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Local Health Unit (local + health_unit)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2010
V. Maio PharmD MS MSPH
Summary Background and objective:, Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. Methods:, A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals ,65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. Results and discussion:, A total of 23 662 elderly in the cohort (25·8%) had at least one PIP. Of these, 14·1% received prescriptions for two medications of concern, and 2·0% for three or more. Using the expert panel's categories, 59·2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33·9% for rarely appropriate drugs, and 19·1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35·7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17·6%), doxazosin (15·5%), and amiodarone (13·6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. Conclusion:, Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy. [source]

Spatial Multistate Transitional Models for Longitudinal Event Data

BIOMETRICS, Issue 1 2008
F. S. Nathoo
Summary Follow-up medical studies often collect longitudinal data on patients. Multistate transitional models are useful for analysis in such studies where at any point in time, individuals may be said to occupy one of a discrete set of states and interest centers on the transition process between states. For example, states may refer to the number of recurrences of an event, or the stage of a disease. We develop a hierarchical modeling framework for the analysis of such longitudinal data when the processes corresponding to different subjects may be correlated spatially over a region. Continuous-time Markov chains incorporating spatially correlated random effects are introduced. Here, joint modeling of both spatial dependence as well as dependence between different transition rates is required and a multivariate spatial approach is employed. A proportional intensities frailty model is developed where baseline intensity functions are modeled using parametric Weibull forms, piecewise-exponential formulations, and flexible representations based on cubic B-splines. The methodology is developed within the context of a study examining invasive cardiac procedures in Quebec. We consider patients admitted for acute coronary syndrome throughout the 139 local health units of the province and examine readmission and mortality rates over a 4-year period. [source]

Drug prescribing by Italian family paediatricians: an exception?

ACTA PAEDIATRICA, Issue 5 2010
A Clavenna
Abstract Aims:, To identify which drugs are considered ,essential' by Italian family paediatricians based on their prescriptions. Methods:, Prescriptions reimbursed by the National Health System, involving 923 177 children < 14 years old, and dispensed during 2005 by the retail pharmacies of 15 local health units (LHUs) in the Lombardy Region, were analysed. The percentage of family paediatricians prescribing each single drug was calculated. A percentage ,75% was considered as a high degree of agreement. Results:, In all, 746 different drugs were prescribed to 486 405 children (52.7%). The median number of drugs prescribed by each paediatrician was 60 (interquartile range 51,71). A total of 22 drugs were prescribed by at least 75% of paediatricians and six were prescribed by all the paediatricians. In all, 95% of the paediatricians prescribed four or more cephalosporins and 92% prescribed four inhaled steroids. Only eight of the 22 most frequent drugs are included in the World Health Organization Essential Medicines for children list. Conclusion:, Despite the huge number of drugs prescribed, only for 22 there was a concordance between family paediatricians. Initiatives to evaluate and promote a more rational use of drugs in Italian children are necessary. [source]