COVID-19 Patient Management in Outpatient Setting: A Population-Based Study from Southern Italy

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients’ management in Southern Italy in the period February 2020–January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27–58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice.

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Real World Use of Antidiabetic Drugs in the Years 2011–2017: A Population-Based Study from Southern Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249514 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9514

Author(s):

Ylenia Ingrasciotta ◽

Maria Paola Bertuccio ◽

Salvatore Crisafulli ◽

Valentina Ientile ◽

Marco Muscianisi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Southern Italy ◽

Population Based ◽

Antidiabetic Drugs ◽

Local Health ◽

Population Based Study ◽

Female Ratio ◽

Local Health Unit ◽

Chronic Hyperglycemia ◽

Using Data

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia. The availability of new antidiabetic drugs (ADs) has led to complex treatment patterns and to changes in the patterns of specific drug utilization. The aim of this population-based study was to describe the pattern of antidiabetic drugs (ADs) use in Southern Italy in the years 2011–2017, in relation to the updated type 2 diabetes mellitus (T2DM) therapy guidelines. A retrospective cohort study was conducted on T2DM patients using data from the Palermo Local Health Unit (LHU) claims database and diabetologist registry. The first-line treatment was investigated and incident treatments were identified and characterized at baseline in terms of demographics, complications, comorbidities, concomitant drugs and clinical parameters. Persistence to AD treatment was also evaluated. During the study period, one-third of first ever ADs users started the treatment with ADs other than metformin, in contrast to guideline recommendations. Among 151,711 incident AD treatments, the male to female ratio was 1.0 and the median age was 66 (57–75) years. More than half (55.0%) of incident treatments discontinued the therapy during the first year of treatment. In Italy, general practitioners (GPs) can only prescribe first-generation ADs, while the prescription of more recently marketed ADs, such as GLP-1RA, DPP4i and SGLT2i, is restricted to diabetologists only, based on a therapeutic plan. The role of GPs in the management of T2DM in Italy should be re-evaluated.

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Are Patients with Psoriasis and Psoriatic Arthritis Undertreated? A Population-Based Study from Southern Italy

Journal of Clinical Medicine ◽

10.3390/jcm10153431 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3431

Author(s):

Ylenia Ingrasciotta ◽

Valentina Isgrò ◽

Valentina Ientile ◽

Michele Tari ◽

Gianluca Trifirò ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Southern Italy ◽

Population Based ◽

Local Health ◽

Biological Drugs ◽

Population Based Study ◽

Local Health Unit ◽

Drug Classes ◽

Synthetic Dmards ◽

Using Data

This study aimed to explore the pattern of use of different treatment lines in psoriasis (PsO) and psoriatic arthritis (PsA) patients from Southern Italy. A retrospective cohort study was performed during the years 2010–2018 using data from the Caserta Local Health Unit (LHU) claims database. All of the PsO or PsA patients were identified. The proportion of PsO/PsA patients untreated or treated with ≥1 drug classes (i.e., non-disease-modifying antirheumatic drugs (non-DMARDs), conventional synthetic DMARDs (csDMARDs), biological drugs (bDMARDs) or targeted synthetic small molecules (tsDMARDs)) was calculated in the years 2016–2018. Among the bDMARD users, the median times from the first registered PsO/PsA diagnosis/from the first csDMARD to the first bDMARD were calculated. Overall, 10,296 (1.1%) and 1724 (0.2%) PsO and PsA patients were identified. More than half of the PsO patients (N = 5301; 51.6%) and 15% of the PsA patients (N = 251) were not treated with any drug. A very low proportion of PsO patients (N = 121; 1.2%) received csDMARDs/bDMARDs dispensing. Instead, 538 (32.2%) PsA patients were treated with bDMARDs. The median times from the first diagnosis to the first bDMARD dispensing were 54.0 (Q1–Q3: 30.5–72.2) and 13.3 (Q1–Q3: 3.1–43.9) months in the PsO and PsA patients, respectively. The median time from the first csDMARD to the first bDMARD dispensing was shorter in the PsO [9.2 months Q1–Q3: 5.5–30.0)] than in the PsA [14.5 months (Q1–Q3: 8.6–33.5)] patients. A potential undertreatment of PsO (much less for PsA) in an LHU from Southern Italy, with a particularly low use of more recently marketed drugs, such as biological ones, was shown.

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Breast Cancer Screening in Older Women—Current Evidence and Future Perspectives

Oncology & Hematology Review (US) ◽

10.17925/ohr.2015.11.01.34 ◽

2015 ◽

Vol 11 (01) ◽

pp. 34

Author(s):

Nienke A de Glas ◽

Gerrit-Jan Liefers ◽

◽

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Older Women ◽

Breast Cancer Screening ◽

Early Stage ◽

Developed Countries ◽

Population Based ◽

Current Data ◽

Current Evidence ◽

Strong Increase

As populations of developed countries are aging, the number of older women with breast cancer will strongly increase. Randomized controlled trials in breast cancer screening rarely included patients over the age of 68. As a consequence, there is no solid evidence for beneficial effects of breast cancer screening in older women. In a recent observational study, we showed that the implementation of screening in women aged 7075 in the Netherlands resulted in a strong increase of the incidence of early-stage breast cancer, while the incidence of advanced stage breast cancer barely decreased. Hence, current data do not support population-based screening in women over the age of 70.

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Do psychological harms result from being labelled with an unexpected diagnosis of abdominal aortic aneurysm or prostate cancer through screening? A systematic review

BMJ Open ◽

10.1136/bmjopen-2017-017565 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017565 ◽

Cited By ~ 14

Author(s):

Anne R Cotter ◽

Kim Vuong ◽

Linda L Mustelin ◽

Yi Yang ◽

Malika Rakhmankulova ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Early Stage ◽

Population Based ◽

Psychological State ◽

Current Evidence ◽

Abdominal Aortic ◽

Psychological Harm

ObjectiveA potential psychological harm of screening is unexpected diagnosis—labelling. We need to know the frequency and severity of this harm to make informed decisions about screening. We asked whether current evidence allows an estimate of any psychological harm of labelling. As case studies, we used two conditions for which screening is common: prostate cancer (PCa) and abdominal aortic aneurysm (AAA).DesignSystematic review with narrative synthesis.Data sources and eligibility criteriaWe searched the English language literature in PubMed, PsychINFO and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for research of any design published between 1 January 2002 and 23 January 2017 that provided valid data about the psychological state of people recently diagnosed with early stage PCa or AAA. Two authors independently used explicit criteria to review and critically appraise all studies for bias, applicability and the extent to which it provided evidence about the frequency and severity of harm from labelling.Results35 quantitative studies (30 of PCa and 5 of AAA) met our criteria, 17 (48.6%) of which showed possible or definite psychological harm from labelling. None of these studies, however, had either appropriate measures or relevant comparisons to estimate the frequency and severity of psychological harm. Four PCa and three AAA qualitative studies all showed clear evidence of at least moderate psychological harm from labelling. Seven population-based studies found increased suicide in patients recently diagnosed with PCa.ConclusionsAlthough qualitative and population-based studies show that at least moderate psychological harm due to screening for PCa and AAA does occur, the current quantitative evidence is insufficient to allow a more precise estimation of frequency and severity. More sensitive measures and improved research designs are needed to fully characterise this harm. In the meantime, clinicians and recommendation panels should be aware of the occurrence of this harm.

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Antidepressant Drug Prescribing Patterns to Outpatients of an Italian Local Health Authority During the Years 1998 to 2008

Journal of Clinical Psychopharmacology ◽

10.1097/jcp.0b013e3181d3cb04 ◽

2010 ◽

Vol 30 (2) ◽

pp. 212-215 ◽

Cited By ~ 4

Author(s):

Paola Deambrosis ◽

Alessandro Chinellato ◽

Gianni Terrazzani ◽

Guido Pullia ◽

Pietro Giusti ◽

...

Keyword(s):

Health Authority ◽

Antidepressant Drug ◽

Prescribing Patterns ◽

Local Health Authority ◽

Local Health ◽

Drug Prescribing

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First drug utilization data related to an anticholinergic agent recently marketed in Italy

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v7i3.264 ◽

2006 ◽

Vol 7 (3) ◽

pp. 187-192

Author(s):

Carlo Lucioni ◽

S. Mazzi ◽

C. Cerra ◽

S. Lottaroli

Keyword(s):

Health Resources ◽

Outpatient Setting ◽

Administrative Database ◽

Chronic Obstructive ◽

Local Health ◽

Anticholinergic Agent ◽

Obstructive Pulmonary Disease ◽

Local Health Unit ◽

Defined Daily Doses ◽

The Cost

A retrospective drug utilisation study was conducted, concerning a new bronchodilator (tiotropium, ATC code: R03BB04) in the first six months after its launch in Italy. The source of data was the administrative database run by a Local Health Unit located in Northern Italy. All patients (920) were selected with at least one prescription for tiotropium between September and December 2004, and data about their use of health resources (hospitalisations, class ATC R03 drugs, lab tests – only drugs and test prescribed in outpatient setting) was collected. Starting from such initial sample, further sub-samples were created (in particular to focus on patients affected by COPD – Chronic Obstructive Pulmonary Disease, for which tiotropium has got the therapeutic indication by the Italian Health Service), for the purpose of different levels of analysis. Results reported in this abstract are referred to the first level (702 patients, aged 40 years or more, still living at the end of the observation period, already with COPD in the previous year); they are expressed as average data per patient on a six-month period. Prescriptions of R03 drugs were 7.8, including 2.4 specifically for tiotropium. To such prescriptions, 348 and 103 DDDs (Defined Daily Doses) respectively corresponded; and, analogously, a cost of 487 and 205 euros. The cost for hospitalisations was 525 euros and the cost for lab tests was 28.5 euros. The other analysis levels (sub-samples with fewer patients) produced not very different outcomes. Evidence given here should prove the potential interest of such kind of studies.

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In search of potential predictors of erythropoiesis-stimulating agents (ESAs) hyporesponsiveness: a population-based study

BMC Nephrology ◽

10.1186/s12882-019-1554-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ylenia Ingrasciotta ◽

Viviana Lacava ◽

Ilaria Marcianò ◽

Francesco Giorgianni ◽

Giovanni Tripepi ◽

...

Keyword(s):

Enzyme Inhibitors ◽

Binary Logistic Regression ◽

Roc Curves ◽

Angiotensin Converting Enzyme Inhibitors ◽

Population Based ◽

Outpatient Setting ◽

Local Health ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors ◽

Erythropoiesis Stimulating Agents

Abstract Background Evidences show that around 20% of biosimilar or originator erythropoiesis-stimulating agents (ESAs) users are hyporesponsive. Controversial post-marketing data exist on the predictors of ESA hyporesponsiveness. The aim of this study was to identify predictors of ESA hyporesponsiveness in patients with chronic kidney disease (CKD) or cancer in clinical practice. Methods During the years 2009–2015, a multi-center, population-based, cohort study was conducted using claims databases of Treviso and Caserta Local Health Units (LHUs). All incident ESA users were characterized at baseline and the differences between the baseline hemoglobin (Hb) value, that is the Hb registered within 30 days prior to the first ESA dispensing (index date, ID) and each outcome Hb value (registered between 30 and 180 days after ID) were calculated and defined as delta Hb (ΔHb). Incident ESA users were defined as hyporesponsive if, during follow-up, they registered at least one ΔHb < 0 g/dL. Including all potential predictors of ESA hyporesponsiveness and stratifying by indication for use, univariate and multivariate binary logistic regression models and Receiver Operating Characteristic (ROC) curves were carried out. Results `In general, 1080 incident ESA users (CKD: 57.0%; cancer: 43.0%) were identified. In CKD, predictors of ESA hyporesponsiveness were C-reactive protein (OR = 1.2, 95% CI: 1.0–1.5; P-value = 0.060) and high levels of baseline Hb (OR = 1.7, 95% CI: 1.2–2.2; P-value< 0,001), the latter being also predictor of ESA hyporesponsiveness in cancer (OR = 1.7, 95% CI: 1.1–2.4; P-value = 0.007). Both in CKD and in cancer, the type of ESA, biosimilar or originator, was not a predictor of ESA hyporesponsiveness. In CKD, concomitant use of iron preparations (OR = 0.3, 95% CI: 0.2–0.7; P-value = 0.002) and of high dosage of angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers (OR = 0.5, 95% CI: 0.3–0.9; P-value = 0.022) were protective factors against ESA hyporesponsiveness. Conclusions The study confirmed traditional potential predictors of hyporesponsiveness to ESA. The use of biosimilar or originator ESA was not a predictor of hyporesponsiveness in an outpatient setting from two large Italian areas. A better knowledge of the predictors of ESA response would allow a better anemia management to improve patients’ quality of life.

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Analisi della persistenza e delle risorse allocate nel trattamento farmacologico dell’ipertensione arteriosa

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v3i3.753 ◽

2002 ◽

Vol 3 (3) ◽

pp. 161-170

Author(s):

Luca Degli Esposti ◽

Alessandro Capone ◽

Ezio Degli Esposti ◽

Giorgio Valpiani ◽

Mirko Di Martino ◽

...

Keyword(s):

Antihypertensive Treatment ◽

Hospital Admissions ◽

Beta Blockers ◽

Population Based ◽

Administrative Databases ◽

Local Health ◽

Channel Blockers ◽

Related Factors ◽

Local Health Unit ◽

Hypertensive Drug

In this study, the persistence with treatment and resources allocated in antihypertensive pharmacotherapy has been evaluated. Administrative databases of the Local Health Unit of Ravenna listing patients baseline characteristics, drug prescriptions and hospital admissions were used to perform a population-based retrospective study. All new users 20 years old or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors or AII-Antagonists between January 1st, 1997 and December 31st, 1997 were included. A one-year follow-up for prescriptions of anti-hypertensive drugs were considered. According to duration of therapy, treated population was divided in persistent patients (continuers and switchers) and non-persistent patients. A total of 16,783 patients was included in the study of whom 64.9% were non-persistents. Persistence with treatment seems to be associated with the class of anti-hypertensive drug initially prescribed, and with patient-related factors. Patients initially prescribed for AII-Antagonists were more likely to persist than those starting on the other antihypertensive classes. Annual antihypertensive treatment cost accounted for • 1,076,053.55 of which 25.4% for non-persistent patients. An appropriate use of claims data may be considered as a powerful tool, providing detailed epidemiological and economic information concerning the antihypertensive treatment.

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Seroprevalence of SARS-CoV-2-specific antibodies in the town of Ariano Irpino (Avellino, Campania, Italy): a population-based study

Future Science OA ◽

10.2144/fsoa-2020-0203 ◽

2021 ◽

pp. FSO673

Author(s):

Pellegrino Cerino ◽

Annachiara Coppola ◽

Palmiero Volzone ◽

Antonio Pizzolante ◽

Biancamaria Pierri ◽

...

Keyword(s):

Public Health ◽

Public Health Intervention ◽

Cost Effective ◽

Population Based ◽

Screening Strategy ◽

Local Health ◽

Local Health Unit ◽

Department Of Health ◽

Asymptomatic Individuals ◽

Regional Authorities

The Italian municipality of Ariano Irpino (Avellino, Campania, Italy) was locked down by the regional authorities from March until April 2020 after several citizens tested positive for SARS coronavirus 2 (SARS-CoV-2). A serological mass screening campaign targeting the Ariano Irpino population using the Roche Cobas Elecsys anti-SARS-CoV-2 assay was organized by the Zoo-Prophylactic Institute of Southern Italy (Portici, Italy) and conducted in cooperation with the Local Health Unit (Azienda Sanitaria Locale – ASL – Avellino, Avellino, Italy), the Department of Public Health of University Federico II (Naples, Italy) and Department of Health Services of Azienda Ospedaliera dei Colli-Cotugno and Monaldi Hospital (Naples, Italy) in May 2020. A total of 13,218 asymptomatic individuals were reviewed in this analysis. A total of 738 citizens tested positive for anti-SARS-CoV-2 antibodies (398 females, 340 males). The overall prevalence in the sample was 5.6% (95% CI: 5.2–6.0). Among seropositive citizens, 101 cases tested positive on RT-PCR (0.76% of the overall population). Among citizens aged 14–18, 18–65 and >65 years, the seroprevalence was equal to 6.1 (95% CI: 4.1–8.7), 5.6 (95% CI: 5.1–6.1) and 4% (95% CI: 3.3–4.8), respectively. In the pediatric cohort (<14 years old), seroprevalence was 13% (95% CI: 10.2–16.2). A serological-based screening strategy could be a cost-effective public health intervention to tackle the COVID-19 pandemic.

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Definition of a Protocol to Manage and Officially Confirm SHB Presence in Sentinel Honeybee Colonies

Applied Sciences ◽

10.3390/app11178260 ◽

2021 ◽

Vol 11 (17) ◽

pp. 8260

Author(s):

Giovanni Formato ◽

Giovanni Federico ◽

Camilla Di Ruggiero ◽

Marco Pietropaoli ◽

Marcella Milito ◽

...

Keyword(s):

Short Communication ◽

Southern Italy ◽

Aethina Tumida ◽

Local Health ◽

Health Unit ◽

Veterinary Services ◽

Local Health Unit ◽

Calabria Region ◽

Supervision And Management ◽

Definition Of

Given the consolidated circulation of Aethina tumida (SHB) in Reggio Calabria and Vibo Valentia provinces of Calabria region (Southern Italy), the need for a more effective and less time-consuming approach to SHB surveillance emerged. Accordingly, honeybee sentinel colonies were established in the infested areas under the supervision and management of the Veterinary Services of the Local Health Unit. In this short communication, we present the protocol adopted in the Calabria region to manage the SHB positive sentinel honeybee colonies. The procedures for safely packing and transport the SHB infested sentinel honeybee colonies from the field to the official laboratory and the subsequent procedure for their careful inspection in the laboratory are illustrated.

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