Lessons from Italy

Learning Objectives: Describe how public health and healthcare services are provided by the Italian National Healthcare System Define the epidemiology and pattern of the spread of COVID-19 in the Italian population Identify strategies that have been adopted in Italy to contain and mitigate the pandemi

Impact of ALLHAT publication on antihypertensive prescribing patterns in Regione Emilia-Romagna, Italy

Background and objective: Studies from the US and Canada observed changes in antihypertensive prescribing patterns in accordance with Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study findings immediately after the study\u27s publication, but little is known about the impact of ALLHAT in Italy. The objective of this study was to examine antihypertensive prescribing patterns in Regione Emilia-Romagna (RER), Italy, following the publication of the ALLHAT main results. Methods: We conducted a time series analysis using automated pharmacy data of approximately 4 million RER residents between 1 January 2000 and 31 December 2003. We computed monthly relative percentages of prescriptions for all antihypertensive medications and separately for all new antihypertensives defined as no recorded antihypertensive use in the previous year. A stepwise auto-regressive forecasting model based on data prior to the ALLHAT publication was used to estimate predicted relative percentages for the 12 months following the ALLHAT publication. Observed and predicted values were compared. Results and discussion: Use of thiazide-type diuretics showed a general increasing trend over the study period, but the difference between the observed and predicted values reached statistical significance only for new prescriptions in October 2003 (3·71% vs. 2·32%; P = 0·0170). The relative percentage of new angiotensin-converting enzyme inhibitor and angiotensin receptor blocker (ACE/ARB) prescriptions was higher than predicted for the months May to August 2003 (P \u3c 0·05), but no significant differences were observed for total ACE/ARB prescriptions. Modest changes in patterns of prescribing of calcium channel blockers and α-blockers were observed. Conclusion: We found little evidence that the ALLHAT study had an impact on antihypertensive prescribing patterns in RER in the year following their publication

Beta-blocker initiation and adherence after hospitalization for acute myocardial infarction.

Aims: We sought to: (1) estimate the proportion of patients who initiated beta-blocker therapy after acute myocardial infarction (AMI) in Regione Emilia-Romagna (RER); (2) examine predictors of post-AMI beta-blocker initiation; and (3) assess adherence to such therapy. Methods and Results: Using healthcare claims data covering all of RER, we identified a cohort of 24,367 patients with a hospitalization for AMI between 2004 and 2007, who were discharged from the hospital alive and without contraindications to beta-blocker therapy. We estimated the proportion of eligible patients with at least one prescription for a beta-blocker following discharge and performed a multivariable logistic regression analysis to identify independent predictors of post-AMI beta-blocker initiation. We computed the proportion of days covered (PCD) as a measure of medication adherence at 6 and 12 months post-discharge. Following discharge, 16,383 (67%) cohort members initiated beta-blocker therapy. Independent predictors of beta-blocker initiation included age and receipt of invasive procedures during hospitalization, such as coronary artery bypass graft surgery (odds ratio [OR], 2.37; 95% confidence interval [CI], 2.00-2.81), percutaneous transluminal coronary angioplasty (OR, 1.42; 95% CI, 1.31-1.54), and cardiac catheterization (OR, 1.21; 95% CI, 1.11-1.32). Among initiators, adherence to beta-blocker treatment at 6 and 12 months was low and decreased in each study year. Conclusion: Overall, use of and adherence to post-AMI beta-blocker therapy was suboptimal in RER between 2004 and 2007. Older patients and those with indicators of frailty were less likely to initiate therapy. The proportion of patients adherent at 6 and 12 months decreased over time

Medicaid Expansion’s Importance to Mental Health Care

Introduction: The 2010 Patient Protection and Affordable Care Act established the Medicaid expansion, which incentivized states to expand their Medicaid programs to include individuals with incomes up to 138% of the federal poverty level. A significant population that stood to benefit from this health care expansion were Americans who suffer from a mental health disorder. This study was conducted to analyze the impact of Medicaid expansion on individuals with mental health and substance abuse disorders. Methods: This political commentary was based on statistics on mental health in the United States derived from research studies and publications from federal government agencies, such as the NIH and SAMHSA. Research articles were extracted from a systematic search on Google Scholar, and government data was obtained directly from government agencies’ publications. We analyzed changes in access to mental health care and mental health-related outcomes, comparing expansion states to non-expansion states in the years prior to and after Medicaid expansion. Results: The adoption of the Medicaid expansion significantly increased the insurance rates and treatment rates for individuals with mental health or substance use disorders, when comparing expansion states to non-expansion states. Similarly, individuals with mental health or substance use disorders reported less mental health decline, fewer mental health sick days, and improved self-reported health following their state’s expansion of their Medicaid program. In 2017 when comparing the insurance rates among individuals with any mental illness, 16 of the 17 lowest-performing states had not expanded Medicaid. Conclusion: Since its adoption in 2014, the ACA’s Medicaid expansion has improved access to mental health care and mental health-related outcomes, when comparing expansion states to non-expansion states. Individuals with mental health or substance abuse disorders in non-expansion states would benefit from further expansion

Appropriate medication prescribing in elderly patients: how knowledgeable are primary care physicians? A survey study in Parma, Italy.

What is known and Objective:  Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians\u27 knowledge of appropriate prescribing in elderly patients. Methods:  In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete anonymously a 19-item paper survey. Knowledge of inappropriate medication use in the elderly was assessed using seven clinical vignettes based on the 2002 Beers Criteria. Topics tested included hypertension, osteoarthritis, arrhythmias, insomnia and depression. Data regarding physician\u27s perceived barriers to appropriate prescribing for elderly patients were also collected. To evaluate the relationship between physician knowledge scores and physician characteristics, physicians were classified as having a \u27low score\u27 (three or below) or a \u27high score\u27 (six or more) with respect to their knowledge of prescribing for the elderly. Results and Discussion:  All physicians completed the survey. Most physicians (88%) felt confident in their ability to prescribe appropriate medications for the elderly. Thirty-nine physicians (25%) received a \u27high score\u27 compared to 26 (17%) who received a \u27low score\u27. \u27Lower score\u27 respondents had been in practice for a longer time (P \u3c 0·05) than \u27higher score\u27 respondents. Perceived barriers to appropriate prescribing included potential drug interactions (79% of respondents) and the large number of medications a patient is already taking (75%). What is new and Conclusion:  The study results show an unsatisfactory knowledge of appropriate prescribing among primary care physicians in the LHU of Parma, especially among older physicians. Educational strategies tailored to primary care physicians should be establish to enhance knowledge in this area and improve quality of prescribing

The Role of Medical Affairs in Health Outcomes Data Generation and Communication

Health economics and outcomes research (HEOR) is a growing field that provides important information for making healthcare coverage and access decisions. As a scientific discipline that quantifies the economic, humanistic and clinical outcomes of medical technology, HEOR helps pharmaceutical and device manufacturers communicate the value of their innovations to stakeholders. In this webinar, we explore relevant, updated content about the intersection between HEOR and Medical Affairs with Dr. Ahmad B. Naim, MD, Vice President, US Medical Affairs, Incyte Corporation. The need to demonstrate the value of products to multiple stakeholders in a dynamic healthcare landscape has driven an increasing intersection between traditional HEOR and Medical Affairs functions in order to generate strategic evidence and value communication throughout the product lifecycle. Presentation: 59:3

Asthma management programs in managed care organizations

The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.2%) responding medical directors reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including general member education (90%), member education by mail (87%), self-management education (85%), and provider education (82%). Educational resources (89%) and telephone advice nurse (77%) were the most common self-management strategies offered. Among factors impeding the provision of effective asthma care, noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications were cited by virtually all respondents. Health plans rely on an array of strategies to manage asthma patients. Education encouraging patient self-management is a key component of asthma management programs. However, a considerable number of treatment approach barriers are impeding the achievement of proper asthma care. Without innovative approaches to care, it appears that current MCOs’ asthma management efforts may not result in substantial improvements in asthma outcomes