Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study

OBJECTIVE

To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions.

MATERIAL AND METHODS

An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P<.05).

RESULTS

We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P=.008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P<.03).

CONCLUSIONS

The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication.

[Family practice and diagnosis of cancer]

OBJECTIVES

To describe the types of cancer identified in primary health care, their clinical presentation, management until diagnosis and delay in diagnosis.

DESIGN

Descriptive study based on secondary information from medical records.

SETTING

Two urban health care centres in Mallorca, Spain.

PARTICIPANTS

Patients over 14 years old diagnosed with cancer between 1994 and 1998.

MEASUREMENTS

Age, sex, location of tumour, symptoms, role of family doctor, specialist referral, care environment, time from first symptom to diagnosis, and stage of tumour.

RESULTS

We identified 408 cancers. Mean age at diagnosis was 66.5 years (95% CI, 65.3-67.7); 237 (58.1%) were male. The most frequent tumours were colorectal, lung, prostate, breast and bladder, and the most common symptom was pain (33.1%; 95% CI, 28-38.3). The family doctor was involved in 63% of diagnoses (95% CI, 58.2-67.8). Mean delay from first symptom until diagnosis was 90 days, of which 26 were attributed to the patient and 55 to primary health care services. For colorectal, lung and prostate cancers, delay was shorter. The tumour was less advanced at diagnosis when family doctors were involved.

CONCLUSIONS

Family doctors are involved in the diagnosis of most cancers. In colorectal, lung and prostate cancers, their contribution could improve prognosis. More studies are needed to confirm these findings.