scholarly journals Operacionalização para Portugal da Lista EU(7)-PIM para Identificação de Medicamentos Potencialmente Inapropriados nos Idosos

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Daniela A. Rodrigues ◽  
Maria T. Herdeiro ◽  
Petra A. Thürmann ◽  
Adolfo Figueiras ◽  
Paula Coutinho ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Older Patients ◽  
European Countries ◽  
New Drugs ◽  
Potentially Inappropriate Medicines ◽  
Sliding Scale ◽  
Active Substances ◽  
The Eu ◽  
National Reality

Introduction: In 2015, the EU(7)-PIM List was published, which identifies potentially inappropriate medicines in older patients and resulted from a consensus of experts from seven European countries. Portugal was not part of this group, so it was not originally adapted to the Portuguese reality. With this work, we intend to elaborate a list of potentially inappropriate medicines adapted to the reality of medicines marketed in Portugal, through the operationalization of the EU(7)-PIM List for the national reality and to evaluate the adequacy of its use for clinical practice.Material and Methods: Search, in INFARMED’s Infomed database, of drugs that are included in the EU(7)-PIM List that have marketing authorization, and analysis of possible new drugs for inclusion in the list. The tool adapted to the Portuguese reality was applied to a sample of 1089 outpatient, polymedicated older patients from 38 primary care units in Central Portugal.Results: The final PIM list adapted to the Portuguese reality includes 184 potentially inappropriate medicines (from these, 178 are active substances, five are classes of drugs, and one corresponds to the sliding scale therapeutic scheme used in insulin therapy). Of 1089 polymedicated older patients, 83.7% took at least one drug included in the final potentially inappropriate medicines list or belonging to one of the groups included in the list, and, on average, each patient took 1.74 (IQR 1 – 2).Discussion: Even though the availability of drugs on the market is quite diverse, the EU(7)-PIM List has been used in several European countries. With this study, we operationalized the European list for the Portuguese reality, which will enable its application in clinical practice.Conclusion: The list drawn up is a useful tool for the identification of potentially inappropriate medicines, easy to use in clinical practice and research.

MO498INSIDE CKD: MODELLING THE CLINICAL AND ECONOMIC IMPACTS OF TARGETED URINARY ALBUMIN-TO-CREATININE RATIO SCREENING IN EUROPEAN COUNTRIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Juan Jose Garcia Sanchez ◽  
Alyshah Abdul Sultan ◽  
Johan Ärnlöv ◽  
Claudia Cabrera ◽  
Joshua Card-Gowers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Clinical Practice ◽  
Economic Impacts ◽  
Urinary Albumin ◽  
European Countries ◽  
Current Clinical Practice ◽  
Creatinine Ratio ◽  
Primary Care Settings ◽  
The Uk

Abstract Background and Aims With an estimated global prevalence of 10% or more, chronic kidney disease (CKD) and its associated complications constitute a major challenge for healthcare systems worldwide, which is worsened by the burden of undiagnosed CKD. Early diagnosis of CKD followed by guideline-recommended interventions can improve patient outcomes, particularly by delaying or preventing progression to kidney failure. This may result in a reduction in the costs associated with managing CKD. Elevated albuminuria is a strong predictor of risk of complications and death in patients with CKD, and measurement of urinary albumin-to-creatinine ratio (UACR) is an important diagnostic and prognostic tool. However, adherence to screening recommendations is suboptimal in routine care. Inside CKD aims to model the global clinical and economic burden of CKD using country-specific, patient-level microsimulation models. We used the Inside CKD microsimulation to model the potential clinical and economic impacts of routine UACR measurement with appropriate intervention in primary care settings in UK patients aged 45 years and over. This analysis is being expanded to further European countries. Method We used the Inside CKD microsimulation to model the clinical and economic impacts of measuring UACR with subsequent appropriate intervention during routine primary care visits in all individuals aged 45 years and over, versus current practice (i.e. screening in patients with diabetes, hypertension or cardiovascular disease). The model covers the period 2020–2025. First, a virtual population representing the general population of the UK was constructed using data from the 2016 Health Survey for England, covering demographics, prevalence of CKD and comorbidities (type 2 diabetes, uncontrolled hypertension and heart failure) and incidence of complications (heart failure, myocardial infarction, stroke and acute kidney injury). The model also included parameters relating to the direct and indirect costs associated with CKD (e.g. cost of renal replacement therapy), the proportion of patients who visit a primary care physician at least once a year, the proportion of patients who agree to UACR measurements, and the diagnostic sensitivity and specificity of UACR measurements. Results Preliminary results from the UK show that over the 2020–2025 period, routinely measuring UACR in all patients aged 45 years and over during primary care visits could prevent progression to CKD stages 3b–5 in approximately 327 000 patients, compared with current clinical practice, with a linear increase in the cumulative number of prevented cases over the 5 years (Figure). Associated savings in costs related to the management of CKD and its complications are projected to be approximately £300M in 2025, corresponding to a 1.9% reduction from current clinical practice. Conclusion Preliminary results from this Inside CKD microsimulation model show that implementation of routine measurement of UACR in primary care settings in the UK could prevent a substantial number of patients progressing to CKD stages 3b–5 and has the potential to reduce the associated healthcare-related costs considerably. This analysis is being extended to other European countries.

scholarly journals The Swedish National Diabetes Register in clinical practice and evaluation in primary health care

2016 ◽  
Vol 17 (06) ◽  
pp. 549-558 ◽  
Author(s):  
Ing-Marie Hallgren Elfgren ◽  
Ewa Grodzinsky ◽  
Eva Törnvall
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Clinical Practice ◽  
Older Patients ◽  
Special Focus ◽  
Nurse Specialist ◽  
Primary Health ◽  
Target Values ◽  
Diabetes Register

AimThe purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients.BackgroundAccording to Swedish law, all health-care units have to maintain a system for quality evaluation and improvement. As the NDR holds the most important quality indicators, implementation of the NDR in primary care was carried out by an implementation project in 2002–2005.MethodsInitially, a digital questionnaire about NDR routines was sent to all PHCC. Statistics about hemoglobin adult 1c (HbA1c) and blood pressure (BP) was presented for the diabetes teams at two centres who were also interviewed. The responses became the basis for a focus group interview with both teams together, with data subject to content analysis.FindingsThe study showed that reporting to the NDR has become a compulsory routine in primary care. The diabetes nurse specialist was responsible for the practical management of the register and used the NDR for continuous monitoring of the patients. Most centres used the NDR’s statistics for evaluation and analyses annually. The diabetes nurse adapted the visits to the patient’s wishes and general condition. Only in terms of target values for HbA1c and BP did they accept slightly higher values for the older patients. Since the NDR was implemented, the registration rate has remained at 75% and has not increased. The reason given was that patients with diabetes living in nursing homes are checked up by the municipal nurse who does not use the NDR. However, the risk of omitting older patients in the NDR could be considerably decreased if data could be transferred from the electronic patient record.

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

2007 ◽  
Vol 30 (4) ◽  
pp. 36
Author(s):  
M. L. Russell ◽  
L. McIntyre
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Community Health ◽  
Royal College ◽  
Community Medicine ◽  
Work Setting ◽  
Public Health Medicine ◽  
Work Settings ◽  
Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697085
Author(s):  
Trudy Bekkering ◽  
Bert Aertgeerts ◽  
Ton Kuijpers ◽  
Mieke Vermandere ◽  
Jako Burgers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Urinary Stones ◽  
Care Practice ◽  
Supporting Evidence ◽  
Supervised Exercise ◽  
Review Team ◽  
New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

Zmiany dochodowości gospodarstw mlecznych w Polsce i wybranych krajach europejskich należących do Europejskiego Stowarzyszenia Producentów Mleka w latach 2006–2012

2015 ◽  
pp. 97-109
Author(s):  
Sylwia Małażewska ◽  
Edyta Gajos
Keyword(s):  
Milk Production ◽  
Dairy Farms ◽  
European Countries ◽  
Global Markets ◽  
Agricultural Producers ◽  
Significant Deterioration ◽  
Gradual Improvement ◽  
The United Kingdom ◽  
National Market ◽  
The Eu

The aim of the article was to present the changes in the profitability of milk production in farms associated in EDF and situated in Poland and selected European countries in 2006–2012. It was found that after the Polish accession to the EU, the situation has improved for milk producers – economic and production results have risen. In 2008–2009, there was a significant deterioration in the profitability of milk production due to, among others, significant declines in milk prices. Since 2010, gradual improvement of the situation is observed. Similar changes occur in dairy farms in other European countries, such as Germany, France and the United Kingdom. This shows how big the interconnectedness between countries is and that the situation of agricultural producers in Poland does not depend only on the local and national market fluctuations, but primarily on fluctuations in the European and global markets.

scholarly journals Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035678
Author(s):  
Michael Harris ◽  
Mette Brekke ◽  
Geert-Jan Dinant ◽  
Magdalena Esteva ◽  
Robert Hoffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Test ◽  
Cancer Survival ◽  
Survival Rates ◽  
European Countries ◽  
Survey Question ◽  
Referral Decisions ◽  
Physician Characteristics ◽  
Care Survey ◽  
Primary Care Practitioners

ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20 European countries with widely varying cancer survival rates.ParticipantsA total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country.ResultsPCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.ConclusionWhen given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.

scholarly journals Adjunctive Perampanel in Older Patients With Epilepsy: A Multicenter Study of Clinical Practice

Drugs & Aging ◽  
2021 ◽  
Author(s):  
Simona Lattanzi ◽  
Claudia Cagnetti ◽  
Nicoletta Foschi ◽  
Roberta Ciuffini ◽  
Elisa Osanni ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Multicenter Study ◽  
Older Patients ◽  
Patients With Epilepsy
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