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Trifirò G, Parrino F, Pizzimenti V, Giorgianni F, Sultana J, Muscianisi M, Troncone C, Tari DU, Arcoraci V, Santoro D, Russo G, Lacava V, Caputi AP. The Management of Diabetes Mellitus in Patients with Chronic Kidney Disease: A Population-Based Study in Southern Italy. Clin Drug Investig 2016; 36:203-12. [PMID: 26692008 DOI: 10.1007/s40261-015-0367-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Diabetes mellitus in patients with chronic kidney disease (CKD) is known as diabetic kidney disease (DKD). Pharmacological management of DKD is challenging due to reduced renal excretion of some antidiabetic drugs. The aim of this population-based study was to explore antidiabetic drug use in DKD patients from Southern Italy. METHODS The Arianna database from Caserta Local Health Unit was used. Diabetic patients with incident CKD [first diagnosis date: index date (ID)] were identified by searching for specific ICD9-CM codes among hospital discharge diagnoses/procedures and/or indication of use associated with drug prescriptions. To evaluate any change in the use of antidiabetic drugs after the CKD diagnosis, the prevalence of antidiabetic drug use among DKD patients was calculated within 1 year prior to/after ID and after dialysis entry. A Kaplan-Meier analysis was used to assess the time to discontinuation of antidiabetic drugs after CKD diagnosis. The frequency of antidiabetic drugs contraindicated in renal disease in DKD patients was measured. RESULTS Overall, 725 diabetic patients (mean age 72.8 ± 11.4 years) had incident CKD from 2006 to 2011. The use of combination antidiabetic drugs, biguanides and sulphonamides decreased by approximately 10, 7 and 5%, respectively, after the ID. The use of insulins increased by 10% after the ID and by 20% after entry into dialysis. The use of antidiabetic drugs not contraindicated in CKD decreased marginally after the diagnosis of CKD. CONCLUSION In a general practice of Southern Italy the management of diabetes mellitus changed only marginally in newly diagnosed CKD patients, suggesting a therapeutic inertia on the part of prescribers.
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Affiliation(s)
- Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Fabrizio Parrino
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Valeria Pizzimenti
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Francesco Giorgianni
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Janet Sultana
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Marco Muscianisi
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | | | | | - Vincenzo Arcoraci
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Domenico Santoro
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Giusi Russo
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Viviana Lacava
- Pharmacology Section, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Achille P Caputi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Department of Clinical and Experimental Medicine, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
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Orlando V, Guerriero F, Putignano D, Monetti VM, Tari DU, Farina G, Illario M, Iaccarino G, Menditto E. Prescription Patterns of Antidiabetic Treatment in the Elderly. Results from Southern Italy. Curr Diabetes Rev 2015; 12:100-6. [PMID: 26126718 PMCID: PMC5384339 DOI: 10.2174/1573399811666150701120408] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 12/05/2022]
Abstract
The treatment of diabetes in the elderly is a major challenge both in terms of clinical management and of public health. Evidence about prescribing patterns in the elderly diabetic population is limited. The aim was to describe trends in antidiabetic drug (AD) utilization patterns in the elderly in Southern Italy with a focus on drugs for cardiovascular prevention and pharmaceutical costs. The data used for this study were obtained from pharmacy records of Caserta Local Health Authority, a province in Southern Italy with 1 million of inhabitants, comprising urban and rural areas. Subjects above 65 years who received at least one dispensing of antidiabetic between January 2010 and December 2014 were selected. Prevalence and incidence rates (%) of AD use were calculated for each calendar year and stratified by class therapy and age group. Sub-analyses by cardiovascular co-medication therapy and pharmaceutical cost analysis were performed. The prevalence rate decreases from 22.0% in 2010 to 17.5% in 2014 (p<0.001). Proportion of subjects treated with monotherapy increases over the study period (33.9% in 2010; 38.6% in 2014; p<0.001). In particular, increases the proportion of users of metformin (18.2% in 2010; 23.7% in 2014; p<0.001), while the proportion of users of sulfonylureas dropped (11.0% in 2010; 7.2% in 2014; p< 0.001). About 90% of elderly diabetic patients are treated with drugs for cardiovascular prevention. The per/patient/yearly drug costs were 2,349 ∈: 28.5% for AD therapy and 71.5% for other treatments. Trend in drug utilization patterns showed a tendency towards treatment recommendations in older adults.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Via Domenico Montesano 49, 80131 Naples, Italy.
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Arcoraci V, Santoni L, Ferrara R, Furneri G, Cannata A, Sultana J, Moretti S, Di Luccio A, Tari DU, Pagliaro C, Corrao S, Tari M. Effect of an educational program in primary care: the case of lipid control in cardio-cerebrovascular prevention. Int J Immunopathol Pharmacol 2014; 27:351-63. [PMID: 25280026 DOI: 10.1177/039463201402700305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lowering blood cholesterol levels reduces the risk of coronary heart disease. However, the effect of interventions depends on the patients' adherence to treatment. Primary care plays an important role in the detection, treatment and monitoring of disease, therefore different educational programs (EP) have been implemented to improve disease management in general practice. The present study is aimed to assess whether a general practitioner auditing and feedback EP may improve dyslipidaemia management in a primary care setting and to evaluate patients' adherence to prescribed lipid-lowering treatment. The quality of cardiovascular and cerebrovascular disease prevention before and after the implementation of an EP offered to 25 general practitioners (GPs), was evaluated. Clinical and prescription data on patients receiving at least one lipid-lowering treatment was collected. To evaluate the quality of the healthcare service provided, clinical and biochemical outcomes, and drug-utilization, process indicators were set up. Adherence was evaluated before and after the EP as the "Medication Possession Ratio" (MPR). A correlation analysis was carried out to estimate the effect of the MPR in achieving pre-defined clinical end-points. Prescription data for lipid-lowering drugs was collected in a sample of 839 patients. While no differences in the achievement of blood lipid targets were observed, a slight but significant improvement of the MPR was registered after the EP (MPR >0.8=64.2% vs 60.6%, p=0.0426). Moreover, high levels of statin adherence were associated with the achievement of total blood cholesterol target (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.7-6.7) or LDL therapeutic goal (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.5-7.2). The EP partially improved the defined clinical targets; probably, a more patient-based approach could be more appropriate to achieve the defined target. Further studies are needed to identify how healthcare services can be improved.
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Affiliation(s)
- V Arcoraci
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - L Santoni
- Pfizer, Department of Outcome Research Roma, Italy
| | - R Ferrara
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - G Furneri
- Italian National Research Center on Aging (I.N.R.C.A.), Scientific Direction Ancona, Italy
| | - A Cannata
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - J Sultana
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - S Moretti
- "Caserta-1" Local Health Unit, Italy
| | | | - D U Tari
- "Caserta-1" Local Health Unit, Italy
| | | | - S Corrao
- Di.Bi.MIS, University of Palermo, Internal Medicine Division ARNAS Civico, Palermo, Italy
| | - M Tari
- "Caserta-1" Local Health Unit, Italy
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Trifirò G, Alacqua M, Corrao S, Moretti S, Tari DU, Galdo M, Caputi AP, Arcoraci V. Lipid-lowering drug use in Italian primary care: effects of reimbursement criteria revision. Eur J Clin Pharmacol 2008; 64:619-25. [PMID: 18213473 DOI: 10.1007/s00228-007-0459-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 12/27/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy. METHODS From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed. RESULTS Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8). The use of both statins and omega-3 fatty acids was reduced particularly for primary prevention. On the other hand, utilization of statins increased in diabetic patients and as secondary prevention from 2004 to 2005. Concerning individual molecules, 1-year prevalence of use of any statin declined from 2004 to 2005, except for rosuvastatin. CONCLUSIONS Revision of reimbursement criteria led to significant changes in the trend in LLD use in general practice in southern Italy: (1) statin utilization was slightly reduced in 2005, although it increased in certain categories, such as diabetic patients, and (2) omega-3 fatty acid use was strongly reduced even though a higher use in postinfarction cases was reported.
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Affiliation(s)
- G Trifirò
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Via Consolare Valeria-Gazzi, 98125 Messina, Italy.
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