scholarly journals The use and adherence of oral anticoagulants in Primary Health Care in Catalunya, Spain: A real-world data cohort study

2020 ◽  
Vol 52 (8) ◽  
pp. 529-538
Author(s):  
Maria Giner-Soriano ◽  
Jordi Cortes ◽  
Ainhoa Gomez-Lumbreras ◽  
Oriol Prat-Vallverdú ◽  
Mª Angeles Quijada-Manuitt ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Real World ◽  
Oral Anticoagulants ◽  
Real World Data ◽  
World Data ◽  
Primary Health

scholarly journals Risk of Thrombotic Events and Other Complications in Anticoagulant Users Infected With SARS-CoV-2: An Observational Cohort Study in Primary Health Care in SIDIAP (Catalonia, Spain)

2021 ◽  
Author(s):  
Maria Giner-Soriano ◽  
Ainhoa Gomez-Lumbreras ◽  
Cristina Vedia ◽  
Dan Ouchi ◽  
Rosa Morros
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Hospital Admission ◽  
Oral Anticoagulants ◽  
Design Data ◽  
Risk Of Death ◽  
Primary Health ◽  
Increased Risk ◽  
Anticoagulated Patients

Abstract Background The risk of thromboembolic events and COVID-19 complications in anticoagulated patients once hospitalized has been widely analyzed. We aim to assess these outcomes in primary health care (PHC) patients chronically treated with oral anticoagulants (OAC) in comparison with non-treated. Methods Cohort study including adults with COVID-19 diagnosis in the PHC records in Catalonia, Spain; from March to June 2020. Patients were matched between exposed and non-exposed to OAC based on age and gender in a 1:2 design. Data source is the Information System for Research in Primary Care (SIDIAP). ResultsWe included 11,828 (33.3%) patients previously exposed to OAC, who were matched by age and sex to 23,656 (66.7%) non-exposed to OAC. Their mean age was 79.3 and 51% were women. Anticoagulated patients had a higher risk of hospital admission (OR 1.30, 95% CI 1.22-1.38), and of stroke and pulmonary embolism than non-anticoagulated (OR 2.5, 95% CI 2.04-3.06). The risk of pneumonia was not different between groups (OR 1.09, 95% CI 0.95-1.26). We found a lower risk of death in patients exposed to OAC (OR 0.88, 95% CI 0.83-0.93). ConclusionsOAC users in our study had more comorbidities and were older than non-users, well known risks for hospitalization being confirmed with our results. We also found in our study that OAC exposure was not associated to an increased risk in the mortality rate, although we cannot assess the effect of the interventions applied during hospital admission on the COVID-19 outcomes, as our database is a PHC database. EUPAS register: EUPAS37205

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

scholarly journals LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao Sen Andrew Fang ◽  
Qiao Gao ◽  
Mong Li Lee ◽  
Wynne Hsu ◽  
Ngiap Chuan Tan
Keyword(s):  
Primary Care ◽  
Clinical Trials ◽  
Cohort Study ◽  
Real World ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Goal Attainment ◽  
Real World Data ◽  
World Data ◽  
Asian Patients

Abstract Background Clinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients. Methods A retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into “No statin”, “Non-titrators” and “Titrators” cohorts based on prescribing patterns. For the “Titrators” cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration. Results Among the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9–24.3%), 28.9% (95%CI = 25.0–32.7%) and 25.2% (95%CI = 12.8–37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were − 12.4% to − 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated. Conclusion In this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.

scholarly journals Costs Of Psychiatric Assistance (Pa) In A Brazilian Health Care Plan (Hp): A Real World Data Analysis

2014 ◽  
Vol 17 (3) ◽  
pp. A131
Author(s):  
Viana ADJR ◽  
AF Lopes ◽  
CP Matias ◽  
VP Moreira ◽  
JL Viana ◽  
...  
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Real World ◽  
Care Plan ◽  
Real World Data ◽  
World Data ◽  
Health Care Plan

Abstract TP519: The Effect of Different Oral Anticoagulants on Vascular Outcomes in Stroke With Atrial Fibrillation: A Real-world Data

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Woo-Keun Seo ◽  
Joon-Tae Kim ◽  
Jong-Won Chung ◽  
Tae-Jin Song ◽  
Yong-Jae Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Oral Anticoagulants ◽  
Real World Data ◽  
World Data

scholarly journals Optimal diagnostic accuracy of quantitative faecal immunochemical test positivity thresholds for colorectal cancer detection in primary health care: A community-based cohort study

2020 ◽  
pp. 205064062094971 ◽  
Author(s):  
Noel Pin-Vieito ◽  
Laura García Nimo ◽  
Luis Bujanda ◽  
Begoña Román Alonso ◽  
María Ángeles Gutiérrez-Stampa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Laboratory ◽  
Faecal Immunochemical Test ◽  
Primary Health ◽  
Immunochemical Test

Background Optimizing colonoscopy resources is challenging, and information regarding performing diagnostic quantitative faecal immunochemical test (FIT) in daily clinical practice in primary health care is still limited. This study aimed to assess the sensitivity, specificity, positive predictive value and negative predictive value of varying FIT positivity thresholds on colorectal cancer (CRC) detection in primary health care. Methods A retrospective cohort study of 38,675 asymptomatic and symptomatic patients with a FIT (OC-Sensor™) performed between 2012 and 2016 in a primary health-care setting, using a clinical laboratory database of two Spanish areas linked with the National Health System’s Hospital Discharge Records Database. The primary outcome was 2-year CRC incidence. Results The mean age of the participants was 63.2 years; 17,792 (46.0%) were male. CRC prevalence was 1.7% (650/38,675). The percentage of patients with a FIT result above the threshold was 20.7% and 14.6% for 10 µg Hb/g faeces and 20 µg Hb/g faeces thresholds, respectively. Sensitivity was 90.5% (95% confidence interval 88.0–92.5%) at a 10 µg Hb/g faeces threshold, and this decreased by 3.1% when a 20 µg Hb/g faeces threshold was used. The negative predictive value for CRC was at least 99.2% in any subgroup analysed. At a 20 µg Hb/g faeces threshold, less than one additional CRC would be missed per 1000 patients investigated, while approximately 1.3 times more colonoscopy examinations were needed to identify an incidence of CRC using the lowest threshold for any situation analysed. Conclusions In primary health care, a quantitative FIT threshold should be tailored to colonoscopy capacity and CRC prevalence in specific populations.

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