Triptan use in Italy: Insights from administrative databases

Cephalalgia ◽  
2014 ◽  
Vol 35 (7) ◽  
pp. 619-626 ◽  
Author(s):  
Roberto Da Cas ◽  
Anna Nigro ◽  
Salvatore Terrazzino ◽  
Grazia Sances ◽  
Michele Viana ◽  
...  
Keyword(s):  
At Risk ◽  
Drug Prescription ◽  
Medication Overuse Headache ◽  
Administrative Databases ◽  
Local Health ◽  
Italian Population ◽  
Frequent Users ◽  
Defined Daily Doses ◽  
Umbria Region ◽  
Prescription Databases

Introduction In this drug utilization study, we aimed at assessing the pattern of triptan use in Italy by means of the drug prescription databases of two local health authorities, accounting for approximately 1 million citizens. Methods The study population included all residents aged 18 to 84 years in the Vercelli province (about 175,000 inhabitants) and in the Umbria region (about 885,000 inhabitants), who had at least one dispensation for triptans in 2012. A frequent user, who might be at risk of medication-overuse headache (MOH), was defined as a patient being dispensed at least 10 defined daily doses (DDD) of triptans every month for at least three consecutive months. Results Triptans were used by 0.7%–1% of the population. While most patients were dispensed fewer than 60 DDDs per year, about 10% of all triptan users were classified as frequent users. In both areas, patients below the age of 29 were less likely to be frequent users while the 40- to 49-year-old population was the most affected, with no sex difference. About two-thirds of frequent users persisted in this behavior for an additional three-month period in the following six months. Conclusions Our data indicate that approximately 10% of all triptan users in the Italian population are potentially at risk for MOH. An approach based on drug prescription databases could be useful to identify patients at risk for MOH.

scholarly journals Spirometry monitoring in asthmatic children in Lombardy Region, Italy

2018 ◽  
Vol 2 (1) ◽  
pp. e000334
Author(s):  
Pietro Casartelli ◽  
Antonio Clavenna ◽  
Massimo Cartabia ◽  
Angela Bortolotti ◽  
Ida Fortino ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Inhaled Corticosteroids ◽  
Drug Prescription ◽  
Administrative Databases ◽  
Function Evaluation ◽  
Local Health ◽  
Local Health Unit ◽  
Lombardy Region ◽  
Asthmatic Children ◽  
Antiasthmatic Drug

ObjectivesTo evaluate the diagnostic and therapeutic approaches in a cohort of asthmatic children before and after starting drug therapy.MethodsData were retrieved from administrative databases of the Lombardy Region. The study population was composed of 78 184 children born in the Lombardy Region in 2002 and followed until their 10th birthday.Children with at least one antiasthmatic drug prescription per year (with the exclusion of nebulised suspension/solution formulations) in 2 consecutive years and at least one antiasthmatic drug prescription after the fifth birthday were identified as potential asthmatics (PA).Each PA was monitored for a period starting from 12 months before and ending 24 months after the first prescription (index prescription, IP). During the monitoring period antiasthmatic drug prescriptions were analysed, as well as spirometry and/or specialist visits.ResultsA total of 59 975 children (76.7%) received ≥1 prescription of antiasthmatic drugs in their first 10 years of life, and 4475 (5.7%) were identified as PAs. In all, 24% of PAs started with short-acting β2-agonists (SABA), 23% with inhaled corticosteroids (ICS) and 20% with SABA+ICS.A total of 33% of PAs had at least one prescription for specialist visit/spirometry: 11% before and 28% after the IP. The factors associated with a greater likelihood of receiving visit/spirometry prescriptions were local health unit of residence, age and high use of asthma drugs.ConclusionsDespite international guideline recommendations, spirometry monitoring is still underused in asthmatic children, even in subjects who initiated pharmacological treatment and therefore need an airway function evaluation. Moreover, the choice of drug therapy appears not always rational, since one out of four children were commenced on ICS as monotherapy.

scholarly journals Association of Hypertriglyceridemia with All‐Cause Mortality and Atherosclerotic Cardiovascular Events in a Low‐Risk Italian Population: The TG‐REAL Retrospective Cohort Analysis

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Marcello Arca ◽  
Chiara Veronesi ◽  
Laura D’Erasmo ◽  
Claudio Borghi ◽  
Furio Colivicchi ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Setting ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Local Health ◽  
Atherosclerotic Cardiovascular Disease ◽  
Italian Population ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Very High

Background Evidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150–500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P <0.001, and HR=3.08 [95% CI 1.46–6.50], P <0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43–1.82], P <0.001, and HR=2.30 [95% CI 1.02–5.18], P <0.05, respectively) as compared to those with normal TG. Conclusions Moderate‐to‐severe elevation of TG is associated with a significantly increased risk of all‐cause mortality and ASCVD events in a large cohort of low‐to‐moderate cardiovascular risk individuals in a real‐world clinical setting.

scholarly journals Adherence to treatment and anticoagulation control in vitamin K antagonists-treated patients: an administrative databases analysis in a large Italian population

2011 ◽  
Vol 12 (2) ◽  
pp. 53-59 ◽  
Author(s):  
Luca Degli Esposti ◽  
Diego Sangiorgi ◽  
Giuseppe Di Pasquale ◽  
Gian Franco Gensini ◽  
Ido Iori ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Vitamin K ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Administrative Databases ◽  
Local Health ◽  
Italian Population ◽  
Treatment And Prevention ◽  
Anticoagulation Control ◽  
Anticoagulation Intensity

Oral anticoagulant therapy is essential for the treatment and prevention of many thromboembolic disorders. The aim of the present study is to evaluate the level of anticoagulation intensity in patients treated with vitamin K antagonists (VKAs) in a clinical practice setting and to explore the relationship between anticoagulation intensity and adherence to VKA treatment. We conducted a retrospective cohort study using the administrative databases of three Italian Local Health Units. Patients were enrolled if they had filled at least one prescription for VKAs (ATC code B01AA) between January 1st, 2007 and June 30th, 2008. In the same period all determinations of the international normalised ratio (INR) were collected. The parameters evaluated were anticoagulation control and adherence to VKA treatment.The survey showed that only 47.9% and 56.3% of INR determinations, in VKA naïve and established patients respectively, were into the recommended range (2.0-3.0). Moreover, the percentage of INR determination below the recommended range was higher than the percentage of INR determination above the recommended range for both naïve and established patients. Moreover, adherence to VKA treatment was poor both in naïve and established patients and, consequently, anticoagulation control is poor. Also in patients with the highest adherence to VKA treatment, only about 60% of INR determinations were into the recommended range. Our findings evidence that the anticoagulation control in clinical practice settings is still unsatisfactory and it is necessary to evaluate interventions to increase the amount of time at which patients’ INR are within the recommended range.

scholarly journals A Network Approach for the Study of Drug Prescriptions: Analysis of Administrative Records from a Local Health Unit (ASL TO4, Regione Piemonte, Italy)

2021 ◽  
Vol 18 (9) ◽  
pp. 4859
Author(s):  
Gianluca Miglio ◽  
Lara Basso ◽  
Lucrezia G. Armando ◽  
Sara Traina ◽  
Elisa Benetti ◽  
...  
Keyword(s):  
Administrative Data ◽  
Anatomical Therapeutic Chemical ◽  
Drug Prescription ◽  
Local Health ◽  
Prescription Data ◽  
Health Unit ◽  
Local Health Unit ◽  
Administrative Records ◽  
Edge Linking ◽  
Novel Approach

In a Drug Prescription Network (DPN), each drug is represented as a node and two drugs co-prescribed to the same patient are represented as an edge linking the nodes. The use of DPNs is a novel approach that has been proposed as a means to study the complexity of drug prescription. The aim of this study is to demonstrate the analytical power of the DPN-based approach when it is applied to the analysis of administrative data. Drug prescription data that were collected at a local health unit (ASL TO4, Regione Piemonte, Italy), over a 12-month period (July 2018–June 2019), were used to create several DPNs that correspond to the five levels of the Anatomical Therapeutic Chemical classification system. A total of 5,431,335 drugs prescribed to 361,574 patients (age 0–100 years; 54.7% females) were analysed. As indicated by our results, the DPNs were dense networks, with giant components that contain all nodes. The disassortative mixing of node degrees was observed, which implies that non-random connectivity exists in the networks. Network-based methods have proven to be a flexible and efficient approach to the analysis of administrative data on drug prescription.

scholarly journals Subclinical hypothyroidism in paediatric population treated with levothyroxine: a real-world study on 2001–2014 Italian administrative data

2017 ◽  
Vol 6 (6) ◽  
pp. 367-374 ◽  
Author(s):  
Nella Augusta Greggio ◽  
Elisa Rossi ◽  
Silvia Calabria ◽  
Alice Meneghin ◽  
Joaquin Gutierrez de Rubalcava ◽  
...  
Keyword(s):  
Real World ◽  
Subclinical Hypothyroidism ◽  
Paediatric Population ◽  
Mean Value ◽  
Administrative Databases ◽  
Slight Reduction ◽  
Local Health ◽  
Annual Dose ◽  
Historical Cohort ◽  
Low Dosage

Objective To estimate the prevalence of subclinical hypothyroidism (SH) among children, by using levothyroxine low dosage as disease proxy, and to describe prescription pattern. Design An historical cohort study was performed through administrative databases of 12 Italian Local Health Units covering 3,079,141 inhabitants. A cohort of children (aged 0–13 years) was selected in the period 2001–2014. A subgroup of new users (aged 0–9 years) was identified and followed up for 5 years. Methods The prevalence was provided as mean value of the whole period, as annual trend, by patient gender and age. Demographic details, information on levothyroxine dosage, comorbidities and co-medications were provided. Therapy duration and medication persistence were evaluated among new users. Results 644 children treated with levothyroxine low dosage was selected, with a mean annual prevalence of 0.20 per 1000 children. The temporal trend of prevalence was stable, with a slight reduction in the 2005–2008. Prevalence by age showed an increase after 10 years. Patients were treated with an average annual dose of 4290 µg/year and 66.9% of children were affected by comorbidities. Among 197 new users, 62.9% received therapy only for one year, whereas out of those treated two or more years, 89.0% resulted persistent to the therapy. Conclusions This study provides real-world epidemiology of SH among children, and it depicts the clinical and therapeutic characteristics of these subjects. Its findings showed that the SH treatment of this disorder was widely variable, also due to lack of evidence concerning paediatric population.

scholarly journals Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986821
Author(s):  
Claire E. Kendall ◽  
Janessa E. Porter ◽  
Esther S. Shoemaker ◽  
Rachel Seoyeon Kang ◽  
Michael Fitzgerald ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Care Providers ◽  
Question Type ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Local Health ◽  
Care Providers ◽  
Patients At Risk ◽  
Survey Responses ◽  
Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

scholarly journals Evaluation of antibiotic usage in swine reproduction farms in Umbria region based on the quantitative analysis of antimicrobial consumption

2017 ◽  
Vol 6 (3) ◽  
Author(s):  
Fausto Scoppetta ◽  
Marco Sensi ◽  
Maria Pia Franciosini ◽  
Marinella Capuccella
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Diagnostic Methods ◽  
Antibiotic Administration ◽  
Oral Antibiotic ◽  
Defined Daily Doses ◽  
Umbria Region ◽  
Antimicrobial Susceptibility Tests ◽  
Critical Aspects

Antibiotic use in food-producing animals has considerable impact on public health, especially with respect to the development and spread of antibiotic resistance. Pigs represent one of the main species in which antibiotics are frequently used for different purposes. Surveillance of antibiotic consumption and dose appropriateness, through novel approaches based on defined daily doses, is strongly needed to assess farms’ antibiotic risk, in terms of spread of antibiotic resistance and possibile presence of residues in meat. In this study, antibiotic consumption was monitored in 14 swine reproduction farms, together with managerial, structural, and health aspects. Most of the controlled farms (65%) were classified as at medium antibiotic risk, 21% at high antibiotic risk, and 14% at low antibiotic risk. Critical aspects of antibiotic administration concerned treatments for suckling and weaner piglets, oral antibiotic administration, treatment and diagnosis of gastroenteric infections, and use of critically important antimicrobials for human medicine, especially colistin. These aspects could be considered critical aspects of antibiotic use in from-farrow-to-wean/finish swine farms in the Umbria region and must be controlled to minimize risks. Even though a small number of farms in Umbria region are at high antibiotic risk, the risk of antibiotic resistance should be minimized, and management and biosecurity of the farms should be improved by extending the use of antimicrobial susceptibility tests and optimizing the diagnostic methods for infectious diseases. Furthermore, farmers’ and veterinarians’ knowledge of antibiotic resistance should be improved and the prudent use of antibiotics encouraged to prevent the development and spread of resistant microorganisms.

scholarly journals Assessment of patients affected by rheumatoid arthritis eligible for biotechnological agents and evaluation of their healthcare resource utilization and related costs

Reumatismo ◽  
2021 ◽  
Vol 73 (1) ◽  
pp. 5-14
Author(s):  
L. Degli Esposti ◽  
V. Perrone ◽  
D. Sangiorgi ◽  
L. Sinigaglia
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Failure ◽  
Renal Damage ◽  
Data Linkage ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Administrative Databases ◽  
Italian Population ◽  
Outpatient Services ◽  
Local Healthcare

Objective. To provide estimates of patients with rheumatoid arthritis (RA) eligible for biotechnological therapy and to evaluate their healthcare costs. Method. An observational analysis was performed based on data-linkage between administrative databases of selected Italian Regional/Local healthcare departments. Data were then re-proportioned to the Italian population. Patients with RA diagnosis defined by discharge diagnosis and/or exemption code during 01/01/2013- 31/12/2017 were included. The criteria applied to evaluate the elegibility for biotechnological therapy were: 1) methotrexate (MTX)-treatment failure ≥6 months and start of a different conventional-synthetic diseasemodifying antirheumatic drugs (csDMARD); 2) corticosteroid ≥6 months with dosage ≥7.5 mg/die; 3) MTX-contraindication (therapy or hospitalization for renal damage/interstizial lung disease/hepatic failure). Mean annual costs per patient included drugs, hospitalizations, outpatient services. Results. Data re-proportioned to the Italian population estimated 318,328 RA patients: 43,361 with, 274,967 without biotechnological agents. Among the latter, 26,487(9.6%) patients met ≥1 criteria applied for eligibility: 1,896 had MTX-treatment failure and started another csDMARD; 15,833 received corticosteroid ≥7.5 mg/die; 7,788 had MTX-contraindication. Regarding patients fulfilling two criteria, 107 had MTX-treatment failure followed by another csDMARDs and corticosteroid ≥7.5 mg/die, 53 were treated with another csDMARDs after MTX-treatment failure and also presented MTX-contraindication, 810 had corticosteroid ≥7.5 mg/die and MTX-contraindication. Mean total annual costs for patients estimated eligible for biotechnological therapy was € 3,132, of which € 177 related to drugs indicated for RA and € 2,955 related to other direct costs. Conclusions. According to our estimates, around 10% RA patients not currently treated with biotechnological agents are eligible for such therapies, highlighting a trend of under-use in clinical practice for RA management.

scholarly journals Risk Characterization and Benefit–Risk Assessment of Brominated Flame Retardant in Commercially Exploited Freshwater Fishes and Crayfish of Lake Trasimeno, Italy

2021 ◽  
Vol 18 (16) ◽  
pp. 8763
Author(s):  
Rossana Roila ◽  
Raffaella Branciari ◽  
David Ranucci ◽  
Arianna Stramenga ◽  
Tamara Tavoloni ◽  
...  
Keyword(s):  
Body Weight ◽  
Flame Retardants ◽  
Central Italy ◽  
Dietary Exposure ◽  
Freshwater Fishes ◽  
Italian Population ◽  
Risk Characterization ◽  
Fish Products ◽  
Benefit Risk Assessment ◽  
Umbria Region

Among brominated flame retardants (BFRs), polybrominateddiphenyl ethers (PBDEs) and hexabromocyclododecanes (HBCDs) were the most widely used in past decades. BFRs not being chemically bonded to polymers means they can easily leach from the products into the environment and bioaccumulate. Humans are exposed to flame retardants mainly through food consumption, especially fish and fish products. In the present study, the occurrence of PBDEs and HBCDs in freshwater fishes and crayfish from Lake Trasimeno (Umbria region, central Italy) was assessed according to monitoring plans recommended by European competent authorities. The dietary exposure of the central Italian population to such molecules was calculated, and the risk characterization and the benefit–risk evaluation were also assessed. A total of 90 samples were analyzed by means of gas and liquid chromatography associated with triple quadrupole mass spectroscopy. A total of 51% of samples were found positive for at least one of the congeners; the most frequently found molecule was BDE-47. The data on dietary exposure ranged from 0.138 to 1.113 pg/kg body weight/day for ∑PBDE and from 0.805 to 0.868 pg/kg body weight/day for ∑HBCD. The data show no health risks for the central Italian population consuming freshwater fish products from Lake Trasimeno in relation to exposure to PBDE and HBCD.

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