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de Burgos-Lunar C, del Cura-González I, Cárdenas-Valladolid J, Gómez-Campelo P, Abánades-Herranz JC, López-de Andrés A, Sotos-Prieto M, Iriarte-Campo V, Salinero-Fort MA. Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'. BMC PRIMARY CARE 2023; 24:4. [PMID: 36600196 PMCID: PMC9811753 DOI: 10.1186/s12875-022-01961-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.
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Affiliation(s)
- C. de Burgos-Lunar
- grid.411068.a0000 0001 0671 5785Department of Preventive Medicine, Hospital Universitario Clínico de San Carlos, Madrid, Spain ,Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain
| | - I. del Cura-González
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Research Unit, Primary Health Care Management, Madrid, Spain ,grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
| | - J. Cárdenas-Valladolid
- Information Systems Department, Primary Health Care Management, Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain
| | - P. Gómez-Campelo
- grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - A. López-de Andrés
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M. Sotos-Prieto
- grid.5515.40000000119578126Department of Preventive Medicine and Public health, Universidad Autónoma de Madrid, Madrid, Spain ,grid.466571.70000 0004 1756 6246CIBERESP (CIBER of Epidemiology and PublicHealth), Madrid, Spain ,grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA USA
| | - V. Iriarte-Campo
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
| | - M. A. Salinero-Fort
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain ,General Subdirectorate of Research and Documentation, Department of Health, Madrid, Spain
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Bezerra CB, Pinho CDBRP, Saintrain MVDL, Sodré AKDMB, Silva CABD, Doucet J. Characteristics of the clinical treatment of Brazilian and French older adults with diabetes. Diabetes Res Clin Pract 2021; 181:109088. [PMID: 34648889 DOI: 10.1016/j.diabres.2021.109088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/17/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. METHOD This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. RESULTS The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. CONCLUSION The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient's clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.
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Affiliation(s)
| | | | | | | | | | - Jean Doucet
- Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, France.
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Franch-Nadal J, García-Gollarte F, Pérez Del Molino A, Orera-Peña ML, de Miguel MR, Melogno-Klinkas M, de Paz HD, Aceituno S, Rodríguez-Fortúnez P. Physicians' and Pharmacists' Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study. Clin Drug Investig 2019; 39:73-84. [PMID: 30315498 DOI: 10.1007/s40261-018-0713-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Management of elderly patients with type 2 diabetes mellitus (T2DM) is complex due to their age-related conditions. Several clinical guidelines provide specific recommendations for management of these patients but little is known about their implementation in clinical practice. OBJECTIVE To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients. METHODS Cross-sectional study. RESULTS A total of 993 physicians and 999 community pharmacists completed the questionnaire. More physicians than pharmacists agreed on the need to establish more flexible HbA1c targets for elderly (79.4% vs. 30.6%; p < 0.001) and frail (92.6% vs. 31.4%; p < 0.001) patients than for the general diabetic population. HbA1c targets < 7.5% for elderly patients and < 8.5% for frail patients (as recommended by the principle guidelines) were set by 38.9% and 28.7% of physicians, respectively. Furthermore, 62.8% of physicians stated they follow guideline recommendations but, based on their prescription decisions for hypothetical patients, less than 50% were aligned with them. In addition, 73.1% of physicians monitor treatment adherence, mainly by using dispensing control (59.1%). Specific nutritional approaches for elderly patients are provided by 62.9% of physicians and 56.0% of pharmacists, whilst 57.4% and 21.7%, respectively, deliver specific physical exercise programs. CONCLUSIONS Low adherence to guideline recommendations (i.e. setting more stringent HbA1c targets or delaying treatment intensification) may lead to suboptimal glycaemic control in elderly patients. The standardization of processes, extensive monitoring of patient treatment adherence and providing advice regarding specific personal lifestyle habits may improve the management of elderly T2DM patients.
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Affiliation(s)
- Josep Franch-Nadal
- CAP Drassanes Raval-Sud, Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Madrid, Spain
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The Effect of Special Medical Examination for Night Shift Workers and Follow-Up Management Against Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050719. [PMID: 30823384 PMCID: PMC6427592 DOI: 10.3390/ijerph16050719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
Background: Special health examination is a screening program introduced in 1973 in Korea to examine health problems of workers who are regularly exposed to 177 hazardous substances and physical environments specified by the Occupational Safety and Health Act. Shiftwork was added as a risk factor in 2013. The purpose of this study was to analyze changes of hypertension status after a special medical examination and subsequent follow-up management. Methods: We used the data based on the special medical examination outcomes for night shift workers, performed at seven different health examination centers under the Korea Medical Institute (KMI) between 2014 and 2016. Workers who received special medical examinations for two consecutive years (2014–2015 and 2015–2016) were selected. A final study population of 2070 was evaluated. Results: Compared with the first-year examination, 1503 subjects (72.6%) received hypertension medication or showed improvement in blood pressure in their second-year examination. Older age (≥40s), women, larger workplaces (≥300 full-time workers), long-term workers (≥12 years), improvement in smoking habits, improvements for diabetes or dyslipidemia, normal or reduced BMI, and normal waist circumference were associated with proper management of hypertension. Conclusions: An appropriate follow-up management program should be developed to provide health management for night shift workers that need to focus on the factors identified in this study.
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