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This study was aimed to investigate the effects of computerized decision support system in improving the prescription of drugs for cardiovascular prevention. A total of 197 Italian general practitioners were randomly allocated to receive... more
This study was aimed to investigate the effects of computerized decision support system in improving the prescription of drugs for cardiovascular prevention. A total of 197 Italian general practitioners were randomly allocated to receive either the alerting computerized decision support system integrated into standard software (intervention arm) or the standard software alone (control arm). Data on 21230 patients with diabetes, 3956 with acute myocardial infarction, and 2158 with stroke were analysed. The proportion of patients prescribed with cardiovascular drugs and days of drug–drug interaction exposure were evaluated. Computerized decision support system significantly increased the proportion of patients with diabetes prescribed with antiplatelet drugs (intervention: +2.7% vs. control: +0.15%; p < 0.001) or lipidlowering drugs (+4.2% vs. +2.8%; p = 0.001). A statistically significant decrease in days of potential interactions has been observed only among patients with stroke (−1.2 vs. −0.5 days/person-year; p = 0.001). In conclusion, computerized decision support system significantly increased the use of recommended cardiovascular drugs in diabetic patients, but it did not influence the exposure to potential interactions
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Clinical Decision Support Systems (CDSSs) are computer-based tools intended to support physicians in clinical decision making. MilleDSS® is an illustrative example for the Italian context. It is featured by four domains of GP-software... more
Clinical Decision Support Systems (CDSSs) are computer-based tools intended to support physicians in clinical decision making. MilleDSS® is an illustrative example for the Italian context. It is featured by four domains of GP-software interaction, such as clinical management and follow-up evaluation, prescribing appropriateness and clinical risk, prevention strategies and medical computerized stewardship on scientific update and training. MilleDSS® registered 23,222 accesses in early September 2021. In specific, the sections on prevention and training were viewed 19,440 and 21,797 times, respectively.The Medical Device Regulation (MDR: (EU) 2017/745) indicates that clinical evidence needs to be provided for any software intended to medical purpose. Clinical research on CDSS effectiveness will be therefore conducted through epidemiological studies. In theory, this generation of evidence would follow the pyramid of evidence as per medications approval but, given the large use and constant update of CDSS for daily clinical practice, attentions should be posed on the most cost-effective study.
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Research Interests: Medicine, Osteoarthritis, Humans, Internal Medicine, Female, and 15 moreMale, Pharmacotherapy, Aged, Middle Aged, Odds ratio, Cardiovascular Diseases, Acetaminophen, Cerebrovascular Disorders, Logistic Models, Confidence Interval, Codeine, Case Control Studies, Cohort Studies, Pharmacology and pharmaceutical sciences, and Drug combinations
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Objectives: To estimate the prevalence and incidence of epilepsy in Italy using a national database of general practitioners (GPs). Methods: The Health Search CSD Longitudinal Patient Database (HSD) has been established in 1998 by the... more
Objectives: To estimate the prevalence and incidence of epilepsy in Italy using a national database of general practitioners (GPs). Methods: The Health Search CSD Longitudinal Patient Database (HSD) has been established in 1998 by the Italian College of GPs. Participants were 700 GPs, representing a population of 912,458. For each patient, information on age and sex, EEG, CT scan, and MRI was included. Prevalent cases with a diagnosis of ‘epilepsy' (ICD9CM: 345*) were selected in the 2011 population. Incident cases of epilepsy were identified in 2011 by excluding patients diagnosed for epilepsy and convulsions and those with EEG, CT scan, MRI prescribed for epilepsy and/or convulsions in the previous years. Crude and standardized (Italian population) prevalence and incidence were calculated. Results: Crude prevalence of epilepsy was 7.9 per 1,000 (men 8.1; women 7.7). The highest prevalence was in patients <25 years and ≥75 years. The incidence of epilepsy was 33.5 per 100,000 (women 35.3; men 31.5). The highest incidence was in women <25 years and in men 75 years or older. Conclusions: Prevalence and incidence of epilepsy in this study were similar to those of other industrialized countries. HSD appears as a reliable data source for the surveillance of epilepsy in Italy. i 2014 S. Karger AG, Basel
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During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing... more
During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing guidelines and clinical decision-based support tools, such as the downloadable version of the Italian SPREAD Guidelines represents one of the most important and common clinical applications. The current experience suggests that the need for best evidence models at the time of decision making is strong and that portable accessibility is critical: including just-in-time information systems that allow physicians to retrieve the best evidence at the point of care, and a standardized electronic health record (EHR) easily integrating into daily practice and is affordable to most family physicians.
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Recent studies show that the risk of cardiovascular adverse events for certain traditional non-steroidal anti-inflammatory drugs (NSAIDs) is similar to that of rofecoxib. While these results are focused on ischemic cardiomyopathy, there... more
Recent studies show that the risk of cardiovascular adverse events for certain traditional non-steroidal anti-inflammatory drugs (NSAIDs) is similar to that of rofecoxib. While these results are focused on ischemic cardiomyopathy, there is little evidence concerning the risk of ischemic stroke/transient ischemic attack and hemorrhagic stroke. Additionally, there is no information on nimesulide and ketoprofen, the most frequently prescribed NSAIDs in Italy, along with diclofenac. This study aims to determine whether the use of NSAIDs is associated with an increased risk of cerebrovascular events in Italy. We performed a case-control analysis nested in a cohort of patients with osteoarthritis between 2002 and 2011 who were newly treated with NSAIDs. The patients were followed until December 31, 2012. Conditional logistic regression was used to estimate odds ratios (ORs) with 95 % confidence intervals (95 % CI) of cerebrovascular events (index date) associated with current (until 30 days before the index date), recent (31-365 days) and past (>365 days) use of NSAIDs. Within a cohort of 29,722 patients, 1566 cases (1546 matched with controls) were identified (incidence rate = 11.0/1000 person-years). The overall rate of cerebrovascular event was not elevated with current NSAIDs overall when compared with past use. Among individual NSAIDs, diclofenac and ketoprofen were the molecules significantly associated with an increased rate of cerebrovascular events (OR = 1.53; 95 % CI 1.04-2.24; OR = 1.62; 95 % CI 1.02-2.58, respectively). The most frequent event was hemorrhagic stroke following the use of ketoprofen (OR = 2.09; 95 % CI 1.05-4.15). Diclofenac and ketoprofen seemed to increase the risk of cerebrovascular events. These findings might influence the choice of NSAIDs according to patient characteristics.
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Chronic spontaneous urticaria (CSU) is a common skin disease, but there is a paucity of precise epidemiological data on this disease.
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The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care... more
The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care frailty index (PC-FI) based on routinely collected health records and providing sex-specific frailty charts. The PC-FI was developed using data from 308,280 primary care patients ≥ 60 years old part of the Health Search Database (HSD) in Italy (baseline 2013–2019) and validated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; baseline 2001–2004), a well-characterized population-based cohort including 3363 individuals ≥ 60 years old. Potential health deficits part of the PC-FI were identified through ICD-9, ATC, and exemption codes and selected through an optimization algorithm (i.e., genetic algorithm), using all-cause mortality as the main outcome for the PC-FI development. The PC-FI association at 1, 3 and 5 years, and disc...
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BackgroundMood disorders are managed predominantly in primary care. However, general practitioners’ (GPs) ability to detect and diagnose patients with mood disorders is still considered unsatisfactory. The aim of the present study was to... more
BackgroundMood disorders are managed predominantly in primary care. However, general practitioners’ (GPs) ability to detect and diagnose patients with mood disorders is still considered unsatisfactory. The aim of the present study was to identify predictors for the early recognition of depressive disorder (DD) and bipolar disorder (BD) in general practice.MethodsA cohort of 1,144,622 patients (605,285 women, 539,337 men) was investigated, using the Health Search IMS Health Longitudinal Patient Database. Predictors of DD or BD were identified at baseline encompassing somatization-related features, lifestyle variables, medical and psychiatric comorbidities. Patients were followed up as long as the following events occurred: diagnoses of DD or BD, death, end of the registration with the GP, end of the study period.ResultsWe found an incidence rate of DD or BD of 53.61 and 1.5 per 10,000 person-years, respectively. For both the conditions, the incidence rate grew with age. Most of the l...
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Objective To train and test a model predicting chronic kidney disease (CKD) using the Generalized Additive2 Model (GA2M), and compare it with other models being obtained with traditional or machine learning approaches. Materials We... more
Objective To train and test a model predicting chronic kidney disease (CKD) using the Generalized Additive2 Model (GA2M), and compare it with other models being obtained with traditional or machine learning approaches. Materials We adopted the Health Search Database (HSD) which is a representative longitudinal database containing electronic healthcare records of approximately 2 million adults. Methods We selected all patients aged 15 years or older being active in HSD between January 1, 2018 and December 31, 2020 with no prior diagnosis of CKD. The following models were trained and tested using 20 candidate determinants for incident CKD: logistic regression, Random Forest, Gradient Boosting Machines (GBMs), GAM, and GA2M. Their prediction performances were compared by calculating Area Under Curve (AUC) and Average Precision (AP). Results Comparing the predictive performances of the 7 models, the AUC and AP for GBM and GA2M showed the highest values which were equal to 88.9%, 88.8% a...
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During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing... more
During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing guidelines and clinical decision-based support tools, such as the downloadable version of the Italian SPREAD Guidelines represents one of the most important and common clinical applications. The current experience suggests that the need for best evidence models at the time of decision making is strong and that portable accessibility is critical: including just-in-time information systems that allow physicians to retrieve the best evidence at the point of care, and a standardized electronic health record (EHR) easily integrating into daily practice and is affordable to most family physicians.
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Chronic spontaneous urticaria (CSU) is a common skin disease, but there is a paucity of precise epidemiological data on this disease.
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BACKGROUND General practitioners (GPs) need a valid, user-friendly tool to identify patients most vulnerable to COVID-19, especially in the hypothesis of a booster vaccine dose. The aim of this study was to develop and validate a... more
BACKGROUND General practitioners (GPs) need a valid, user-friendly tool to identify patients most vulnerable to COVID-19, especially in the hypothesis of a booster vaccine dose. The aim of this study was to develop and validate a GP-friendly prognostic index able to forecast severe COVID-19 outcomes in primary care. Indeed, no such prognostic score is as yet available in Italy. RESEARCH DESIGN AND METHODS In this retrospective cohort study, a representative sample of 47,868 Italian adults were followed up for 129,000 person-months. The study outcome was COVID-19-related hospitalization and/or death. Candidate predictors were chosen on the basis of systematic evidence and current recommendations. The model was calibrated by using Cox regression. Both internal and external validations were performed. RESULTS Age, sex and several clinical characteristics were significantly associated with severe outcomes. The final multivariable model explained 60% (95%CI 58-63%) of variance for COVID-19-related hospitalizations and/or deaths. The area under the receiver-operator curve (AUC) was 84% (95% CI: 83-85%). On applying the index to an external cohort, the AUC was 94% (95% CI: 93-95%). CONCLUSIONS This index is a reliable prognostic tool that can help GPs to prioritize their patients for preventive and therapeutic interventions.
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... Francesco Mazzoleni1, Monica Simonetti2, Francesco Lapi3,Serena Pecchioli2, Gianluca Trifirò4, Iacopo Cricelli2, Giampiero Mazzaglia2 ... le patologie psichiatriche come la depressione maggiore (DM), la distimia, i disturbi... more
... Francesco Mazzoleni1, Monica Simonetti2, Francesco Lapi3,Serena Pecchioli2, Gianluca Trifirò4, Iacopo Cricelli2, Giampiero Mazzaglia2 ... le patologie psichiatriche come la depressione maggiore (DM), la distimia, i disturbi d'ansia [disturbo da attacco di panico (DAP), disturbo ...
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Recent studies show that the risk of cardiovascular adverse events for certain traditional non-steroidal anti-inflammatory drugs (NSAIDs) is similar to that of rofecoxib. While these results are focused on ischemic cardiomyopathy, there... more
Recent studies show that the risk of cardiovascular adverse events for certain traditional non-steroidal anti-inflammatory drugs (NSAIDs) is similar to that of rofecoxib. While these results are focused on ischemic cardiomyopathy, there is little evidence concerning the risk of ischemic stroke/transient ischemic attack and hemorrhagic stroke. Additionally, there is no information on nimesulide and ketoprofen, the most frequently prescribed NSAIDs in Italy, along with diclofenac. This study aims to determine whether the use of NSAIDs is associated with an increased risk of cerebrovascular events in Italy. We performed a case-control analysis nested in a cohort of patients with osteoarthritis between 2002 and 2011 who were newly treated with NSAIDs. The patients were followed until December 31, 2012. Conditional logistic regression was used to estimate odds ratios (ORs) with 95 % confidence intervals (95 % CI) of cerebrovascular events (index date) associated with current (until 30 da...
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A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD) recommended that regular monitoring of quality of primary care by means of compliance with... more
A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD) recommended that regular monitoring of quality of primary care by means of compliance with standards of care for chronic diseases is performed. A previous ecological study demonstrated that compliance with standards of care could be reliably estimated on regional level using administrative databases. This study compares estimates based on administrative data with estimates based on GP records for the same persons, to understand whether ecological fallacy played a role in the results of the previous study. We compared estimates of compliance with diagnostic and therapeutic standards of care for type 2 diabetes (T2DM), hypertension and ischaemic heart disease (IHD) from administrative data (IAD) with estimates from medical records (MR) for the same persons registered with 24 GP's in 2012. Data were linked at an individual level. 32,688 persons ...
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We evaluated the prescription appropriateness of cyproterone acetate in combination with ethinylestradiol (CPA/EE) in a primary care setting before and after the 2013 European Medicines Agency's (EMA) recommendation relating to the... more
We evaluated the prescription appropriateness of cyproterone acetate in combination with ethinylestradiol (CPA/EE) in a primary care setting before and after the 2013 European Medicines Agency's (EMA) recommendation relating to the risk profile of CPA/EE. Data were obtained from the Health Search IMS Health Longitudinal Patient Database (HSD). We compared the results from 2011 to 2012 with the results of 2014, namely before and after the 2013 EMA recommendation, and investigated the burden of concurrent use of CPA/EE and other hormonal contraceptives (HCs) and the reported indication at the time of CPA/EE prescription. Overall, 1189 new users of CPA/EE were identified: 495 in 2011, 446 in 2012, and 261 in 2014. Concomitant use of CPA/EE and other HCs was found in 1% of cases in 2011-2012 and 2% of cases in 2014, while potential concomitant use was observed in 4% of cases in 2011 and 2% of cases in 2012 and 2014. A recent (within 365 days) diagnosis of any hyperandrogenic conditi...
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Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of... more
Despite management guidelines advocating statin/ezetimibe use in very high cardiovascular risk (CV) conditions, adherence to this therapy is still suboptimal and LDL-C target attainment unsatisfactory. We aimed to investigate the level of adherence to statin/ezetimibe and LDL-C target achievement rates in an unselected very high CV risk population in primary care setting in Italy. We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD), including adult patients at very high CV risk, newly treated with statin, ezetimibe or their combination, with 3 and 6 months of follow-up. Although the large majority of patients had previous major CV events (99.9%), only 61% and 55.14% resulted adherent (Proportion of Days Covered, PDC≥80%) after 3 and 6 months, respectively. High adherence entailed almost a three times higher probability to reach the therapeutic LDL-C target (3 months: OR = 2.26 [95% [CI]: 1.88 to 2.72]; 6-months: ...
Research Interests: Primary Health Care, Atherosclerosis, Medication Adherence, Treatment Outcome, Probability, and 15 moreItaly, Humans, Female, Male, Risk factors, LDL-cholesterol, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Retrospective Studies, Cardiovascular Diseases, Risk Factors, Ezetimibe, and Cardiovascular medicine and haematology
The aim of the present study was to assess the occurrence and determinants of poor adherence to pharmacological treatment in a cohort of primary care patients with chronic obstructive pulmonary disease (COPD), paying special attention to... more
The aim of the present study was to assess the occurrence and determinants of poor adherence to pharmacological treatment in a cohort of primary care patients with chronic obstructive pulmonary disease (COPD), paying special attention to the role of age, comorbidity and polypharmacy. We identified a cohort of COPD patients using the primary care Italian Health Search - IMS Longitudinal Patient Database. We assessed 1-year adherence to COPD maintenance pharmacotherapy (encompassing inhaled corticosteroids, long-acting beta agonists and long-acting anticholinergics). Poor adherence was defined as <80% of proportion of days covered by pharmacological treatment over a 1-year period. Of 22 505 patients (mean age 67.3 ± 13.2; 41.3% women) entering the study, 17 486 (77.7%) were poorly adherent. According to multivariate analysis, poor adherence is less likely in older adults (OR 0.51, 95% CI 0.40-0.66), in non-smokers (OR 0.77, 95% CI 0.69-0.86) and in those with a history of alcohol a...
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Chronic heart failure (CHF) is a major public health concern. From a public health perspective, the epidemiology of CHF needs to be distinguished from that of its related acute form. Data stemming from primary care are crucial to better... more
Chronic heart failure (CHF) is a major public health concern. From a public health perspective, the epidemiology of CHF needs to be distinguished from that of its related acute form. Data stemming from primary care are crucial to better know and update the prevalence and incidence rates of CHF. To update the epidemiology of CHF in an Italian primary care setting and to describe socio-demographic, lifestyle, and clinical characteristics of these patients. A population-based study was conducted among 800 Italian general practitioners collecting data in a dedicated database. Information was extracted from adult subjects with a diagnosis of CHF from 2002 to 2013, and the prevalence and incidence rate of CHF were calculated. The study population was described in terms of socio-demographic, lifestyle, and clinical characteristics. A total of 13,633 patients with CHF were identified. Overall, the prevalence of CHF was 1.25% (95% CI 1.23-1.27), and the incidence rate was 1.99 per 1000 perso...
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There are contrasting positions concerning the benefit-risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen-codeine combinations according to their regimen of... more
There are contrasting positions concerning the benefit-risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen-codeine combinations according to their regimen of use, we evaluated whether being a regular user (adherent) of these medications decreased the occurrence of rescue therapy with non-steroidal anti-inflammatory drugs (NSAIDs). Using the Health Search IMS Health Longitudinal Patient Database, we formed a cohort of patients aged ≥18 years and newly treated with acetaminophen or acetaminophen-codeine combinations for OA between 1 January 2001 and 31 December 2013. These patients were followed up for one year in which they were categorized as regular or irregular users of these medications according to a variable medication possession ratio (VMPR) ≥ 50% or lower. We operationally defined the rescue therapy as the use of any NSAIDs prescribed for OA-related pain. Overall, 40,029 patients (69.5% females; ...