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Giner-Soriano M, Prat-Vallverdú O, Ouchi D, Vilaplana-Carnerero C, Morros R. Sex and gender differences in the use of oral anticoagulants for non-valvular atrial fibrillation: A population-based cohort study in primary health care in catalonia. Front Pharmacol 2023; 14:1110036. [PMID: 36825151 PMCID: PMC9941166 DOI: 10.3389/fphar.2023.1110036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Objectives: To describe the sex and gender differences in the treatment initiation and in the socio-demographic and clinical characteristics of all patients initiating an oral anticoagulant (OAC), and the sex and gender differences in prescribed doses and adherence and persistence to the treatment of those receiving direct oral anticoagulants (DOAC). Material and methods: Cohort study including patients with non-valvular atrial fibrillation (NVAF) who initiated OAC in 2011-2020. Data proceed from SIDIAP, Information System for Research in Primary Care, in Catalonia, Spain. Results: 123,250 people initiated OAC, 46.9% women and 53.1% men. Women were older and the clinical characteristics differed between genders. Women had higher risk of stroke than men at baseline, were more frequently underdosed with DOAC and discontinued the DOAC less frequently than men. Conclusion: We described the dose adequacy of patients receiving DOAC, finding a high frequency of underdosing, and significantly higher in women in comparison with men. Adherence was generally high, only with higher levels in women for rivaroxaban. Persistence during the first year of treatment was also high in general, being significantly more persistent women than men in the case of dabigatran and edoxaban. Dose inadequacy, lack of adherence and of persistence can result in less effective and safe treatments. It is necessary to conduct studies analysing sex and gender differences in health and disease.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari Per a la Recerca a l’Atenció Primària De Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma De Barcelona (Cerdanyola del Vallès), Bellaterra, Spain,*Correspondence: Maria Giner-Soriano,
| | | | - Dan Ouchi
- Fundació Institut Universitari Per a la Recerca a l’Atenció Primària De Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma De Barcelona (Cerdanyola del Vallès), Bellaterra, Spain
| | - Carles Vilaplana-Carnerero
- Fundació Institut Universitari Per a la Recerca a l’Atenció Primària De Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma De Barcelona (Cerdanyola del Vallès), Bellaterra, Spain,Plataforma SCReN, UIC IDIAPJGol, Barcelona, Spain
| | - Rosa Morros
- Fundació Institut Universitari Per a la Recerca a l’Atenció Primària De Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Plataforma SCReN, UIC IDIAPJGol, Barcelona, Spain,Departament De Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma De Barcelona (Cerdanyola del Vallès), Bellaterra, Spain,Institut Català De la Salut, Barcelona, Spain
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Visser CD, Linthorst JM, Kuipers E, Sont JK, Lacroix JPW, Guchelaar HJ, Teichert M. Respiratory Adherence Care Enhancer Questionnaire: Identifying Self-Management Barriers of Inhalation Corticosteroids in Asthma. Front Pharmacol 2022; 12:767092. [PMID: 35002706 PMCID: PMC8729223 DOI: 10.3389/fphar.2021.767092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Suboptimal self-management of inhaled corticosteroids (ICS) in asthma patients is frequently observed in clinical practice and associated with poor asthma control. Driving factors for suboptimal self-management are complex and consist of a range of behavioral barriers (cognitive, affective and practical) with a considerable inter-individual variability. Identification of individual barriers facilitates the use of corresponding behavior change techniques and tailored care to improve asthma treatment outcomes. Objective: This study describes the development and validation of the 'Respiratory Adherence Care Enhancer' (RACE) questionnaire to identify individual barriers to self-management of ICS therapy in asthma patients. Methods: The development included: 1) an inventory of self-management barriers based on a literature review, 2) expert assessment on relevance and completeness of this set, linking these barriers to behavioral domains of the Theoretical Domains Framework (TDF) and 3) the formulation of corresponding questions assessing each of the barriers. A cross-sectional study was performed for validation. Primary care asthma patients were invited to fill out the RACE-questionnaire prior to a semi-structured telephonic interview as golden standard. Barriers detected from the questionnaire were compared to those mentioned in the interview. Results: The developed questionnaire is made up of 6 TDF-domains, covering 10 self-management barriers with 23 questions. For the validation 64 patients completed the questionnaire, of whom 61 patients were interviewed. Cronbach's alpha for the consistency of questions within the barriers ranged from 0.58 to 0.90. Optimal cut-off values for the presence of barriers were determined at a specificity between 67 and 92% with a sensitivity between 41 and 83%. Significant Areas Under the Receiver Operating Curves values were observed for 9 barriers with values between 0.69 and 0.86 (p-value <0.05), except for 'Knowledge of ICS medication' with an insignificant value of 0.53. Conclusion: The RACE-questionnaire yields adequate psychometric characteristics to identify individual barriers to self-management of ICS therapy in asthma patients, facilitating tailored care.
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Affiliation(s)
- Claire D Visser
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Jip M Linthorst
- Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | | | - Jacob K Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Joyca P W Lacroix
- Department of Digital Engagement, Behavior and Cognition, Philips Research, Eindhoven, Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands.,Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
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Rolland B, Dalon F, Gauthier N, Nourredine M, Bérard M, Carton L, Brousse G, Llorca PM, Jacoud F, Van Ganse E, Belhassen M. Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007-2017). Front Psychiatry 2022; 13:1021780. [PMID: 36387010 PMCID: PMC9659890 DOI: 10.3389/fpsyt.2022.1021780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Antipsychotics are used in a large variety of psychiatric and neurological disorders; investigating their use in real life is important to understand national prescribing practices, as well as to determine the levels of patient adherence. METHODS Using a 1/97e random sample (General Sample of Beneficiaries, EGB) of the French health insurance reimbursement database, we conducted a historical cohort study on the 2007-2017 period. The aim was to describe the sociodemographic characteristics of patients, the types of antipsychotics dispensed, the types of prescribers, the mean doses and average durations of treatment, the co-dispensed medications, and the levels of adherence to treatment. To exclude punctual uses of antipsychotics, we selected only patients with a continuous dispensing of the same antipsychotic over at least 3 months. RESULTS In total, 13,799 subjects (1.66% of the EGB sample) were included (56.0% females; mean age 55.8 ± 19.4 years). Risperidone (19.3%), cyamemazine (18.7%), olanzapine (11.9%), tiapride (8.8%), and haloperidol (7.5%) were the five most prescribed antipsychotics. 44.9% of prescriptions were written by general practitioners, 34.1% by hospital practitioners, and 18.4% by private-practice psychiatrists. On average, the mean dispensed doses were relatively low, but the variation range was large. Long-acting forms were used in 5.4% of the sample, and clozapine in 1.3%. 34.2% of patients received more than one antipsychotic, and almost 15% were prescribed at least three concomitant antipsychotics. Paliperidone and clozapine were associated with the highest levels of adherence, and risperidone and haloperidol with the lowest ones. CONCLUSION An important heterogeneity of antipsychotic prescribing practices was observed in France. The rate of use of long-acting antipsychotics was low, whereas multiple antipsychotic prescriptions were frequent.
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Affiliation(s)
- Benjamin Rolland
- Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Academic Department of Addiction Medicine (SUAL), Bron, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Noémie Gauthier
- Saint-Cyr au Mont d'Or Hospital, Hospital Pharmacy, Saint-Cyr-au Mont-d'Or Psychiatric Hospital, Saint-Cyr-au Mont-d'Or, France
| | - Mikaïl Nourredine
- Hospices Civils de Lyon, Pharmacotoxicology Laboratory, Department of Clinical Research and Epidemiology, Lyon, France.,Faculté de Médecine Lyon Sud, Lyon 1 University, Lyon, France
| | | | - Louise Carton
- CHU Lille, Department of Pharmacology, Inserm, Lille Neuroscience and Cognition, UMR-S1172, Université de Lille, Lille, France
| | - Georges Brousse
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, University Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, University Clermont Auvergne, Clermont-Ferrand, France
| | | | - Eric Van Ganse
- PELyon, Lyon, France.,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.,Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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