Ulcerative colitis: understanding the impact of ulcerative colitis on everyday life and exploring the unmet needs of patients.

BACKGROUND: Ulcerative colitis (UC) is a life-long disease characterised by flare ups and periods of remission. This market research sponsored by Janssen-Cilag Ltd was designed to gain an understanding of the impact of UC from the patient's perspective and to establish the main unmet needs associated with it. METHODS: The market research was conducted by telephone among 30 patients in the UK with a diagnosis of moderate to severe UC. RESULTS: Delayed referral from primary care to secondary care was identified as the key unmet need. Hospital appointments were often unavailable for months and in some cases, it was 6 months before a procedure was performed. Specialists rarely involved the patient in discussions regarding diagnosis and initial treatment. Communications improved when treatment changes became necessary but gaps still existed particularly regarding the continued emotional impact of UC. All patients required treatment changes to regain or maintain control and the response to medications varied between patients. Patients who had transitioned through multiple treatments feared they would run out of options and therefore require surgery. The UC "journey" was highly individualized and patients experienced many emotional "ups and downs". CONCLUSIONS: Healthcare bodies should aim to improve earlier referral to secondary care and waiting times for investigation need to be reduced significantly. Patients felt that specialists could support them in understanding their condition by discussing it with them immediately following diagnosis and by involving them in the development of their individual treatment plans. There is a need for more effective and better tolerated medications to expand the armamentarium and thus reduce the need for surgery.

Nine-year trends in achievement of risk factor goals in the US and European outpatients with cardiovascular disease.

BACKGROUND: Although control of major cardiovascular risk factors (hypertension, hyperlipidemia, diabetes) has been the centerpiece of guidelines for the prevention of cardiovascular disease, periodic surveys suggest adherence to recommendations and achievement of goals is poor. Few data are available in outpatients, and no studies describe trends in meeting clinical targets. METHODS: A survey of outpatients with cardiovascular disease or risk factors was conducted annually, with a unique cohort each year, and included medical history, clinical data, and pharmacologic therapies. Data from 1998 to 2006 in the United States, United Kingdom, France, Italy, Spain, and Germany were analyzed for achievement of evidenced-based goals for hypertension, hyperlipidemia, and diabetes. RESULTS: Over 9 years, 102,318 patients were entered, with a mean age of 60 years, half were male, and each had at least one cardiovascular disease risk factor. In 1998, nearly half of patients in the United States were not at their target for blood pressure or low-density lipoprotein cholesterol. In Europe, <1 in 3 was at blood pressure goal, and a minority had low-density lipoprotein recorded. Only modest improvements were observed by 2006. Hemoglobin A(1c) levels improved from 2005 to 2006 in the United States and Europe, indicating improving glycemic control in these cohorts. CONCLUSIONS: Adherence to guidelines in these outpatients was suboptimal and lower in Europe than in the United States. Increased adherence to evidence-based targets for the treatment of hypertension, hyperlipidemia, and diabetes is needed to achieve ideal cardiovascular prevention.

Patient preference for a maintenance inhaler in chronic obstructive pulmonary disease: a comparison of Breezhaler and Respimat.

BACKGROUND: Good compliance in chronic obstructive pulmonary disease (COPD) is of 'paramount importance' in reducing the occurrence of acute exacerbations, hospitalisation and mortality and in improving quality of life. However, a number of studies have confirmed that long-term compliance is low and often associated with difficulties in handling maintenance inhalers. Therefore, the easier an inhaler is to use, the more likely the patient will comply with handling instructions and so, optimise control of the condition. A research study was undertaken comparing the maintenance inhalers BreezhalerTM (BH-available in combination with Ultibro, Seebri and Onbrez from Novartis) and RespimatTM (RM-available in combination with Spiriva, Spiolto and Striverdi from Boehringer Ingelheim). METHODS: The research was conducted among 240 maintenance inhaler-naive participants who before handling the inhalers were asked to indicate how important they felt it was that an inhaler offered each of a list of 22 handling-related attributes. They then handled each inhaler on three separate occasions familiarising themselves with the correct handling procedure by consulting respective 'Instructions for use' and short training videos. Following the handling process, participants rated the individual inhaler against each of the 22 attributes and finally expressed their preference between the two on a number of key handling-related attributes and indicated which they preferred overall. RESULTS: A significant majority of participants preferred BH to RM overall. BH was rated statistically superior on 20 of the 22 handling-related attributes particularly those participants rated most highly including dosing confidence, 'easy to use' and 'easy to learn'. CONCLUSIONS: Significantly more participants were confident that BH would deliver a full dose of medication and was easier to learn and use. These attributes are crucial for achieving improved patient compliance. As a result, BH offers an opportunity for improved symptom control in the maintenance treatment of COPD.

The impact of morning symptoms on daily activities in chronic obstructive pulmonary disease.

BACKGROUND: This survey assessed the impact of symptoms of COPD on patients' ability to perform activities throughout the day and the extent to which physicians provided advice including how medications may help maintain quality of life. METHODS: The survey had three inclusion criteria--physician's diagnosis of COPD, age 30-70 years and presence of at least one of four listed symptoms to a greater extent in the morning. Participants were randomly selected from a panel who had previously agreed to participate in surveys. The survey was conducted in eight countries and contained 31 questions in the main section on the effects of symptoms of COPD throughout the day on patients' ability to perform tasks, how patients adjusted their lives and the extent to which physicians offered advice and support. RESULTS: Routine activities took 10-15 minutes longer and more strenuous activities around 30 minutes longer than before symptoms had become worse in the morning. Half had made changes to their morning routines and just over half confirmed that morning symptoms affected the rest of their day. The majority believed their medications provided sufficient relief of morning symptoms but less than a quarter believed they helped improve their ability to perform tasks. Physicians were unlikely to discuss this aspect of patient care routinely even though there was evidence to suggest that the challenge of performing tasks had a greater impact on patients than the symptoms themselves. CONCLUSIONS: Morning symptoms of COPD can severely compromise patients' ability to perform tasks throughout the day. Despite this, physicians are unlikely to discuss with patients how their ability to perform tasks might be improved.

An annual, prospective, international study of outpatients with cardiovascular disease or risk factors: design and methods of the CardioMonitor registry.

OBJECTIVE: To assess penetration and patterns of treatments in outpatients with cardiovascular disease (CVD) or risk factors. STUDY: An international, observational survey of physicians treating outpatients with CVD or risk factors. DESIGN AND SETTING: A unique, diversified group of physicians caring for patients with CVD or risk factors is sampled annually in countries around the world. Participating physicians register up to 15 patients with CVD or risk factors, recording demographics, medical history, clinical data, diagnoses, and medications. The registry has run annually, with different cohorts of physicians and patients each year. RESULTS: Over 9 years, the CardioMonitor registry has included participation by 18,145 physicians, registering 264,570 patients from 16 countries. Of these, 100,495 (38%) patients had cardiac disease, 26,720 (10%) had cerebrovascular disease, and 21,231 (8%) had peripheral arterial disease (not exclusive diagnoses). The remainder, 139,234 (52.6%) patients did not have clinically significant vascular disease, but had risk factors, including hypertension, diabetes, or dyslipidemia. CONCLUSION: This registry of outpatients with cardiovascular risk factors or disease with detailed medication use recorded offers new insights into trends in current practice of medicine for this large group of patients.