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Clin Ter ; 171(5): e401-e406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901782


INTRODUCTION: The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility. MATERIALS AND METHODS: This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient. RESULT: The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give. CONCLUSION: In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.

Consentimento Livre e Esclarecido/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Humanos , Itália , Administração dos Cuidados ao Paciente , Participação do Paciente , Autonomia Pessoal
Value Health ; 4(4): 295-307, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11705297


OBJECTIVES: This paper examines three processes: SSRI antidepressant choice, adherence to treatment guidelines, and long-term health care expenditures associated with antidepressant treatment for patients with a diagnosis of depression. METHODS: Patient records were abstracted from a medical claims database covering employer-provided health care plans. Treatment episodes required a 6-month antidepressant-free prior period; initial treatment with sertraline, paroxetine or fluoxetine; and data on direct medical costs over the 24 months following the initial prescription. The multivariate model of drug selection, patient adherence to antidepressant use guidelines, and cost was subjected to specification testing to rule out the possibility that nonrandom initial antidepressant selection might lead to sample selection bias. Further tests indicated that the results were free of bias due to a possible correlation between antidepressant selection and use of the medication, or because of the endogeneity of use patterns in the process driving cost. However, there was evidence of unobserved variables correlated with both achieving guideline adherent use and expenditures, which might have led to sample selection bias. RESULTS: Subjects who met the study criteria included 796 initiating therapy with sertraline, 352 with paroxetine, and 882 with fluoxetine. Fluoxetine patients were significantly more likely than sertraline or paroxetine patients to achieve a use pattern that was consistent with guidelines for treating depressive disorder (p < .05). There were no statistically significant differences between the three treatment cohorts in total direct health care expenditures over the 2-year period (p < .05), and depression-related expenditures, other mental health expenditures, and non-mental health care expenditures did not show significant differences across the treatments (p < .05). Natural logged values of antidepressant drug expenditures were predicted to be highest for fluoxetine, followed by sertraline, then paroxetine (p < .01). Predicted log values of mental health expenditures were lower for sertraline relative to fluoxetine. CONCLUSIONS: Fluoxetine patients had the highest likelihood of using antidepressant medication according to treatment guidelines that were developed to assure quality care. This benefit was achieved without incurring greater total health care expenditures.

Efeitos Psicossociais da Doença , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/economia , Cuidado Periódico , Fluoxetina/uso terapêutico , Fidelidade a Diretrizes , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Paroxetina/uso terapêutico , Cooperação do Paciente , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Adulto , Custos de Medicamentos/estatística & dados numéricos , Farmacoeconomia , Feminino , Fluoxetina/economia , Planos de Assistência de Saúde para Empregados , Humanos , Assistência de Longa Duração/economia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paroxetina/economia , Estudos Retrospectivos , Inibidores de Captação de Serotonina/economia , Sertralina/economia , Estados Unidos
Am J Manag Care ; 6(12): 1327-36, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11151810


OBJECTIVE: To understand the determinants of the outcome of an episode of major depression, including factors that affect receipt of guideline-consistent care and their subsequent effect on treatment outcomes, particularly relapse or recurrence. Results of previous studies are generalized to a population typical of depressed individuals in the United States, i.e., a cohort of antidepressant users with employer-provided health benefits. STUDY DESIGN: A quasi-experimental design was used to assess the determinants of the outcome of an episode of major depression. Healthcare utilization-based measures of treatment characteristics and outcomes were used. PATIENTS AND METHODS: The final analytical file for this study contained data on 2917 patients who had an antidepressant prescription associated with an indicator of a depressive disorder. We identified relapse or recurrence of depression by (1) a new episode of antidepressant therapy, (2) suicide attempt, (3) psychiatric hospitalization, (4) mental health-related emergency department visits, or (5) electroconvulsive therapy. Antidepressant use patterns were used to construct a measure for adherence to treatment guidelines. Multivariate Cox proportional hazard and logit regression models were used to predict relapse/recurrence and adherence with treatment guidelines, respectively, for each patient. RESULTS: Factors that affect relapse/recurrence include comorbidities, demographics, and adherence to treatment guidelines. Factors that affect adherence to treatment guidelines include choice of initial antidepressant drug, comorbidities, psychotherapy, and frequency of physician visits. CONCLUSIONS: Adherence to treatment guidelines was associated with a significant reduction in the likelihood of relapse or recurrence of depression. Choice of initial antidepressant drug affects adherence to treatment guidelines.

Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Resultado do Tratamento , Coleta de Dados , Revisão de Uso de Medicamentos , Cuidado Periódico , Feminino , Planos de Assistência de Saúde para Empregados , Humanos , Masculino , Cooperação do Paciente , Guias de Prática Clínica como Assunto , Recidiva , Estados Unidos
Int J Psychiatry Clin Pract ; 3(1): 23-30, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-24945063


We attempted to evaluate differences in healthcare resource utilization following the initiation of antidepressant therapy with dothiepin or fluoxetine in primary care in the United Kingdom, by means of retrospective analysis of data from the Doctors Independent Network (DIN-LINK) records system, with a two-stage, multiple regression adjusted for potential bias stemming from non-random selection of initial drug choice in clinical practice. We counted patients' use of healthcare resources in the year following initiation of antidepressant therapy. After controlling for both observed and unobserved baseline characteristics correlated with initial drug selection, we found that dothiepin patients would have 0.18 additional non-accident and emergency (ACE) admission, 0.007 more ACE admissions, and 1.09 more general referrals than patients who started therapy with fluoxetine. Fluoxetine patients would have 0.35 more prescriptions for the initial antidepressant. Dothiepin patients would make 5.4 fewer visits to GPs' surgery, have 0.2 fewer prescriptions for hypnotic drugs, and 6.5 fewer prescriptions for other drugs than fluoxetine patients. This shows that the total economic impact of initial antidepressant selection is broader than the acquisition costs of antidepressants.