Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study.

BACKGROUND: Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease. METHODS: We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI). RESULTS: We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence. CONCLUSIONS: Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.

Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database.

BACKGROUND: Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. METHODS: Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). RESULTS: Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. CONCLUSIONS: Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.

Monitoring patients on chronic treatment with antidepressants between 2003 and 2011: analysis of factors associated with compliance.

BACKGROUND: Clinical practice guidelines consider the use of antidepressants as one of the standard treatments for anxiety disorders, due to the significant improvements obtained in quality of life and functional disability. In addition, in patients who have not achieved a favorable response after 3 months of psychotherapy, antidepressants are recommended as part of a combined treatment approach. This combination with psychotropic drugs and psychotherapy appears to be indicated from baseline in patients with moderate, severe or recurrent depression. In the last decade, antidepressant prescription rates in general practice have increased between 4 and 10 times. Depression presents high rates of relapse and recurrence. Treatment is often interrupted prematurely, leading to increases in both relapse rates and health care costs. Few studies have analysed the chronic use of antidepressant drugs and long-term adherence. OBJECTIVE: To evaluate compliance with antidepressant treatment between 2003 and 2011 and to explore the associated factors. METHODS: Retrospective cohort study of antidepressant dispensing. SETTING: Health Region of Lleida between 2003 and 2011. PARTICIPANTS: Patients with chronic prescription of antidepressants (ATC code NO6A) during 2003 were followed up until December 2011. The sample comprised 3684 subjects. MAIN MEASURES: The compliance rate was calculated on the basis of the number of units withdrawn from the pharmacy and the theoretical number of units required according to the scheduled duration of treatment: compliance was defined in cases with scores greater than or equal to 80%. RESULTS: 12.5% of patients received chronic antidepressant treatment for at least 4 years. Mean age was 54 years, and 73.2% of patients were female. Almost a third (32.4%) presented anxiety disorders and 26.5% mood disorders. The overall compliance rate was 22% (28% in patients with depression, and 21% in patients with anxiety). According to gender, compliance rates were 21.4% for males and 22.4% for females. Compliance was more likely in patients with polypharmacy. CONCLUSIONS: One in 4 patients complied with treatment. Factors associated with better compliance were polypharmacy and diagnosis of depressive or mixed anxiety-depressive disorder.

[Using treatment compliance to determine the under-notification of tuberculosis in a health region for the years 2007-2009]. / Cumplimiento terapéutico para determinar la infranotificación de tuberculosis en una región sanitaria durante los años 2007-2009.

INTRODUCTION: To determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed. METHODS: Descriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009. RESULTS: The incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%). CONCLUSIONS: The incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations.

[Factors determining antibiotic prescription in primary care]. / Determinantes de la prescripción de antibióticos en atención primaria.

INTRODUCTION: To determine patient and physician-related factors associated with variability in antibiotic prescription. MATERIAL AND METHODS: Observational study of the prevalence of antibacterial medication prescription >14 years old. DATA SOURCE: official prescriptions, clinical histories and individual health cards. Patient-related variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models. RESULTS: The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who madeno visits: OR=10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR=1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician's workload, the higher the likelihood of antibiotic prescription. CONCLUSIONS: The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates.

[High exposure to antibiotics in the population and differences by sex and age]. / Alta exposición a antibióticos en la población y sus diferencias por género y edad.

PURPOSE: To determine antibiotic use and its distribution by age and gender, as well as the most prescribed therapeutic group. DESIGN: Observational descriptive with retrospective data. SETTINGS AND PARTICIPANTS: Population from the Lleida (Spain) Health Region receiving antibiotic prescriptions from 2002 to 2007. MEASUREMENTS: Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patients under treatment. The study variables were: age, gender, number of patients under antibiotic treatment and pharmacological group. RESULTS: Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and 40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had received antibiotics once a year. The antibiotic consumption prevalence has a "V" shape with higher values among children and old people. There is an annual exposure to antibiotics in 58.8% of the 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic. CONCLUSIONS: We observe a high antibiotic prescription rate among children and older people, the high consumption in childhood being of note. There is also a higher use of antibiotics among women and changing of prescription towards broad spectrum antibiotics.

Cumplimiento terapéutico para determinar la infranotificación de tuberculosis en una región sanitaria durante los años 2007-2009 / Using treatment compliance to determine the under-notification of tuberculosis in a health region for the years 2007-2009

Introducción: Determinar la incidencia anual acumulada de tuberculosis (TB) en la Región Sanitaria (RS) de Lleida a través de los casos declarados, y/o retirada de fármacos indicados. Evaluar el grado de cumplimiento del tratamiento, sobre la base de los fármacos dispensados con prescripción. Métodos: Estudio descriptivo de incidencia sobre la base de los casos declarados de TB y dispensación de fármacos antituberculosos (ATB) en la RS de Lleida, Cataluña, entre el año 2007 y el 2009. Resultados: La incidencia anual de la RS entre los años 2007 y 2009 oscila entre 38 y 29 casos por 100.000 habitantes. El 72,6% de los casos fueron declarados mientras que el resto han sido detectados a través de los fármacos indicados retirados en farmacia. Existe una mayor incidencia de TB entre la población inmigrante. Los autóctonos presentan un mejor porcentaje de buen cumplimiento (el 75,8% versus el 61,2%). El colectivo magrebí presenta un menor cumplimiento (43,7%) y el colectivo de América Latina es el colectivo inmigrante con un mayor cumplimiento (82,4%). Conclusiones: La incidencia de la TB en nuestra región sanitaria ha descendido entre los años 2007 y 2009, con más incidencia entre la población inmigrante. Existe una elevada infranotificación de los casos de TB. La población autóctona presenta una mayor adherencia al tratamiento y entre el colectivo inmigrante, la población magrebí es la que menos cumple. Se debe realizar una gran tarea de información para la detección de la enfermedad, sobre todo en atención primaria, y una tarea informativa en el colectivo inmigrante para favorecer el cumplimiento terapéutico. Sería interesante estudiar los factores socioeconómicos que pueden determinar la incidencia y el peor cumplimiento entre la población inmigrante(AU)

Introduction: To determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed. Methods: Descriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009. Results: The incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%). Conclusions: The incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations(AU)

Alta exposición a antibióticos en la población y sus diferencias por género y edad / High exposure to antibiotics in the population and differences by sex and age

Objetivo: Determinar la prevalencia de consumo de antibióticos y su distribución por edad ysexo, así como el grupo terapéutico más prescrito.Diseño: Estudio observacional descriptivo con datos retrospectivos.Emplazamiento: Región Sanitaria de Lleida.Participantes: Personas que reciben prescripción de antibacterianos entre los años 2002 y 2007.Mediciones principales: Se calcula la dosis habitante día (DHD) y los pacientes expuestos atratamiento. Las variables de estudio son: edad, sexo, número de pacientes con tratamientoantibacteriano y grupo farmacológico.Resultados: La prevalencia de pacientes expuestos a tratamiento con antibacterianos en un añoes del 37% con un 33,5% en hombres y un 40,4% en mujeres. La DHD de Lleida durante el año 2007fue de 23,52. Un 56% han recibido antibiótico una sola vez durante el año. La prevalencia deconsumo tiene una forma de V en relación a la edad con cifras superiores en los grupos extremos(niños y ancianos). En el grupo de edad de 0 a 4 años un 58,8% de niños se encuentra expuestoa antibiótico al año. El principio activo más prescrito es la amoxicilina/ácido clavulánico.Conclusiones: Observamos una elevada prescripción de antibióticos con un mayor consumo enlas edades extremas de la vida, siendo llamativa la elevada prevalencia en la infancia, así comoun mayor consumo de antibióticos en mujeres de 5 a 74 años y en hombre mayores de 74 años.También se constata una desviación de las prescripciones hacia moléculas de amplio espectro(AU)

Purpose: To determine antibiotic use and its distribution by age and gender, as well as the mostprescribed therapeutic group.Design: Observational descriptive with retrospective data.Settings and participants: Population from the Lleida (Spain) Health Region receiving antibioticprescriptions from 2002 to 2007.Measurements: Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patientsunder treatment. The study variables were: age, gender, number of patients under antibiotictreatment and pharmacological group.Results: Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had receivedantibiotics once a year. The antibiotic consumption prevalence has a ‘‘V’’ shape with highervalues among children and old people. There is an annual exposure to antibiotics in 58.8% ofthe 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic.Conclusions: We observe a high antibiotic prescription rate among children and older people,the high consumption in childhood being of note. There is also a higher use of antibiotics amongwomen and changing of prescription towards broad spectrum antibiotics(AU)

Determinantes de la prescripción de antibióticos en atención primaria / Factors determining antibiotic prescription in primary care

Introducción Determinar los factores del paciente y el médico asociados a la variabilidad en la prescripción de antibióticos. Material y métodos Estudio observacional de prevalencia de las dispensaciones de medicamentos antibacterianos en población mayor de 14 años. Fuente de datos: receta oficial, historia clínica y tarjeta sanitaria individual. Las variables del usuario fueron: edad, sexo, número de consultas al médico durante el año, presencia de comorbilidad, envase antibacteriano dispensado con prescripción, y las variables del médico: edad, sexo, número de usuarios asignados, centro de trabajo y ruralidad. Las variables asociadas a la prescripción se estudiaron mediante la estimación de la odds ratio (OR) a partir del ajuste de modelos de regresión logística multinivel. Resultados La tasa de prescripción de antibióticos durante un año en la población es de un 31,4%. Los factores asociados a la prescripción fueron la mayor frecuentación (usuarios con más de 5 visitas-año multiplican la probabilidad de recibir antibiótico respecto los no visitados: OR=10,8), la edad con más prescripción en jóvenes y mayores y el sexo con más prescripciones en mujeres (OR=1,5). Ni la edad ni el sexo del profesional presentaron asociación con la prescripción. Los médicos con alta carga asistencial tienen una mayor probabilidad de prescripción de antibióticos. Conclusiones El principal factor asociado al aumento de prescripciones es la frecuentación en consulta. También reciben más antibióticos las mujeres, los jóvenes y los mayores. Los médicos con más carga asistencial prescriben más antibióticos. Se debe realizar una intervención multifactorial (sobre demanda, pacientes y médicos) para reducir la prescripción (AU)

Introduction: To determine patient and physician-related factors associated with variability in antibioticprescription. Material and methods: Observational study of the prevalence of antibacterial medication prescription>14 years old. Data source: official prescriptions, clinical histories and individual health cards. Patien trelated variables were: age, sex, number of medical visits-year, comorbidity, antibacterials dispensed with prescription. Physician-related variables were age, sex, number of patients assigned, place of work and rurality. Variables associated with prescription were studied by estimating the odds ratio (OR) from the fit of the multilevel logistic regression models. Results: The rate of antibiotic prescription-year in the population was 31.4%. Factors associated with prescription were high rate of visits (users with more than 5 annual visits multiply the probability of receiving antibiotics, compared to those who made no visits: OR= 10.8), age (non-linearly, with a greater likelihood in the young and the elderly) and sex, with a higher rate in women (OR = 1.5). No association was found between prescription and age and sex of the physician, but an association was found with workload: the higher the physician’s workload, the higher the likelihood of antibiotic prescription Conclusions: The most important factor associated with the increase in prescription rate was the frequency of visits. In addition, women, the young and the elderly receive more antibiotics. A multi-factor intervention focusing on demand, patients, and physicians should be carried out to reduce prescription rates (AU)