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Orós M, Perejón D, Serna MC, Siscart J, Leon J, Ortega M, Salinas-Roca B. Prevalence and risk factors of gestational diabetes in the health region of Lleida: a retrospective observational cohort study. J Endocrinol Invest 2023; 46:2639-2646. [PMID: 37330946 PMCID: PMC10632204 DOI: 10.1007/s40618-023-02120-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Diabetes is a very common metabolic condition during pregnancy. The number of cases increases with age and obesity. The prevalence of pre-gestational diabetes and gestational diabetes (GD) differs between different ethnic groups. OBJECTIVE The aim of the study was to analyse the prevalence of pre-gestational diabetes and GD in the health region of Lleida. We also studied the GD risk factors during pregnancy according to the country of origin of the pregnant woman. METHODS We performed a retrospective observational cohort study among pregnant women between 2012 and 2018 in the health region of Lleida. A multivariate model was performed with the different variables analysed by calculating the regression coefficient and its 95% confidence interval (CI). RESULTS In our sample of 17,177 pregnant women, we observed a prevalence of pre-gestational diabetes and GD of 8.2% and 6.5%, respectively. We found a relationship of gestational diabetes with different factors: age, with 6.8% in 30-34 year-old women and 11.3% in women over 35 (OR 1.78 and 3.29, respectively); overweight, with 8.29% (OR 1.89); and obesity, with 12.9% (OR 3.15). Finally, women from Asia and the Middle East and the Maghreb had a higher risk of diabetes, with 12.2% (OR 2.1) and 9.91% (OR 1.3), respectively, and Sub-Saharan women had a lower risk of it 6.07% (OR 0.71). CONCLUSIONS GD has different risk factors, such as age, overweight, and obesity. Non-related conditions include hypothyroidism, arterial hypertension, and dyslipidaemia. Finally, pregnant women from the Maghreb, and Asia and the Middle East, are at higher risk of developing diabetes during pregnancy; meanwhile, Sub-Saharan origin is protector factor.
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Affiliation(s)
- M Orós
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - D Perejón
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - M C Serna
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - J Siscart
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - J Leon
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Grup d'investigació en Immunologia i Metabolisme (GRIM), Institut de Recerca Biomèdica, Lleida, Spain
| | - M Ortega
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
- Grup de Recerca Terapèutica en Atenció Primària (GRETAPS), Institut Català de la Salut, Lleida, Spain
| | - B Salinas-Roca
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig 2, 25198, Lleida, Spain.
- Global Research On Wellbeing (GRoW) Research Group, Blanquerna School of Health Science, Ramon Llull University, Padilla, 326-332, 08025, Barcelona, Spain.
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Siscart J, Orós M, Serna MC, Perejón D, Galván L, Ortega M. Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study. BMC Pregnancy Childbirth 2022; 22:168. [PMID: 35232385 PMCID: PMC8886742 DOI: 10.1186/s12884-022-04483-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/07/2021] [Accepted: 02/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease. Methods We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI). Results We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence. Conclusions Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04483-8.
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Affiliation(s)
- Júlia Siscart
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain. .,Eixample Health Center, Catalan Institute of Health, Lleida, Spain. .,Family Medicine Department, University of Lleida, Lleida, Spain.
| | - Míriam Orós
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | - M Catalina Serna
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | - Dani Perejón
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | | | - Marta Ortega
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain. .,Family Medicine Department, University of Lleida, Lleida, Spain. .,Therapeutic Research Group in Primary Care (GRETAP), Catalan Institute of Health, Lleida, Spain.
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Real J, Serna MC, Giner-Soriano M, Forés R, Pera G, Ribes E, Alzamora M, Marsal JR, Heras A, Morros R. Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database. BMC Cardiovasc Disord 2018; 18:85. [PMID: 29739318 PMCID: PMC5941464 DOI: 10.1186/s12872-018-0822-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. METHODS Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009-2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). RESULTS Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. CONCLUSIONS Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients.
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Affiliation(s)
- Jordi Real
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Sant Cugat, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Catalina Serna
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Lleida, Spain
- Universitat de Lleida, Lleida, Spain
- Institut Català de la Salut, Lleida, Spain
| | - Maria Giner-Soriano
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Institut Català de la Salut, Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
| | - Rosa Forés
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Esther Ribes
- Unitat de Farmàcia. Direcció d’Atenció Primària Lleida. Institut Català de la Salut, Lleida, Spain
| | - Maite Alzamora
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Mataró, Spain
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Lleida, Spain
- Epidemiology Unit of the Cardiovascular Service, Hospital Universitari Vall d’Hebron, CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III Barcelona, Barcelona, Spain
| | - Antonio Heras
- Centre d’Atenció Primària Riu Nord-Riu Sud Santa Coloma de Gramenet. Direcció d’Atenció Primària Metropolitana Nord. Institut Català de la Salut, Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Institut Català de la Salut, Gran Via de les Corts Catalanes 587, àtic, 08007 Barcelona, Spain
- Plataforma SCReN (Spanish Clinical Research Network), Unidad de Investigación Clínica y Ensayos Clínicos (UICEC) IDIAPJGol, Barcelona, Spain
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Serna MC, Real J, Cruz I, Galván L, Martin E. Monitoring patients on chronic treatment with antidepressants between 2003 and 2011: analysis of factors associated with compliance. BMC Public Health 2015; 15:1184. [PMID: 26611468 PMCID: PMC4661976 DOI: 10.1186/s12889-015-2493-8] [Citation(s) in RCA: 18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines consider the use of antidepressants as one of the standard treatments for anxiety disorders, due to the significant improvements obtained in quality of life and functional disability. In addition, in patients who have not achieved a favorable response after 3 months of psychotherapy, antidepressants are recommended as part of a combined treatment approach. This combination with psychotropic drugs and psychotherapy appears to be indicated from baseline in patients with moderate, severe or recurrent depression. In the last decade, antidepressant prescription rates in general practice have increased between 4 and 10 times. Depression presents high rates of relapse and recurrence. Treatment is often interrupted prematurely, leading to increases in both relapse rates and health care costs. Few studies have analysed the chronic use of antidepressant drugs and long-term adherence. OBJECTIVE To evaluate compliance with antidepressant treatment between 2003 and 2011 and to explore the associated factors. METHODS Retrospective cohort study of antidepressant dispensing. SETTING Health Region of Lleida between 2003 and 2011. PARTICIPANTS Patients with chronic prescription of antidepressants (ATC code NO6A) during 2003 were followed up until December 2011. The sample comprised 3684 subjects. MAIN MEASURES The compliance rate was calculated on the basis of the number of units withdrawn from the pharmacy and the theoretical number of units required according to the scheduled duration of treatment: compliance was defined in cases with scores greater than or equal to 80%. RESULTS 12.5% of patients received chronic antidepressant treatment for at least 4 years. Mean age was 54 years, and 73.2% of patients were female. Almost a third (32.4%) presented anxiety disorders and 26.5% mood disorders. The overall compliance rate was 22% (28% in patients with depression, and 21% in patients with anxiety). According to gender, compliance rates were 21.4% for males and 22.4% for females. Compliance was more likely in patients with polypharmacy. CONCLUSIONS One in 4 patients complied with treatment. Factors associated with better compliance were polypharmacy and diagnosis of depressive or mixed anxiety-depressive disorder.
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Affiliation(s)
- M Catalina Serna
- Universidad de Lleida- IRB-Lleida, Lleida, Spain.
- Centre d'Atenció Primària Eixample, Institut Català de la Salut, Lleida, Spain.
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida-Pirineus, Àmbit Atenció Primària Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Rambla Ferran, 44, 3ª planta, 25007, Lleida, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat Intenacional de Catalunya, Sant Cugat, Barcelona, Spain.
| | - Inés Cruz
- Unitat de Suport a la Recerca Lleida-Pirineus, Àmbit Atenció Primària Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Rambla Ferran, 44, 3ª planta, 25007, Lleida, Spain.
- Centre d'Atenció Primària Primer de Maig, Institut Català de la Salut, Lleida, Spain.
| | | | - Elisabet Martin
- Centre d'Atenció Primària Consell de Cent, Institut Català de la Salut, Barcelona, Spain.
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Yuguero O, Serna MC, Real J, Galván L, Riu P, Godoy P. [Using treatment compliance to determine the under-notification of tuberculosis in a health region for the years 2007-2009]. Aten Primaria 2012; 44:703-8. [PMID: 22819371 DOI: 10.1016/j.aprim.2012.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/01/2012] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed. METHODS Descriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009. RESULTS The incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%). CONCLUSIONS The incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations.
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Affiliation(s)
- Oriol Yuguero
- Atención Primaria, Institut Català de la Salut Lleida, Lleida, España.
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Serna MC, Real J, Ribes E, Marsal JR, Godoy P, Galván L. Determinantes de la prescripción de antibióticos en atención primaria. Enferm Infecc Microbiol Clin 2011; 29:193-200. [DOI: 10.1016/j.eimc.2010.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 08/03/2010] [Accepted: 09/02/2010] [Indexed: 11/25/2022]
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Serna MC, Ribes E, Real J, Galván L, Gascó E, Godoy P. [High exposure to antibiotics in the population and differences by sex and age]. Aten Primaria 2010; 43:236-44. [PMID: 21145134 DOI: 10.1016/j.aprim.2010.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 04/19/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine antibiotic use and its distribution by age and gender, as well as the most prescribed therapeutic group. DESIGN Observational descriptive with retrospective data. SETTINGS AND PARTICIPANTS Population from the Lleida (Spain) Health Region receiving antibiotic prescriptions from 2002 to 2007. MEASUREMENTS Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patients under treatment. The study variables were: age, gender, number of patients under antibiotic treatment and pharmacological group. RESULTS Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and 40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had received antibiotics once a year. The antibiotic consumption prevalence has a "V" shape with higher values among children and old people. There is an annual exposure to antibiotics in 58.8% of the 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic. CONCLUSIONS We observe a high antibiotic prescription rate among children and older people, the high consumption in childhood being of note. There is also a higher use of antibiotics among women and changing of prescription towards broad spectrum antibiotics.
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Serna MC, Cruz I, Real J, Gascó E, Galván L. Duration and adherence of antidepressant treatment (2003 to 2007) based on prescription database. Eur Psychiatry 2009; 25:206-13. [PMID: 20005684 DOI: 10.1016/j.eurpsy.2009.07.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 07/15/2009] [Accepted: 07/20/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Many patients discontinue antidepressant therapy long before the six-month minimum duration recommended for the treatment of major depression and many other diagnoses. PURPOSE To estimate the duration of antidepressant treatment and to analyse the following factors in relation to treatment adherence: age, sex, polypharmacy and type of drug. METHODS Retrospective cohort followed up for five years (2003-2007) based on prescription database. SELECTION CRITERIA Users who had received at least one antidepressant prescription in 2003 and who had not received antidepressants during the previous 12 months. VARIABLES STUDIED Age, sex, drug, polypharmacy, period of treatment, packs dispensed. Adequate adherence was defined as dispensation of medication during at least 80% of the treatment period, and compliance was defined as good when, in addition, the treatment lasted more than four months. RESULTS Of the 7525 patients selected, 56% abandoned medication during the first four months. Men were more likely to give up medication before time than women. Good compliance was recorded in 22% of patients and was twice as frequent in patients with high levels of polypharmacy than in those with low levels (31% vs. 15.3%). Patients receiving maprotiline, venlafaxine, mirtazapine, citalopram, clomipramine and fluoxetine presented the highest percentages of good compliance. CONCLUSIONS Only one out of five patients complied with treatment for over four months. Treatment periods were shorter in men. In chronic processes, patients receiving polypharmacy presented the best compliance.
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Affiliation(s)
- M C Serna
- Regional Primary Care Management Office, Catalan Institute of Health, University of Lleida, Lleida, Spain
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