Evaluation of antihypertensive drug prescribing in a primary care clinic

Although the National High Blood Pressure Education Program has been in existence since the early 1970's, reported evaluation of drug prescribing for ambulatory, hypertensive patients for conformance with the stepped-care approach and approved drug labeling is lacking in the literature. To study this, charts of hypertensive patients from a primary care clinic were retrospectively reviewed against explicit treatment criteria. It was found that nearly all the antihypertensive drug prescribing was in accord with the criteria, with the exception of the scheduling of return visits to the clinic and monitoring. The community pharmacist's role in improving patient monitoring is discussed.     

Measurement of changes in antihypertensive drug utilisation following primary care educational interventions

PURPOSE: To measure changes in drug utilisation following a national general practice education program aimed at improving prescribing for hypertension. METHODS: A series of nationally implemented, multifaceted educational interventions using social marketing principles focusing on prescribing for hypertension, was commenced in October 1999, and repeated in September 2001 and August 2003. The target group was all primary care prescribers in Australia and interventions were both active (voluntary) and passive. Newsletter and prescribing feedback was mailed in October 1999, September 2001 (newsletter only) and August 2003. Approximately a third of general practitioners (GPs) in Australia undertook at least one active educational activity (clinical audit, educational visit or case study) during the period October 1999-April 2004. National dispensing data from 1996 to 2004 were analysed using time series methodology with a decay term for intervention effect, to assess trends in prescribing of various classes of antihypertensives. In particular, the program aimed to increase the prescribing of thiazide diuretics and beta blockers. RESULTS: Consistent with key intervention messages, the program achieved an increase in low-dose thiazide and beta blocker prescribing. The rate of prescribing of low-dose thiazides doubled from 1.1 per 1000 consultations in October 1999 to 2.4 per 1000 in October 2003. Beta-blocker utilisation showed a more modest but significant increase over the time of the study, with the change in observed versus expected rate of prescribing increasing by 8% by April 2004. Therapeutic options for treating hypertension changed markedly in the time of the study with the advent of ACE inhibitor/Angiotensin II receptor antagonists and thiazide combination products. It is important, therefore, to interpret the results in light of these changes. CONCLUSION: A national education program aimed at GPs was successful in improving prescribing for hypertension. Lessons learned will be applied in evaluation of future NPS programs and are also applicable to analysis of other interventions aimed at influencing prescribing behaviour.     

Anticoagulant treatment of patients in Swedish primary health care

OBJECTIVE: Assessing the quality of anticoagulant (AC) treatment in primary health care with regard to safety. DESIGN: Surveys of patients on AC treatment during 1999. SETTING: Community health centres (CHCs) in the northeastern region of Stockholm County. SUBJECTS: Nine hundred and fifty-seven patients, from 16 CHCs. MAIN OUTCOME MEASURES: Rate of bleeding and thromboembolic events during AC treatment and rate of values within the recommended treatment interval. The reporting of prothrombin-time (PT) results changed during the year from PT values to international normalised ratio (INR). RESULTS: A total of 48 bleeding events in 44 patients were noted, i.e. 6.8 per 100 patient-years. Of these, ten were major bleedings, 1.4 per 100 patient-years, including three fatal bleedings, 0.4 per 100 patient-years. Six thrombo-embolic events were noted during treatment, i.e. 0.8 per 100 patient-years. Bleeding events were more common at INR values greater than 2.80 than at values of 2.80, [relative risk (RR) 3.30, 95% confidence interval 1.90-5.71]. Of all the noted PT values, 65% were within the recommended intervals (the most common being PT 15-25%) and of all noted INR values 60% (the most common being INR 2.1-3.0). No differences in the rate of bleeding or the number of thrombo-embolic events between the periods of PT and INR results were found. CONCLUSIONS: The rate of complications was low and AC treatment in primary health care seems to be as safe as in hospital clinics.     

基层医院241例高血压住院患者抗高血压药物使用分析

目的 了解基层医院高血压住院患者抗高血压药的使用情况.方法 随机抽取该院2007年1月1日-2009年月1月1日第一诊断为高血压的住院患者241例,对其病史、并发症、用药种类、联用药情况进行统计分析.结果 住院患者中80.50%既往有高血压病史,93.78%的患者有并发症,住院期间最常用的抗高血压药是钙通道阻滞剂,有80.91%的患者采用联合用药进行治疗.结论 该院抗高血压药使用基本合理.     

Evaluation of drug use practices at primary healthcare centers of Kuwait

Purpose  

The aim of this study was to investigate current prescribing and dispensing practices at primary healthcare centers in Kuwait and compare them with those reported in other countries.     

Persistence with pharmacological treatment in the specialist mental healthcare of patients with severe mental disorders

Purpose

The aim of this study was to measure persistence with pharmacological treatment in the specialist mental healthcare of patients with schizophrenia, bipolar disorder, and unipolar depression in Lombardy, a region of 10 million inhabitants located in the northernmost part of Italy.

Methods

The data concerning psychiatric care used in this study were retrieved from the regional Psychiatric Information System, while information on drug treatment was retrieved from the regional administrative database. Time to lack of persistence with initial pharmacological treatment was the outcome measure.

Results

A total of 11,797 patients, followed in the specialist mental healthcare system, started a new pharmacological treatment for depression, schizophrenia, or bipolar disorder during 2007. Overall, 8,500 patients (72.1%) discontinued treatment during the 12?month follow-up, with a median duration of 101?days. Very similar discontinuation rates were observed in patients with unipolar depression, schizophrenia, and bipolar disorder. In the multivariate analysis, operational definitions of continuity and intensity of care were the most robust determinants of persistence with drug treatment in each of the three cohorts of psychiatric diagnoses.

Conclusions

High rates of treatment discontinuation were found in a population of patients with severe mental disorders followed in the specialist mental healthcare system of an Italian region, with no differences among patients with unipolar major depression, schizophrenia, and bipolar disorder. These findings corroborate the notion that the problem of treatment discontinuation in psychiatric disorders is a factor related to the capacity of the mental health system to assure and maintain continuity and intensity of care.     

酸枣仁汤加味联合常规降压药物治疗原发性高血压伴焦虑症的临床效果

目的研究酸枣仁汤加味联合常规降压药物治疗原发性高血压伴焦虑症的临床效果。方法收集2013年6月~2014年1月本院收治的原发性高血压伴焦虑症患者60例,随机分为实验组和对照组,各30例,实验组采用酸枣仁汤加味联合常规降压药物治疗,对照组采用常规降压药物治疗。治疗8周后评定两组的疗效。结果两组治疗后血压水平均有所降低,实验组降低较对照组明显,差异有统计学意义（P〈0.05）。两组治疗后的HAMA评分均较治疗前有显著改善,且实验组较对照组改善更明显,差异有统计学意义（P〈0.05）。实验组的降压总有效率及焦虑治疗总有效率明显高于对照组,差异有统计学意义（P〈0.05）。结论酸枣仁汤加味联合常规降压药物治疗原发性高血压伴焦虑症的效果显著,值得临床推广应用。     

抗高血压药物使用中的注意事项

抗高血压药在我院药品的消耗金额中占很大份额，品种主要有：硝苯地平、尼群地平、维拉帕米、长效心痛定、波依定、吲达帕胺、螺内酯、阿替洛尔、倍他乐克、卡托普利、复方罗布麻、北京降压0号、珍菊降压片等，由于我院做到了合理选择使用，遵循阶梯治疗原则和注意这些药物的不良反应，取得了更好的治疗效果。     

Linkage into specialist hepatitis C treatment services of injecting drug users attending a needle syringe program-based primary healthcare centre

Injecting drug users (IDUs), the key risk population for hepatitis C virus (HCV) infection, constitute just a small proportion of HCV treatment clients. This study describes an HCV treatment assessment model developed by an inner-city IDU-targeted primary healthcare (PHC) facility and, using a retrospective clinical audit, documents predictors of successful referrals to a tertiary liver clinic. Between July 2006-December 2010, 479 clients attended the PHC, of whom 353 (74%) were screened for HCV antibody. Sixty percent (212/353) tested positive, of whom 93% (197/212) were screened for HCV-RNA with 73% (143/197) positive. Referrals to a tertiary liver clinic were provided to 96 clients, of whom 68 (71%) attended. Eleven clients commenced antiviral therapy (AVT), with seven achieving sustained virological responses by December 2010. Clients who had not recently injected drugs and those with elevated ALT levels were more likely to attend the referrals, while those not prescribed psychiatric medications were more likely to commence AVT. The relatively high uptake of referrals, the number of individuals commencing AVT and final treatment outcomes are reasonably encouraging, highlighting the potential of targeted PHC services to facilitate reductions in liver disease burden among IDUs.     

Chemopreventive drug treatment in subjects with genetic predisposition to cancer: prescriber liability and healthcare disparities

Advancements in pharmacogenomics and chemoprevention promise to reduce cancer incidence and mortality, but utilization will undoubtedly be accompanied with ethical and legal issues that largely remain unexplored or discussed. As pharmacogenomic information is assessed more comprehensively and inexpensively, it will influence decisions regarding when and to whom chemoprevention therapy will be initiated. Pharmacogenomics will change the manner in which the liability system will perceive and analyse risks. Management of the risks related to chemopreventive treatment will differ from traditional disease management. Knowledge about cancer susceptibility will need to consider environmental factors as they relate to healthcare disparities.     

降压治疗中的J形曲线:临床证据带来的困惑和启示

在高血压的循证治疗中,始终存在着相矛盾的临床证据。人群调查显示,血压越低心血管病危险越少。因此,不少学者坚信,在患者耐受的情况下,应力争最大限度地降低血压。也有一些临床研究证实,血压降到一定程度后,反而增加心血管事件的危险,出现所谓的J形曲线。本文回顾性综述上述两种观点近几年的临床研究证据,为正确认识这些研究结果,制定科学合理的血压管理策略提供依据。     

Effects of antihypertensive drug treatment on the risk of dementia and cognitive impairment

Dementia is a common and serious health problem that affects 33 million persons globally. With the increase in life expectancy, the prevalence of dementia is expected to reach 81.1 million persons by 2040. Dementia impairs quality of life and is associated with profound disease burden, morbidity, and mortality in both patients and caregivers. Therefore, identifying measures to prevent dementia is a research priority. Midlife hypertension has increased the risk of dementia in large prospective cohort studies. Researchers have investigated the blood pressure-lowering effects of antihypertensive drugs on the incidence of dementia. Although prospective cohort studies have shown that use of antihypertensive drugs was associated with a reduced rate of cognitive impairment and dementia, these studies were not placebo controlled. Four randomized, placebo-controlled studies-the Systolic Hypertension in Europe (Syst-Eur) study, Study on Cognition and Prognosis in the Elderly (SCOPE), Systolic Hypertension in the Elderly Program (SHEP), and Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-investigated the effects of antihypertensive agents on the incidence of dementia. The Syst-Eur study found that active treatment with nitrendipine, enalapril, and/or hydrochlorothiazide reduced the rate of dementia by 50% compared with placebo (p=0.05). The PROGRESS study showed that active treatment with perindopril and indapamide was associated with reduced cognitive decline compared with placebo (risk ratio 19%, p=0.01). In contrast, the SCOPE study (candesartan or hydrochlorothiazide vs placebo) and the SHEP trial (chlorthalidone, atenolol, or reserpine vs placebo) found no significant difference between the active treatment and placebo groups on the incidence of dementia. Some researchers have suggested that certain antihypertensive drug classes, such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, and calcium channel blockers, may offer benefit in reducing dementia risk in addition to their blood pressure-lowering effect. Further prospective randomized studies comparing different antihypertensive classes are needed to provide more evidence regarding the effects of antihypertensive drugs on dementia risk and to determine whether certain antihypertensive classes provide greater benefits than others.