[Atrial fibrillation: use of healthcare resources and expenditures in the Lazio region (Italy)]. / Fibrillazione atriale: attività assistenziale e assorbimento di risorse nella Regione Lazio.

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia and is an important risk factor for mortality and morbidity related mainly to an increased risk of cerebrovascular events and heart failure.An observational cross-sectional study was performed to evaluate the use of healthcare resources (including hospital and outpatient care) by patients with AF in the Lazio region (central Italy), from 1 January 2006 to 31 December 2008.Atrial fibrillation is an important source of healthcare resource utilization because of repeated emergency room visits, hospital admissions, outpatient consultations and procedures and extensive use of laboratory tests and pharmacological treatments.Results show that 55% of costs are attributable to hospital admissions and Emergency Room visits, 37% to pharmacological treatment and the remaining 8% to outpatient care. These results are consistent with the international literature.The impact of AF in terms of cost is not negligible and it is therefore desirable to implement an organizational scheme that safeguards the appropriateness of care, taking charge of the patient as early as possible. The aims of early diagnosis of AF are to improve the appropriateness of care and optimize the use of specialized tests, thereby reducing hospital admissions for complications or recurrences of AF.

Emergency Medical Services Calls Analysis for Trend Prediction during Epidemic Outbreaks: Interrupted Time Series Analysis on 2020-2021 COVID-19 Epidemic in Lazio, Italy.

(1) Background: During the COVID-19 outbreak in the Lazio region, a surge in emergency medical service (EMS) calls has been observed. The objective of present study is to investigate if there is any correlation between the variation in numbers of daily EMS calls, and the short-term evolution of the epidemic wave. (2) Methods: Data from the COVID-19 outbreak has been retrieved in order to draw the epidemic curve in the Lazio region. Data from EMS calls has been used in order to determine Excess of Calls (ExCa) in the 2020−2021 years, compared to the year 2019 (baseline). Multiple linear regression models have been run between ExCa and the first-order derivative (D') of the epidemic wave in time, each regression model anticipating the epidemic progression (up to 14 days), in order to probe a correlation between the variables. (3) Results: EMS calls variation from baseline is correlated with the slope of the curve of ICU admissions, with the most fitting value found at 7 days (R2 0.33, p < 0.001). (4) Conclusions: EMS calls deviation from baseline allows public health services to predict short-term epidemic trends in COVID-19 outbreaks, and can be used as validation of current data, or as an independent estimator of future trends.

Implementing a guideline for the treatment of type 2 diabetics: results of a cluster-randomized controlled trial (C-RCT).

BACKGROUND: In Italy many diabetics still lack adequate care in general practice. We assessed the effectiveness of different strategies for the implementation of an evidence-based guideline for the management of non-complicated type 2 diabetes among General Practitioners (GPs) of Lazio region. METHODS: Three-arm cluster-randomised controlled trial with GPs as units of randomisation (clusters). 252 GPs were randomised either to an active strategy (training module with administration of the guideline), or to a passive dissemination (administration of the guideline only), or to usual care (control). Data on prescriptions of tests and drugs were collected by existing information systems, whereas patients' data came from GPs' databases. Process outcomes were measured at the cluster level one year after the intervention. Primary outcomes concerned the measurement of glycosilated haemoglobin and the commissioning of micro- and macrovascular complications assessment tests. In order to assess the physicians' drug prescribing behaviour secondary outcomes were also calculated. RESULTS: GPs identified 6395 uncomplicated type 2 patients with a high prevalence of cardiovascular risk factors. Data on GPs baseline performance show low proportions of glycosilated haemoglobin assessments. Results of the C-RCT analysis indicate that the active implementation strategy was ineffective relating to all primary outcomes (respectively, OR 1.06 [95% IC: 0.76-1.46]; OR 1.07 [95% IC: 0.80-1.43]; OR 1.4 [95% IC:0.91-2.16]. Similarly, passive dissemination of the guideline showed no effect. CONCLUSION: In our region compliance of GPs with guidelines was not enhanced by a structured learning programme. Implementation through organizational measures appears to be essential to induce behavioural changes. TRIAL REGISTRATION: ISRCTN80116232.