Enfermedad musculoesquelética en población trabajadora: perfil de los afectados y manejo farmacológico / Musculoesqueletic diseases in working population: subjects' profile and pharmacological management

El presente estudio describe las enfermedades musculoesqueléticas (EME) de una cohorte de trabajadores de tipo manual, así como el uso de los fármacos indicados para el control del dolor. Estudio observacional retrospectivo llevado a cabo en el ámbito del Aragon Workers' Health Study (AWHS). Se ha analizado la prevalencia de las diferentes EME, la tasa de utilización de fármacos empleados en el tratamiento del dolor y el número de dosis diarias definidas (DDD) consumidas. El 15,4% de los trabajadores estudiados fueron diagnosticados de, al menos, una EME. De ellos, el 54,1% tenía sobrepeso y el 74,0% eran mayores de 55 años. La tasa de utilización de los antiinflamatorios no esteroideos (AINE) fue del 69,5%, y de los analgésicos no opiáceos, del 29,9%. Los datos presentados ponen de manifiesto la utilización elevada y, en algunos casos, continuada que existe de tratamientos analgésicos y antiinflamatorios. (AU)

The present study describes the musculoskeletal diseases (MSD) of a cohort of manual workers, as well as the use of drugs indicated for pain control. Retrospective observational study carried out within the framework of the Aragon Workers' Health Study (AWHS). The prevalence of the different EMEs, the rate of use of drugs used in the treatment of pain and the number of defined daily doses (DDD) consumed have been analysed. 15.4% of the workers studied were diagnosed with at least one EME. Of them, 54.1% were overweight and 74.0% were older than 55 years. The utilization rate of non-steroidal anti-inflammatory drugs (NSAIDs) was 69.5%, and of non-opioid analgesics, 29.9%. The data presented show the high use and, in some cases, the continuous use of analgesic and anti-inflammatory treatments. (AU)

Patterns of statin adherence in primary cardiovascular disease prevention during the pandemic.

Background: Study of medication adherence patterns can help identify patients who would benefit from effective interventions to improve adherence. Objectives: To identify and compare groups of statin users based on their adherence patterns before and during the COVID-19 pandemic, to characterize the profile of users in each group, and to analyze predictors of distinct adherence patterns. Methods: Participants of the CARhES (CArdiovascular Risk factors for HEalth Services research) cohort, comprising individuals aged >16 years, residing in Aragón (Spain), with hypertension, diabetes mellitus and/or dyslipidemia, took part in this observational longitudinal study. Individuals who began statin therapy during January-June 2019 were selected and followed up until June 2021. Those with a cardiovascular event before or during follow-up were excluded. Data were obtained from healthcare system data sources. Statin treatment adherence during the implementation phase was estimated bimonthly using the Continuous Medication Availability (CMA9) function in the AdhereR package. Group-based trajectory models were developed to group statin users according to their adherence pattern during July 2019-June 2021. Group characteristics were compared and predictors of each adherence pattern were analyzed using multinomial logistic regression. Results: Of 15,332 new statin users, 30.8% had a mean CMA9 ≥80% for the entire study period. Four distinct adherence patterns were identified: high adherence (37.2% of the study population); poor adherence (35.6%); occasional use (14.9%); and gradual decline (12.3%). The latter two groups included users who showed a change in adherence (increase or decrease) during the pandemic emergence. Users with suboptimal adherence were likely to be younger, not pensioners, not institutionalized, with low morbidity burden and a low number of comorbidities. Female sex and switching between statins of different intensity increased the likelihood of belonging to the occasional use group, in which improved adherence coincided with the pandemic. Conclusion: We identified four distinct adherence patterns in a population of new statin users; two of them modified their adherence during the pandemic. Characterization of these groups could enable more effective distribution of resources in future similar crisis and the routine implementation of patient-centered interventions to improve medication adherence.

Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization.

We sought to identify specific profiles of new lipid-lowering drug users based on adherence to a healthy lifestyle and persistence with medication, and to characterize co-morbidities, co-treatments, and healthcare utilization for each of the profiles identified. Observational study in 517 participants in the Aragon Workers' Health Study (AWHS) without previous cardiovascular disease (CVD) and who initiated lipid-lowering therapy. Data were collected from workplace medical examinations and administrative health databases (2010-2018). Using cluster analysis, we identified distinct patient profiles based on persistence with therapy and lifestyle. We then compared characteristics, morbidity, and healthcare utilization across clusters. Participants were aggregated into four clusters based on persistence with therapy, smoking status, adherence to Mediterranean diet, and physical activity. In cluster 1 (n = 113), comprising those with a healthiest lifestyle (14.2% smokers, 84.0% with medium-high adherence to Mediterranean diet, high physical activity), 16.8% were persistent. In cluster 3 (n = 108), comprising patients with the least healthy lifestyle (100% smokers, poor adherence to the Mediterranean diet, low level of physical activity), all were non-persistent. Clusters 2 (n = 150) and 4 (n = 146) both comprised patients with intermediate lifestyle behaviors, but differed in terms of persistence (100 and 0%, respectively). Compared with other clusters, the burden of morbidity, cardiovascular score, and healthcare utilization were lower in cluster 1. The healthy adherer effect was only observed in new lipid-lowering drug users of certain profiles. Furthermore, we found that differences in adherence to lifestyle and medication recommendations for CVD prevention influenced morbidity burden and healthcare utilization.

Effect of patient and treatment factors on persistence with antihypertensive treatment: A population-based study.

PURPOSE: To analyze patterns of antihypertensive drug use among new users in a Southern European population, and identify patient- and treatment-related factors that influence persistence. METHODS: This is a retrospective observational study of new antihypertensive drug users aged ≥40 years in Aragón, Spain. Information on antihypertensive drugs (2014-2016) prescribed and dispensed at pharmacies via the public health system were collected from a regional electronic population-based pharmacy database. Persistence was assessed using the gap method. Kaplan-Meier and Cox regression analyses were conducted to analyze patterns of use and factors that influence persistence. RESULTS: The 25,582 new antihypertensive drug users in Aragón during the study period were prescribed antihypertensive drugs in monotherapy (73.3%), fixed combination (13.9%), free combination (9.1%), or other (3.7%). One in five received antihypertensive drugs within 15 days of the prescription date, but not after. During the first year of follow-up, 38.6% of the study population remained persistent. The likelihood of treatment discontinuation was higher for participants who were male, aged ≥80 years, and received an antihypertensive drug in monotherapy compared with fixed combination. CONCLUSION: Overall persistence with antihypertensive therapy was poor, and was influenced by the sex, age and type of therapy. Fixed combinations appear to be a good choice for initial therapy, especially in patients with a higher risk of discontinuation. Nonetheless, adverse drug effects and the patient's preferences and clinical profile should be taken into account.

Prescribing pattern of antihypertensive drugs in two European cohorts: a population-based database study.

Background: Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and mortality. Variability in prescribing patterns constitutes a major challenge for current healthcare systems. This study aimed to compare patterns of use of antihypertensives in general practice in two southern European populations. Methods: Observational study. Data on antihypertensive drugs consumption in primary care setting (2016) were obtained from pharmacy refill records in Campania (Italy) and Aragon (Spain). Prescribing rates and the number of defined daily doses [DDD/1,000 inhabitants/day (DID)] were calculated, and the Drug Utilization 90% (DU90%) approach used to reveal differences in prescribing patterns in both regions. Results: Antihypertensive prescribing rates in Campania and Aragon were 250.8 (95%CI: 250.2-251.3) and 201.7 (95%CI: 200.9-202.5) users/1,000 inhabitants/year. Overall consumption was of 310.1 and 256.8 DID, respectively. Spanish users, especially women and the elderly, consumed a greater volume of diuretics. Conversely, other therapeutic subgroups were more consumed in Campania. However, the most prescribed subgroups accounted for comparable proportions of the total consumption in each region. Conclusions: Both prescribing rates and intensity of antihypertensive use were higher in Campania. Pharmacy refill records in cross-country comparisons allow to know the factors influencing variability in prescribing habits with a view to improving prescribing quality.

Use of Non-Steroidal Anti-Inflammatory Drugs and Associated Gastroprotection in a Cohort of Workers.

BACKGROUND: This study describes the prevalence of non-steroidal anti-inflammatory drug (NSAID) use, and analyses prescribing patterns of NSAIDs and associated gastroprotection. METHODS: The study population consisted of 5650 workers at the General Motors automobile assembly plant in Zaragoza, Spain. NSAID prescription data for 2014 were obtained from the prescription database of Aragon (Spain). NSAID consumption was determined based on the number of defined daily doses purchased per year. Heavy NSAIDs users were identified using Lorenz curves. RESULTS: NSAID use in the cohort was high (40.7% of workers, 95% CI 39.4⁻41.9). The prescription of proton pump inhibitors increased with age. Gastrointestinal protection was lacking in some participants who were being treated with drugs associated with a high risk of gastrointestinal bleeding. Heavy NSAID users (defined as those above the 95th percentile of consumption), accounted for 26% of total DDDs, and consumed a greater proportion of coxibs than non-heavy users. CONCLUSIONS: The rate of NSAID consumption in the cohort was high. To reduce the risk of gastrointestinal complications, monitoring and adequate gastroprotection are essential in patients who are prescribed NSAIDs for long periods of time or who are treated concomitantly with drugs that increase the risk of gastrointestinal bleeding.

Persistencia con estatinas en prevención primaria de enfermedad cardiovascular: resultados en una cohorte de trabajadores españoles / Persistence with statins in primary prevention of cardiovascular disease: findings from a cohort of spanish workers

Introducción y objetivos: El objetivo de este estudio es analizar el patrón de persistencia con estatinas en prevención primaria de enfermedad cardiovascular en una cohorte de trabajadores españoles. Métodos: Este estudio descriptivo se llevó a cabo en el marco del estudio prospectivo longitudinal Aragon Workers'Health Study (n = 5.400). Se identificó a los nuevos usuarios de estatinas varones a partir de datos recogidos en el sistema de información de consumo farmacéutico de Aragón. Se analizaron los patrones de persistencia con estatinas prescritas en prevención primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el año de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensación de la primera receta y, el 42,1% de ellos no reiniciaron el tratamiento durante el resto del año. La mayor edad (HR = 0,55; IC95%, 0,39-0,77) y el cotratamiento con fármacos antihipertensivos (HR = 0,68; IC95%, 0,56-0,82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociación entre la persistencia con el tratamiento y la toma concomitante de fármacos antidiabéticos o antitrombóticos, las concentraciones basales de lipoproteínas de baja densidad o las de colesterol total. Sin embargo, la persistencia sí estuvo influida por el tipo de la primera estatina prescrita. Conclusiones: Nuestro análisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilización de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripción (AU)

Introduction and objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers'Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions (AU)

Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers.

INTRODUCTION AND OBJECTIVES: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. METHODS: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. RESULTS: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. CONCLUSIONS: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions.

Different approaches to the assessment of adherence and persistence with cardiovascular-disease preventive medications.

OBJECTIVE: To assess suitability and comparability of the most common methods of treatment adherence and persistence assessment, as applied to the same pharmacy dataset. METHODS: Data on drugs prescribed for cardiovascular primary prevention to participants in the Aragon Workers' Health Study (AWHS) were collected from a regional electronic drug prescription database. Several different approaches were used to measure treatment adherence (with the medication possession ratio [MPR]) and proportion of days covered [PDC]) and persistence in new users by therapeutic subgroup. Defined daily dose (DDD) was used as a proxy of the number of days' supply, or substituted with surrogate daily dose values. RESULTS: Higher mean adherence values and proportions of adherent patients were obtained using MPR versus PDC, with additional differences depending on the approach used. The proportion of adherent patients was lowest for oral antidiabetics (14.4%-30.6%) and highest for antihypertensives (70.2%-82.1%). The use of surrogate daily dose values increased adherence for antidiabetics and statins and decreased adherence for antihypertensives. After a 1 year follow-up, treatment persistence was observed for 21.1%, 58.7%, and 29.5% of antidiabetic, antihypertensive and statin users, respectively. CONCLUSIONS: Our findings indicate that use of multiple measures of treatment adherence and persistence provides a more complete overview of medication use patterns, and certain limitations associated with DDD for some drug groups can be overcome with replacement by surrogate doses. The PDC indicator seems to provide a more accurate reflection of patient behavior and treatment continuity than the MPR. Any comparison of adherence/persistence should always consider the method used, variables analyzed, and corresponding data collection process.

Poor congruence with guidelines in the use of antibiotics for acute bronchitis: a descriptive study based on electronic health records.

BACKGROUND: Although acute bronchitis is frequently viral in nature, antibiotics are usually inappropriately prescribed in Primary Care to treat this condition, with serious public health consequences. OBJECTIVE: To determine the prevalence and predictors of appropriate management of antibiotic use in acute bronchitis processes diagnosed in outpatients in the Spanish region of Aragón. METHODS: Four different electronic health databases provided demographic and clinical information pertaining to patients diagnosed with acute bronchitis in Primary Care in Aragón during 2011, as well as data for corresponding antibiotic prescriptions dispensed at pharmacies. We evaluated adherence to recommendations for antibiotic use in acute bronchitis episodes in adults collected in both international and national guidelines. Finally, regression analyses were used to identify factors associated with appropriate antibiotic management. RESULTS: A total of 54701 episodes of acute bronchitis were registered, 9.5% of which corresponded to patients with an underlying chronic respiratory disease. In adults, antibiotics were prescribed in 64.9% of episodes, 17.9% of which involved prescription of a first-choice agent. Overall, 48.5% of episodes were appropriately managed according to guidelines. The likelihood of appropriate treatment was higher for female patients, and lower for patients who were older, presented chronic co-morbidities or were using corticoids. CONCLUSIONS: We observed poor levels of adherence to recommendations for antibiotic prescribing in adults with acute bronchitis, in terms of both the decision to prescribe and the choice of antibiotic agent. Older acute bronchitis patients and those with co-morbidities were at greater risk of being inappropriately treated.

ASSOCIATION BETWEEN DAILY SITTING TIME AND PREVALENT METABOLIC SYNDROME IN AN ADULT WORKING POPULATION: THE AWHS COHORT.

OBJECTIVE: the aim of this analysis was to measure the association between daily sitting time and prevalent metabolic syndrome, independently of the physical activity performed. SUBJECTS AND METHODS: the Aragon Workers' Health Study cohort consists of 5 865 participants from which a sample of 1 415 male participants (40-55 years old) with completed data at baseline was selected. Sitting time and physical activity were assessed by validated questionnaires, and the socio-demographic, clinical and biochemical covariates needed to diagnose metabolic syndrome were collected as part of the study protocols. Metabolic syndrome was defined according to the modified National Cholesterol Education Program - Adult Treatment Panel III. Multiple linear and logistic regression models were carried out to quantify this association using sitting time categorized into tertiles. RESULTS: mean sitting time was 5.78 ± 1.72 h/day, and the prevalence of metabolic syndrome was 19.2%. Comparing participants in the highest (> 6.57 h/day) versus lowest (1.85-4.57 h/day) tertile of sitting time, a positive association was observed for metabolic syndrome (OR 1.77, 95%CI: 1.25-2.49) and triglyceride (OR 1.70, 95%CI: 1.30-2.24), HDL-cholesterol (OR 1.65, 95%CI: 1.06-2.58), waist circumference (OR 1.57, 95%CI: 1.17-2.11) and fasting blood glucose (OR 1.35, 95%CI: 1.03-1.77) criteria, adjusting the level of physical activity. CONCLUSIONS: higher sitting time is associated with an increased prevalence of metabolic syndrome independently of physical activity performed. These results could be useful to carry out effective strategies for cardiovascular health promotion especially in workplaces.

Objetivo: el objetivo del presente análisis fue medir la asociación entre el tiempo sentado y la prevalencia de síndrome metabólico, de forma independiente a la actividad física realizada. Sujetos y métodos: la cohorte del Aragon Workers' Health Study está formada por 5.865 participantes de los cuales se seleccionó una muestra de 1.415 voluntarios varones (40-55 años) con datos completos al inicio del estudio. El tiempo sentado y la actividad física se valoraron mediante cuestionarios validados, y las variables sociodemográficas, clínicas y bioquímicas necesarias para el diagnóstico del síndrome metabólico fueron recogidas como parte de los protocolos del estudio. Para la definición de síndrome metabólico se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Se llevaron a cabo modelos de regresión lineal y logística para cuantificar esta asociación usando el tiempo sentado categorizado en tertiles. Resultados: la media de tiempo sentado fue de 5,78 ± 1,72 h/día, y la prevalencia de síndrome metabólico del 19,2%. Comparando los participantes en el tertil superior de tiempo sentado frente a los del tertil inferior observamos una asociación positiva para síndrome metabólico (OR 1,77, 95%CI: 1,25-2,49) y los criterios de triglicéridos (OR 1,70, 95%CI: 1,30-2,24), HDL-colesterol (OR 1,65, 95%CI: 1,06-2,58), circunferencia de cintura (OR 1,57, 95%CI: 1,17-2,11) y glucosa en ayunas (OR 1,35, 95%CI: 1,03-1,77), ajustando por el nivel de actividad física. Conclusiones: un mayor tiempo sentado se asocia con un aumento de la prevalencia de síndrome metabólico independientemente de la actividad física realizada. Estos resultados podrían ser útiles para llevar a cabo estrategias efectivas de promoción de la salud cardiovascular, especialmente en los lugares de trabajo.

Association between daily sitting time and prevalent metabolic syndrome in an adult working population: the AWHS cohorte / Asociación entre tiempo sentado y prevalencia de síndrome metabólico en una población adulta trabajadora: la cohorte AWHS

Objective: the aim of this analysis was to measure the association between daily sitting time and prevalent metabolic syndrome, independently of the physical activity performed. Subjects and methods: the Aragon Workers’ Health Study cohort consists of 5 865 participants from which a sample of 1 415 male participants (40-55 years old) with completed data at baseline was selected. Sitting time and physical activity were assessed by validated questionnaires, and the socio-demographic, clinical and biochemical covariates needed to diagnose metabolic syndrome were collected as part of the study protocols. Metabolic syndrome was defined according to the modified National Cholesterol Education Program - Adult Treatment Panel III. Multiple linear and logistic regression models were carried out to quantify this association using sitting time categorized into tertiles. Results: mean sitting time was 5.78 ± 1.72 h/day, and the prevalence of metabolic syndrome was 19.2%. Comparing participants in the highest (>6.57 h/day) versus lowest (1.85-4.57 h/day) tertile of sitting time, a positive association was observed for metabolic syndrome (OR 1.77, 95%CI: 1.25-2.49) and triglyceride (OR 1.70, 95%CI: 1.30-2.24), HDL-cholesterol (OR 1.65, 95%CI: 1.06-2.58), waist circumference (OR 1.57, 95%CI: 1.17-2.11) and fasting blood glucose (OR 1.35, 95%CI: 1.03-1.77) criteria, adjusting the level of physical activity. Conclusions: higher sitting time is associated with an increased prevalence of metabolic syndrome independently of physical activity performed. These results could be useful to carry out effective strategies for cardiovascular health promotion especially in workplaces (AU)

Objetivo: el objetivo del presente análisis fue medir la asociación entre el tiempo sentado y la prevalencia de síndrome metabólico, de forma independiente a la actividad física realizada. Sujetos y métodos: la cohorte del Aragon Workers’ Health Study está formada por 5.865 participantes de los cuales se seleccionó una muestra de 1.415 voluntarios varones (40-55 años) con datos completos al inicio del estudio. El tiempo sentado y la actividad física se valoraron mediante cuestionarios validados, y las variables sociodemográficas, clínicas y bioquímicas necesarias para el diagnóstico del síndrome metabólico fueron recogidas como parte de los protocolos del estudio. Para la definición de síndrome metabólico se siguieron los criterios del Programa Nacional de Educación del Colesterol en el marco del III Panel de Tratamiento de Adultos (NCEPATP III). Se llevaron a cabo modelos de regresión lineal y logística para cuantificar esta asociación usando el tiempo sentado categorizado en tertiles. Resultados: la media de tiempo sentado fue de 5,78 ± 1,72 h/día, y la prevalencia de síndrome metabólico del 19,2%. Comparando los participantes en el tertil superior de tiempo sentado frente a los del tertil inferior observamos una asociación positiva para síndrome metabólico (OR 1,77, 95%CI: 1,25-2,49) y los criterios de triglicéridos (OR 1,70, 95%CI: 1,30-2,24), HDL-colesterol (OR 1,65, 95%CI: 1,06-2,58), circunferencia de cintura (OR 1,57, 95%CI: 1,17-2,11) y glucosa en ayunas (OR 1,35, 95%CI: 1,03-1,77), ajustando por el nivel de actividad física. Conclusiones: un mayor tiempo sentado se asocia con un aumento de la prevalencia de síndrome metabólico independientemente de la actividad física realizada. Estos resultados podrían ser útiles para llevar a cabo estrategias efectivas de promoción de la salud cardiovascular, especialmente en los lugares de trabajo (AU)

Compliance with recommendations on outpatient antibiotic prescribing for respiratory tract infections: the case of Spain.

Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bacterial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evaluating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and antibiotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifaceted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.

The quality of outpatient antimicrobial prescribing: a comparison between two areas of northern and southern Europe.

PURPOSE: The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing. METHODS: Outpatient antimicrobial prescription data were obtained from the National Institute for Health Data and Disease Control in Denmark, and from the Aragón Information System of Drug Consumption. The number of Defined Daily Doses (DDD) of the different substances were calculated, and the quality of the antimicrobial prescription was analysed using the 'Drug Utilization 90 %' method and the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators for outpatient antimicrobial use. RESULTS: The majority of the prescriptions (90 % of total DDD) were comprised of 14 (of 39) different antimicrobials in Denmark, based mainly on narrow spectrum penicillin, and 11 (of 59) antimicrobials in Aragón, principally broad spectrum penicillins. The quality indicators described an elevated consumption of antimicrobials and an important seasonal variation in Aragón. In Denmark, the values obtained reflected a more moderate use with minor seasonal variation. CONCLUSIONS: The results showed important differences between the two study areas in relation to quantity and quality of outpatient antimicrobial prescription. The data indicate an overuse (and/or misuse) of antimicrobials in the Spanish region, despite national and local guidelines. The pattern of prescription in Denmark reflects a better adherence to recommendations.