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Martínez-Ibáñez P, Marco-Moreno I, García-Sempere A, Peiró S, Martínez-Ibáñez L, Barreira-Franch I, Bellot-Pujalte L, Avelino-Hidalgo E, Escrig-Veses M, Bóveda-García M, Calleja-del-Ser M, Robles-Cabaniñas C, Hurtado I, Rodríguez-Bernal CL, Giménez-Loreiro M, Sanfélix-Gimeno G, Sanfélix-Genovés J. Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension: A Secondary Analysis of the ADAMPA Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2410063. [PMID: 38728033 PMCID: PMC11087839 DOI: 10.1001/jamanetworkopen.2024.10063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Patient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce. Objective To evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement. Design, Setting, and Participants The ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024. Interventions Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. Main Outcomes and Measures The main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP <140 mm Hg and DBP <90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Results Among 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was -3.4 mm Hg (95% CI, -4.7 to -2.1 mm Hg; P < .001), and the AMD in DBP was -2.5 mm Hg (95% CI, -3.5 to -1.6 mm Hg; P < .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice. Trial Registration ClinicalTrials.gov Identifier: NCT03242785.
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Affiliation(s)
- Patricia Martínez-Ibáñez
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Irene Marco-Moreno
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Aníbal García-Sempere
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Salvador Peiró
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | | | | | | | | | | | | | - Celia Robles-Cabaniñas
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Isabel Hurtado
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Clara L. Rodríguez-Bernal
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | - Gabriel Sanfélix-Gimeno
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - José Sanfélix-Genovés
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
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García-Sempere A, Hurtado I, Peiró S, Sánchez-Sáez F, Santaana Y, Rodríguez-Bernal C, Sanfélix-Gimeno G, Sanfélix-Genovés J. Predictive Performance of the FRAX Tool Calibrated for Spain vs. an Age and Sex Model: Prospective Cohort Study with 9082 Women and Men Followed for up to 8 Years. J Clin Med 2022; 11:jcm11092409. [PMID: 35566539 PMCID: PMC9101808 DOI: 10.3390/jcm11092409] [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: 04/04/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
In Spain, the Fracture Risk Assessment Tool (FRAX) was adapted using studies with a small number of patients, and there are only a few external validation studies that present limitations. In this prospective cohort study, we compared the performance of FRAX and a simple age and sex model. We used data from the ESOSVAL cohort, a cohort composed of a Mediterranean population of 11,035 women and men aged 50 years and over, followed for up to 8 years, to compare the discrimination, calibration, and reclassification of FRAX calibrated for Spain and a logistic model including only age and sex as variables. We found virtually identical AUC, 83.55% for FRAX (CI 95%: 80.46, 86.63) and 84.10% for the age and sex model (CI 95%: 80.91, 87.29), and there were similar observed-to-predicted ratios. In the reclassification analyses, patients with a hip fracture that were reclassified correctly as high risk by FRAX, compared to the age and sex model, were −2.86%, using either the 3% threshold or the observed incidence, 1.54% (95%CI: −8.44, 2.72 for the 3% threshold; 95%CI: −7.68, 1.97 for the incidence threshold). Remarkably simple and inexpensive tools that are easily transferable into electronic medical record environments may offer a comparable predictive ability to that of FRAX.
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Affiliation(s)
- Aníbal García-Sempere
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
- Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain
| | - Isabel Hurtado
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
- Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain
| | - Salvador Peiró
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
- Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain
| | - Francisco Sánchez-Sáez
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
| | - Yared Santaana
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
| | - Clara Rodríguez-Bernal
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
- Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
- Spanish Network for Research in Primary Care and Chronicity (RICAPPS), 46020 Valencia, Spain
- Correspondence:
| | - José Sanfélix-Genovés
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (A.G.-S.); (I.H.); (S.P.); (F.S.-S.); (Y.S.); (C.R.-B.); (J.S.-G.)
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Hurtado I, García-Sempere A, Peiró S, Rodríguez-Bernal C, Sanfélix-Genovés J, Sanfélix-Gimeno G. Trends and Geographical Variability in Osteoporosis Treatment After Hip Fracture: A Multilevel Analysis of 30,965 Patients in the Region of Valencia, Spain. J Bone Miner Res 2020; 35:1660-1667. [PMID: 32297654 PMCID: PMC9328445 DOI: 10.1002/jbmr.4028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 12/02/2022]
Abstract
Despite improvements in the therapeutic arsenal and the recommendations of guidelines, low rates of prescribing osteoporosis medications are being reported worldwide for patients surviving a hip fracture, and important geographical variation remain. We aimed to describe trends in the proportion of patients that receive osteoporosis medication after hip fracture and to analyze the geographical variation in the prescription of drug therapy and its associated factors in the region of Valencia, Spain. We studied a population-based retrospective cohort of 30,965 patients aged 65 years and older, discharged from hospital after a hip fracture from January 2008 to December 2015, who were followed up for 3 months after discharge to identify the presence of any prescription of osteoporosis medication. We conducted a multilevel multiple logistic regression analysis with two levels (individuals and health departments [HD]) to determine which individual covariates were associated with receiving a prescription of osteoporosis medication in the 3 months after discharge, as well as the importance of the HD of hospitalization. The percentage of patients treated in the region decreased from a maximum of 28.9% in 2009 to 16.4% in 2015. By sex, the proportion of women treated reached a maximum of 33.4% in 2009 and declined to 19% in 2015, while the proportion of men reached a maximum of 14% in 2011 and reduced to 8.1% in 2015. By health department, there was a noticeable variability in the rate of patients treated, ranging from 40.9% to 11.1% in the whole period (intraclass correlation coefficient [ICC] = 7.54%; median odds ratio [MOR] = 1.64). Proportion of treated patients decreased in 20 of the 24 HDs. Variability could be also observed with regard to choice of medication by HD. This situation pressingly demands action (both at the organizational and professional levels) focused on populations at a higher risk (such as hip fracture patients) that particularly address underutilization and unwarranted variation.
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Affiliation(s)
- Isabel Hurtado
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Aníbal García-Sempere
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Clara Rodríguez-Bernal
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - José Sanfélix-Genovés
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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García-Sempere A, Hurtado I, Sanfélix-Genovés J, Rodríguez-Bernal C, Peiró S, Sanfélix-Gimeno G. Improving the accuracy of medication adherence measures using linked prescription and dispensation data: findings from the ESOSVAL cohort of patients treated with osteoporosis drugs. Curr Med Res Opin 2019; 35:1535-1544. [PMID: 30924690 DOI: 10.1080/03007995.2019.1601944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: We compare estimates of proportion of days covered (PDC) based on dispensation-only data versus linked prescription and dispensation information, and we analyse their differences in a real-world cohort of patients with osteoporosis.Methods: Prospective cohort study. We compared four alternative measures of PDC, using dispensation-only data: a) with a fixed assessment interval; b) censoring the assessment interval at the moment of the last refill; and using linked prescription and dispensation data: c) considering a minimum prescription gap of three months to interpret interruption by the physician; and d) considering any prescription gap.Results: The mean PDC at 12 months for new users was 63.1% using dispensation-only data and a fixed interval, 86.0% using dispensation-only data and a last-refill interval, 81% using linked dispensation and prescription data and censoring any period without prescription, and 78.3% when using linked prescription and dispensation data and censoring periods of at least 3 months. For experienced users, the figures were 80.0%, 88.9%, 83% and 81%, respectively. Overall, dispensation-based measures presented issues of patient misclassification.Conclusions: Linked prescription and dispensation data allows for more precise PDC estimates than dispensation-only data, as both primary non-adherence and early non-adherence periods, and fully non-adherent patients, are all identified and accounted for.
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Affiliation(s)
- Aníbal García-Sempere
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Spanish Network for Health Services Research in Chronic Care - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Isabel Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Spanish Network for Health Services Research in Chronic Care - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | | | - Clara Rodríguez-Bernal
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Spanish Network for Health Services Research in Chronic Care - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Salvador Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Spanish Network for Health Services Research in Chronic Care - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Spanish Network for Health Services Research in Chronic Care - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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Hurtado-Navarro I, García-Sempere A, Rodríguez-Bernal C, Sanfélix-Genovés J, Peiró S, Sanfélix-Gimeno G. Impact of Drug Safety Warnings and Cost-Sharing Policies on Osteoporosis Drug Utilization in Spain: A Major Reduction But With the Persistence of Over and Underuse. Data From the ESOSVAL Cohort From 2009 to 2015. Front Pharmacol 2019; 10:768. [PMID: 31354484 PMCID: PMC6635591 DOI: 10.3389/fphar.2019.00768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/03/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Recent studies in several countries show a significant decrease in the consumption of osteoporosis drugs from a peak around 2009, mainly attributed to bisphosphonate safety warnings issued by regulatory agencies on jaw osteonecrosis, atypical fractures, and esophageal cancer, but no studies have assessed the impact of these warnings by risk of fracture strata. Aim: The aim of this work is to assess changes in the utilization of osteoporosis drugs in the region of Valencia (Spain) after safety warnings from regulatory agencies and cost-sharing changes, according to patient socio-demographic and risk of fracture characteristics. Patients and Methods: We constructed a monthly series of osteoporosis drug consumption for 2009–2015 from the ESOSVAL cohort (n = 11,035; women: 48%; mean age: 65 years old) and used interrupted time series and segmented linear regression models to assess changes in osteoporosis drug utilization while controlling for previous levels and trends after three natural intervention dates: the issue of the Spanish Agency for Drugs and Medical Products (AEMPS) Osteonecrosis Jaw Warning (Sept 2009), the AEMPS Atypical femur Fracture Warning (Apr 2011), and the modification of the cost-sharing scheme (Jul 2012). Results: The AEMPS Osteonecrosis Jaw Warning was not associated with a decline in the consumption of osteoporosis drugs, while the warning on atypical fracture (a downward trend of 0.11% fewer people treated each month) and the increase in the cost-sharing scheme (immediate change level of -1.07% in the proportion of people treated) were associated with a strong decline in the proportion of patients treated, so that by the end of 2015 osteoporosis drug consumption was around half that of 2009. The relative decline was similar in people with both a high and low risk of fracture. Conclusion: The AEMPS Atypical femur Fracture Warning of Apr 2010 was associated with a significant decrease in the number of people treated, reinforced by the increase in the pharmaceutical cost-sharing in 2012. Decreases in treatment affected patients both at a low and higher risk of fracture.
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Affiliation(s)
- Isabel Hurtado-Navarro
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Aníbal García-Sempere
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Clara Rodríguez-Bernal
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - José Sanfélix-Genovés
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Sanfélix-Genovés J, Rodríguez-Bernal CL, Marco-Moreno I, Martinez-Ibañez P, Martinez-Ibañez L, Bóveda-García M, Barreira-Franch I, Calleja-Del Ser M, Borrás-Moreno G, Avelino-Hidalgo E, Escrig-Veses M, Lauriano M, Giménez-Loreiro M, Bellot-Pujalte L, García-Sempere A, Peiró S, Sanfélix-Gimeno G. Rationale and design of a pragmatic clinical trial to assess the impact of self-monitoring blood pressure at home and self-titration of antihypertensive medication in poorly controlled hypertension: the ADAMPA study protocol. BMC Fam Pract 2018; 19:160. [PMID: 30249203 PMCID: PMC6154875 DOI: 10.1186/s12875-018-0846-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/03/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lack of control of hypertension is one of the most prevalent problems encountered by general practitioners (GPs). Self-measured blood pressure monitoring at home (SMBP) and self-titration of medication could be a good strategy to improve hypertension management, however, evidence is limited and not conclusive. We aimed to assess the effectiveness, in the primary care setting, of an intervention that includes educational components, SMBP and self-titration of antihypertensive medication to decrease systolic blood pressure compared to usual care, in a population with poorly controlled hypertension, during a 12-month period. METHODS Pragmatic, controlled, randomized, unblinded clinical trial with two parallel groups assigned in a ratio of 1:1 to self-management (which includes educational components, SBMP and self-titration of antihypertensive medication based on a patient's GP's pre-established adjustment plan) or to usual care (with educational components too). DISCUSSION If the data from this trial show positive results, the study may contribute to a change of strategy in the treatment of hypertension, focusing on the patient as the main actor to achieve blood pressure control. Furthermore, this approach might contribute to the financial sustainability of the National Health Service. TRIAL REGISTRATION This trial has been registered in the database with reference number EudraCT: 2016-003986-25. Registered 05 May 2017, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2016-003986-25.
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Affiliation(s)
- José Sanfélix-Genovés
- Centro de Salud de Nazaret, Departamento de Salud de Valencia Clínic-La Malvarrosa, Valencia, Spain
- Health Services Research Unit, FISABIO, Valencia, Spain
- Spanish Network of Chronic Care and Health Services Research (REDISSEC), Valencia, Spain
- Health Research Institute (INCLIVA), Valencia, Spain
| | - Clara L. Rodríguez-Bernal
- Health Services Research Unit, FISABIO, Valencia, Spain
- Spanish Network of Chronic Care and Health Services Research (REDISSEC), Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Aníbal García-Sempere
- Health Services Research Unit, FISABIO, Valencia, Spain
- Spanish Network of Chronic Care and Health Services Research (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, FISABIO, Valencia, Spain
- Spanish Network of Chronic Care and Health Services Research (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, FISABIO, Valencia, Spain
- Spanish Network of Chronic Care and Health Services Research (REDISSEC), Valencia, Spain
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García-Sempere A, Hurtado I, Sanfélix-Genovés J, Rodríguez-Bernal CL, Gil Orozco R, Peiró S, Sanfélix-Gimeno G. Primary and secondary non-adherence to osteoporotic medications after hip fracture in Spain. The PREV2FO population-based retrospective cohort study. Sci Rep 2017; 7:11784. [PMID: 28924156 PMCID: PMC5603562 DOI: 10.1038/s41598-017-10899-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/16/2017] [Indexed: 01/27/2023] Open
Abstract
Osteoporotic medication after hip fracture is widely recommended by clinical practice guidelines, and medication adherence is essential to meet clinical trial risk reduction figures in the real world. We assessed primary and secondary non-adherence to osteoporosis medications in patients discharged following a hip fracture and identified factors associated with secondary non-adherence. From a population-based retrospective cohort of 19,405 patients aged 65 years and over discharged from a hip fracture in the region of Valencia (Spain) from January 1, 2008 and June 30, 2012, we followed, over a minimum of 365 days, 4,856 patients with at least one osteoporotic medication prescribed within the first six months after discharge. Less than one third of the patients discharged alive after a hip fracture received osteoporotic treatment. Primary non-adherence among naïve patients was low. However, long-term secondary adherence measured by Proportion of Days Covered with medication (PDC) and persistence was largely suboptimal, with naïve users having worse results than experienced patients. Secondary non-adherence was associated with primary non-adherence and age, dementia or sedative treatments for naïve users and with being male, being older than 85 and having dementia for experienced users. Three quarters of naïve users and two thirds of experienced users had interrupted treatment at 48 months.
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Affiliation(s)
- Aníbal García-Sempere
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Isabel Hurtado
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
| | - José Sanfélix-Genovés
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Centro de Salud de Nazaret, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Clara L Rodríguez-Bernal
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Rafael Gil Orozco
- Servicio de Medicina Preventiva, Hospital de Vinaroz, Castellon, Spain
| | - Salvador Peiró
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Sanfélix-Genovés J, Catalá-López F, Sanfélix-Gimeno G, Hurtado I, Baixauli C, Peiró S. Variabilidad en las recomendaciones para el abordaje clínico de la osteoporosis. Med Clin (Barc) 2014; 142:15-22. [DOI: 10.1016/j.medcli.2012.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/04/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Hurtado I, Sanfélix-Gimeno G, Baixauli-Pérez C, Peiró S, Sanfélix-Genovés J. Impact on the population of different bone mineral density testing criteria and appropriateness of densitometries in the ESOSVAL cohort, Spain. J Clin Endocrinol Metab 2014; 99:142-50. [PMID: 24384018 DOI: 10.1210/jc.2013-3448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT There is little consensus regarding which individuals should be recommended for bone mineral density (BMD) testing, a situation that could eventually affect the appropriateness of routine clinical practice. OBJECTIVES The aim of this study was to estimate the impact on the population of the application of the BMD testing criteria provided by the National Osteoporosis Guideline Group (NOGG), National Osteoporosis Foundation (NOF), and Osteoporosis Canada and to assess the appropriateness of the BMD tests currently performed. DESIGN A cross-sectional study was conducted using the baseline data of the ESOSVAL cohort. PARTICIPANTS Participants included 11 035 men and women aged 50 years old and over attending primary health care centers in the Valencia region, Spain (2009-2010). MAIN OUTCOME AND MEASURES BMD testing by dual-energy X-ray absorptiometry was recorded. RESULTS Of the 10 710 people included in the study, 1617 (15.1%; 95% confidence interval [CI]: 14.4-15.8) received a BMD test. When applying the NOGG criteria, BMD testing would be recommended in 17.4% (95% CI: 16.7-18.1) of individuals, whereas this percentage would rise to 74.6% (95% CI: 73.7-75.4) and 80.1% (95% CI: 79.4-80.9) when using the Osteoporosis Canada and the NOF criteria, respectively. Regarding the appropriateness of the BMD tests performed in the ESOSVAL cohort, 40.7% (95% CI: 38.3-43.1), 86.0% (95% CI: 84.3-87.7), and 82.2% (95% CI: 80.3-84.1) of individuals having a BMD test met the NOGG, NOF, and the Canadian guidelines criteria, respectively. Of the tests performed, 40.7% would be deemed as appropriate, whereas 10.7% would be considered inappropriate. CONCLUSIONS The impact on the population of the different recommendations is enormous, varying from 17% to 80% of the population over 50 who would be tested. Although in men it seems that a clinical rationale exists between the presence of risk factors and the rates of BMD testing, this pattern does not seem to exist in women. One in 10 of the densitometric tests performed were inappropriate according to all the guidelines.
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Affiliation(s)
- Isabel Hurtado
- Health Services Research Unit (I.H., G.S.G., C.B.P., S.P., J.S.G.), Center for Public Health Researh (CSISP-FISABIO), Valencia 46020, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (I.H., G.S.G., C.B.P., S.P., J.S.G.), Valencia 46020, Spain; and Fundación de Investigación del Hospital Clínico Universitario-Instituto de Investigación Sanitaria (J.S.G.), Valencia 46020, Spain
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Sanfélix-Gimeno G, Sanfélix-Genovés J, Rodriguez-Bernal CL, Peiró S, Hurtado I. Prevalence, determinants, and inappropriateness of calcium supplementation among men and women in a Spanish Mediterranean area: cross-sectional data from the ESOSVAL cohort. J Bone Miner Res 2013; 28:2286-94. [PMID: 23661631 DOI: 10.1002/jbmr.1977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/16/2013] [Accepted: 04/26/2013] [Indexed: 11/07/2022]
Abstract
Recently, safety concerns about calcium supplementation have arisen. In this situation, ensuring appropriateness of use is highly important. We aimed to describe the use of calcium and vitamin D supplements, the factors related to it, and to assess the appropriateness of calcium prescription among men and women aged 50 years or older. We performed a cross-sectional study in 2009-2010 including 11,035 adults who belong to the ESOSVAL cohort and attend 272 primary healthcare centers in the Valencia region of Spain. Criteria for the inappropriateness of calcium prescription, based on guidelines and recent evidence, were: excessive or insufficient daily total intake (diet plus supplements), excessive single doses of supplements, excessive or insufficient association with vitamin D, and overall inappropriateness. Calcium and/or vitamin D were prescribed to about 17% of the population. Older age, antiosteoporotic treatment, use of glucocorticoids, and a diagnosis of osteoporosis were related to prescription. The presence of other secondary causes of osteoporosis determined supplementation only in men. Calcium dietary intake was not related to the prescription of supplements. Among calcium users, 85.8% met at least one criterion of inappropriate prescription; 29% had an inappropriate daily total intake mainly resulting from excessive consumption (>2000 mg/day); 53.8% of patients were given calcium supplements in quantities higher than 500 mg per dose; and 38.9% of individuals receiving calcium supplements had inappropriate (absent or below 800 UI/day) vitamin D supplementation (all of them at high risk). In conclusion, we found high inappropriateness of calcium supplementation, mainly because of calcium overdosing, and also to undertreatment and underdosing of vitamin D in high-risk patients. Physicians should be encouraged to assess calcium dietary intakes before supplementation, recommending intake from food whenever possible, and to prescribe low calcium doses and high vitamin D doses when given in fixed-dose combinations, or vitamin D alone when calcium is not necessary.
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Affiliation(s)
- Gabriel Sanfélix-Gimeno
- Center for Public Health Research (CSISP), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Catalá-López F, Sanfélix-Gimeno G, Tobías A, Hurtado I, Sanfélix-Genovés J, Peiró S. Efficacy of osteoporosis therapies in a network meta-analysis with indirect comparisons: many concerns for new tools of evidence synthesis? Osteoporos Int 2013; 24:1927-8. [PMID: 23408017 DOI: 10.1007/s00198-013-2294-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Sanfélix-Genovés J, Hurtado I, Sanfélix-Gimeno G, Peiró S. Prevalence of osteoporosis in the ESOSVAL cohort: reply to the comment by Pedrera-Zamorano et al. Osteoporos Int 2013; 24:1925-6. [PMID: 23052932 DOI: 10.1007/s00198-012-2146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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Sanfélix-Genovés J, Sanfélix-Gimeno G, Peiró S, Hurtado I, Fluixà C, Fuertes A, Campos JC, Giner V, Baixauli C. Prevalence of osteoporotic fracture risk factors and antiosteoporotic treatments in the Valencia region, Spain. The baseline characteristics of the ESOSVAL cohort. Osteoporos Int 2013; 24:1045-55. [PMID: 22618269 DOI: 10.1007/s00198-012-2018-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED This study provides information on the prevalence of the most important risk factors for osteoporosis and osteoporotic fracture in a large sample of women and men from the Valencia region and also provides the FRAX 10-year major and hip fracture risks for this population, as well as data about the use of diagnostic tests and antiosteoporotic treatments. INTRODUCTION The purpose of this study was to describe demographic characteristics, osteoporosis risk factors, the 10-year risk of osteoporotic fracture, and the use of densitometry and antiosteoporotic treatments in the Valencia region, Spain. METHODS A cross-sectional study using the ESOSVAL cohort baseline data was conducted. We analyze the data from 5,310 women and 5,725 men aged 50 and over who attended to 272 collaborating primary care centers in 2009-2010. We collected the demographic, anthropometric, clinical, and pharmacy data from the electronic medical record. RESULTS The mean age of participants was 64.3 years old for women and 65.6 years old for men. The most frequent fracture risk factors were sedentary life (22.2 %) and previous fracture (15.8 %) in women and low calcium intake (21.4 %) and current smoker (20.9 %) in men. According to FRAX(®), the 10-year risk of presenting a major fracture was 5.5 % for the women and 2.8 % for the men. The 10-year risk for hip fracture was 1.9 and 1.1 % for the women and the men, respectively; 23.8 % of the women and 5.2 % of the men had a densitometry test, 27.7 % of the women and 3.5 % of the men were taking calcium and/or vitamin D supplements, and 28.2 % of the women (22.0 % in the 50-64 age group) and 2.3 % of the men were taking antiosteoporotic drugs. CONCLUSIONS The prevalence of certain fracture risk factors not included in the FRAX tool (sedentary life, falls, low calcium intake) is high. In young women, their low risks estimated by FRAX contrast with the high figures for densitometry testing and treatment.
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Affiliation(s)
- J Sanfélix-Genovés
- Health Services Research Unit, Centro Superior de Investigación en Salud Pública, Avda de Cataluña 21, 46020 Valencia, Spain.
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Sanfélix-Genovés J, Arana E, Sanfélix-Gimeno G, Peiró S, Graells-Ferrer M, Vega-Martínez M. Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures. Osteoporos Int 2012; 23:2129-34. [PMID: 22170523 DOI: 10.1007/s00198-011-1819-3] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/05/2011] [Indexed: 01/12/2023]
Abstract
UNLABELLED Semi-automatic morphometry is highly reproducible and not time intensive; however, no study has evaluated agreement between semi-automated morphometric methods and the Genant semi-quantitative method performed as a rule by radiologists. Our study shows substantial agreement between both methods; however, semi-automatic morphometry upgrades mild deformities and overestimates the prevalence of fractures. INTRODUCTION The aim of this study was to evaluate the agreement between radiologists using the Genant semi-quantitative (SQ) method and semi-automated morphometry in the diagnosis of vertebral fractures in post-menopausal women. METHODS Cross-sectional study was conducted in 2006-2007 in an age-stratified population-based sample of 824 post-menopausal women over the age of 50. From this population two sets of 95 and 50 X-ray were randomly extracted to test inter-rater agreement and agreement between SQ and semi-automated morphometry, and vertebral fractures were classified according to both methods. The Genant method was used to homogenise the diagnosis of fractures. Agreement was evaluated with weighted kappa. We evaluated each vertebral body independently and also the whole vertebral column (T4-L4) classifying women into the worst grade of fracture. For the qualitative interpretation of the agreement, we used the criteria described by Landis and Koch (Biometrics 33:159-174, 1977). RESULTS The radiologists' agreement was 98.4% (Kappa, 0.75; 95% CI, 0.42-0.89). Agreement between semi-automated morphometry and SQ reached 97.6% and Kappa was 0.86 (95% CI, 0.66-0.94). In the whole evaluation of the spine semi-automated morphometry overestimates, the prevalence of fractures compared with the radiologists were 15.8% of women with fractures and 7.4% of women with moderate-severe fractures by semi-automated morphometry vs. 8.4% and 3.2% by the SQ method. The negative predictive value for MorphoXpress was 99% while the positive was 40%. CONCLUSIONS Semi-automated morphometry shows high reliability and a substantial agreement with the SQ approach but overestimates the prevalence of fractures. Its role in routine clinical practice is limited because positive results should be reassessed by qualitative or semi-quantitative methods.
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Affiliation(s)
- J Sanfélix-Genovés
- Health Services Research Unit, Centro Superior de Investigación en Salud Pública, Avda. Cataluña 21, Valencia, Spain.
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Sanfélix-Gimeno G, Sanfélix-Genovés J, Peiró S, Hurtado I, Trillo JL, Usó R, Ruiz VG, de la Torre MP, Ferreros I. Adherence to and appropriateness of anti-osteoporotic treatments in patients aged 50 and over in the Valencia Region (Spain). The ESOSVAL-AD study. BMC Musculoskelet Disord 2011; 12:178. [PMID: 21813007 PMCID: PMC3224353 DOI: 10.1186/1471-2474-12-178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/03/2011] [Indexed: 12/15/2022] Open
Abstract
Summary
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Affiliation(s)
- Gabriel Sanfélix-Gimeno
- Centro Superior de Investigación en Salud Pública (Center for Public Health Research),Valencia, Spain.
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Sanfélix-Genovés J, Hurtado I, Sanfélix-Gimeno G, Reig-Molla B, Peiró S. Impact of osteoporosis and vertebral fractures on quality-of-life. a population-based study in Valencia, Spain (The FRAVO Study). Health Qual Life Outcomes 2011; 9:20. [PMID: 21470396 PMCID: PMC3080275 DOI: 10.1186/1477-7525-9-20] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/06/2011] [Indexed: 12/16/2022] Open
Abstract
Background To describe the health related quality of life in a population sample of postmenopausal women over the age of 50 and resident in the city of Valencia (Spain), according to the presence/absence of osteoporosis and the severity of prevalent morphometric vertebral fractures. Methods A cross-sectional age-stratified population-based sample of 804 postmenopausal women of 50 years of age and older were assessed with the SF-12 questionnaire. Information about demographic features, lifestyle, clinical features, educational level, anti-osteoporotic and other treatments, comorbidities and risk factors for osteoporosis were collected using an interviewer-administered questionnaire and densitometric evaluation of spine and hip and spine x-rays were carried out. Results In the non-adjusted analysis, mild and moderate-severe vertebral fractures were associated with decreased scores in the SF-12 Physical Component Summary (PCS) but not in the Mental Component Summary (MCS), while densitometric osteoporosis with no accompanying fracture was not associated with a worse health related quality of life. In multivariate analysis worse PCS scores were associated to the age groups over 70 (-2.43 for 70-74 group and -2.97 for 75 and older), chronic conditions (-4.66, -6.79 and -11.8 according to the presence of 1, 2 or at least 3 conditions), obesity (-5.35), peripheral fracture antecedents (-3.28), hypoestrogenism antecedents (-2.61) and the presence of vertebral fracture (-2.05). Conclusions After adjusting for confounding factors, the physical components of health related quality of life were significantly lower in women with prevalent osteoporotic vertebral fractures than in women -osteoporotic or not- without vertebral fractures.
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Sanfélix-Genovés J, Reig-Molla B, Sanfélix-Gimeno G, Peiró S, Graells-Ferrer M, Vega-Martínez M, Giner V. The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study). Bone 2010; 47:610-6. [PMID: 20601286 DOI: 10.1016/j.bone.2010.06.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/10/2010] [Accepted: 06/11/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate the prevalence of vertebral fracture and densitometric osteoporosis in postmenopausal women over the age of 50 in Valencia, Spain. METHODS This cross-sectional study was conducted in 2006-2007. An age-stratified population-based random sample of 824 postmenopausal women over the age of 50 answered a questionnaire and received a densitometric examination of the lumbar spine and hip with dual-energy X-ray absorptiometry and a lateral X-ray of the thoracic spine and lumbar regions. Osteoporosis was defined as a T-score less than or equal to -2.5 compared to a population of young women, and the presence of vertebral fractures was classified according to Genant's semiquantitative method. RESULTS The average age of the women was 64 years (range 50-87 years). The prevalence for all vertebral fractures was 21.4% (95% CI: 17.7%-25.1%) and 9.7% (95% CI: 6.7%-12.7%) for moderate-severe fractures. In women over the age of 75, the respective values were 46.3% (95% CI: 34.2%-58.3%) and 23.9% (95% CI:13.6%-34.2%). Only 1.5% of the women with vertebral fractures were aware of their condition. The prevalence of osteoporosis was estimated as 27.0% (95% CI:23.1%-30.8%) for the lumbar spine, 15.1% (95% CI:11.7%-18.5%) in the femoral neck, and 31.8% (95% CI:27.8%-35.7%) at either sites. CONCLUSIONS The study confirms that osteoporosis (1 in 3 women over the age of 50) and vertebral fracture (1 in 5 for all fractures and 1 in 10 for moderate-severe fractures) constitute a major public health and healthcare challenge; measuring their real impact will depend in part on the criteria used to define a fracture.
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Affiliation(s)
- José Sanfélix-Genovés
- Centro Superior de Investigación en Salud Pública (CSISP), Health Services Research Unit, Valencia, Spain.
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Sanfélix-Genovés J, Peiró S, Sanfélix-Gimeno G, Giner V, Gil V, Pascual M, Fluixá C, Fuertes A, Hurtado I, Ferreros I. Development and validation of a population-based prediction scale for osteoporotic fracture in the region of Valencia, Spain: the ESOSVAL-R study. BMC Public Health 2010; 10:153. [PMID: 20334639 PMCID: PMC2848634 DOI: 10.1186/1471-2458-10-153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/24/2010] [Indexed: 11/20/2022] Open
Abstract
Background Today, while there are effective drugs that reduce the risk of osteoporotic fracture, yet there are no broadly accepted criteria that can be used to estimate risks and decide who should receive treatment. One of the actual priorities of clinical research is to develop a set of simple and readily-available clinical data that can be used in routine clinical practice to identify patients at high risk of bone fracture, and to establish thresholds for therapeutic interventions. Such a tool would have high impact on healthcare policies. The main objective of the ESOSVAL-R is to develop a risk prediction scale of osteoporotic fracture in adult population using data from the Region of Valencia, Spain. Methods/Design Study design: An observational, longitudinal, prospective cohort study, undertaken in the Region of Valencia, with an initial follow-up period of five years; Subjects: 14,500 men and women over the age of 50, residing in the Region and receiving healthcare from centers where the ABUCASIS electronic clinical records system is implanted; Sources of data: The ABUCASIS electronic clinical record system, complemented with hospital morbidity registers, hospital Accidents & Emergency records and the Regional Ministry of Health's mortality register; Measurement of results: Incident osteoporotic fracture (in the hip and/or major osteoporotic fracture) during the study's follow-up period. Independent variables include clinical data and complementary examinations; Analysis: 1) Descriptive analysis of the cohorts' baseline data; 2) Upon completion of the follow-up period, analysis of the strength of association between the risk factors and the incidence of osteoporotic fracture using Cox's proportional hazards model; 3) Development and validation of a model to predict risk of osteoporotic fracture; the validated model will serve to develop a simplified scale that can be used during routine clinical visits. Discussion The ESOSVAL-R study will establish a prediction scale for osteoporotic fracture in Spanish adult population. This scale not only will constitute a useful prognostic tool, but also it will allow identifying intervention thresholds to support treatment decision-making in the Valencia setting, based mainly on the information registered in the electronic clinical records.
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Sanfélix-Gimeno G, Reig-Mollá B, Sanfélix-Genovés J, Giner-Ruiz V. Respuesta de los autores. Med Clin (Barc) 2008. [DOI: 10.1157/13127579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sanfélix-Gimeno G, Reig-Mollá B, Sanfélix-Genovés J, Giner-Ruiz V. [Effectiveness of drugs used in degenerative joint diseases (arthroses)]. Med Clin (Barc) 2008; 130:463-5. [PMID: 18405503 DOI: 10.1157/13118109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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