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Flor-Escriche X, Sanz Bas A, Álvarez Álvarez S, Zamora Putin V, Monteagudo Zaragoza M. Riesgos, fenotipos y comparación de tratamiento de EPOC en atención primaria según guías GOLD y GesEPOC. Semergen 2022; 48:101839. [DOI: 10.1016/j.semerg.2022.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022]
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Carmona-Pírez J, Poblador-Plou B, Ioakeim-Skoufa I, González-Rubio F, Gimeno-Feliú LA, Díez-Manglano J, Laguna-Berna C, Marin JM, Gimeno-Miguel A, Prados-Torres A. Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort. Sci Rep 2021; 11:4784. [PMID: 33637795 PMCID: PMC7910602 DOI: 10.1038/s41598-021-83964-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15-44, 45-64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.
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Affiliation(s)
- Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain.
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), 50009, Zaragoza, Spain.
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), 50009, Zaragoza, Spain
| | - Luis Andrés Gimeno-Feliú
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain
- San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), University of Zaragoza, 50003, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Jesús Díez-Manglano
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Clara Laguna-Berna
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
| | - Jose M Marin
- Respiratory Service, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28222, Madrid, Spain
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Pinto CR, Lemos ACM, Assunção-Costa L, Alcântara ATD, Yamamura LLL, Souza GS, Martins Netto E. Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns. ACTA ACUST UNITED AC 2019; 45:e20170194. [PMID: 30758425 PMCID: PMC6534407 DOI: 10.1590/1806-3713/e20170194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/08/2018] [Indexed: 12/31/2022]
Abstract
Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient’s pharmacological treatment was evaluated by comparing the patient’s current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.
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Affiliation(s)
- Charleston Ribeiro Pinto
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina, Universidade Federal da Bahia, Salvador (BA) Brasil.,. Curso de Farmácia, Departamento de Ciências e Tecnologias, Universidade Estadual do Sudoeste da Bahia, Jequié (BA) Brasil.,. Ambulatório de Pneumologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil
| | - Antônio Carlos Moreira Lemos
- . Ambulatório de Pneumologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil
| | | | | | | | | | - Eduardo Martins Netto
- . Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina, Universidade Federal da Bahia, Salvador (BA) Brasil.,. Laboratório de Pesquisa em Doenças Infecciosas, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador (BA) Brasil
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