), persistence (61.5% versus 55.1%), and metabolic control (63.3% versus 57.6%). They also had lower rates of hypoglycemia (17.4% versus 42.8%) and cardiovascular events (4.4% versus 8.6%) and lower total costs (&euro;2,544 versus &euro;2,699, P&lt;0.05). Conclusion: Patients treated with metformin and vildagliptin showed better adherence and metabolic control and lower rates of hypoglycemia, resulting in lower health care costs for the national health system. Keywords: vildagliptin, diabetes, metabolic control, hypoglycemia, cardiovascular events, health cost

Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis

Antoni Sicras-Mainar,1 Ruth Navarro-Artieda2 1Research Unit, Badalona Serveis Assistencials SA, 2Medical Documentation Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To describe antidepressant (AD) use in the treatment of major depressive disorder during a period of economic crisis.Patients and methods: This was a retrospective, observational study using population-based databases. Two periods were considered: 1) 2008&ndash;2009, precrisis, and 2) 2012&ndash;2013, economic crisis. Certain inclusion/exclusion criteria were taken into account for the study (initiation of AD treatment). Patients were followed up for 12&nbsp;months. The main measures were use (defined daily doses), epidemiologic measures, strategies used and treatment persistence, referrals, and use of resources. Statistical significance was set at P&lt;0.05.Results: In the precrisis period, 3,662 patients were enrolled, and 5,722 were enrolled in the period of economic crisis. Average age was 58.8&nbsp;years and 65.4% were women. Comparing the two periods, major depressive disorder prevalence was 5.4% vs 8.1%, P&lt;0.001. During the period of economic crisis, AD use rose by 35.2% and drug expenditures decreased by 38.7%. Defined daily dose per patient per day was 10.0&nbsp;mg vs 13.5&nbsp;mg, respectively, P&lt;0.001. At 12-month follow-up, the majority of patients (60.8%) discontinued the treatment or continued on the same medication as before, and in 23.3% a change of AD was made.Conclusion: Primary health care professionals are highly involved in the management of the illness; in addition, during the period of economic crisis, patients with major depressive disorder showed higher rates of prevalence of the illness, with increased use of AD drugs. Keywords: consumption, antidepressants, economic crisi