Spanish Primary Care Centres Research Articles

Study protocol for a randomized, controlled trial comparing the efficacy of two educational interventions to improve inhalation techniques in patients with chronic obstructive pulmonary disease (COPD): TIEPOC Study.

An appropriate inhalation technique and adherence to treatment are both critical determinants of the success of chronic obstructive pulmonary disease (COPD) management. We have observed that up to 75% of patients do not use a successful inhalation technique. Knowledge evaluation and frequent reassessment of inhaler use, together with education of patients and healthcare professionals, can significantly improve the benefits that patients with COPD will derive from inhaler therapy. The objective of this study is to test the efficacy of two educational interventions to improve inhalation techniques in patients with COPD. Multicenter randomized controlled trial with 296 patients diagnosed with COPD selected by a non-probabilistic method of sampling from seven Spanish Primary Care Centers. The patients will be divided into three groups by block randomization. The three groups are: 1) control; 2) Intervention A; and 3) Intervention B. The control group will comprise patients with no explanations or written information; the Intervention A group will comprise patients to whom we give written information only; and the Intervention B group will comprise patients to whom we give written information plus instructor training. Every patient in each group will be visited four times during the year of the study at the health centers. Our hypothesis is that the application of educational interventions (A or B) in patients with COPD who use inhaler therapy will increase the number of patients who perform a correct inhalation technique by at least 25%. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, where feasible within the context of clinical practice.

Therapeutic inertia in hypercholesterolaemia is associated with ischaemic events in primary care patients. A case-control study

The frequency of therapeutic inertia (TI) is very high in the management of vascular risk factors, although its impact on the incidence of ischaemic events is not well-established. Our aim was to investigate the relationship between TI in the treatment of hypercholesterolaemia and the appearance of ischaemic events. An observational, multicentre, case-control study was conducted in 70 primary care centres in Spain. Case subjects (n=235) were high-risk hypercholesterolaemic patients (both genders, ≥18years) who had had a first event in the 12months prior to recruitment. They were matched with 235 controls (by vascular risk, age and gender). The observation period was 18months prior to the onset of a first event (cases) or to date of recruitment (control subjects). The TI in the basal visit (an average of 7.8months before the event) was slightly higher in cases than in controls (39.7% vs. 34.8%, NS). However, the accumulated TI was similar in both groups (70.7% for cases and 73.95% for controls, NS). The multivariate analysis, taking ischaemic events as the dependent variable, showed that the TI at baseline visit was significantly associated with the development of the event [OR 2.18 (95% CI 1.04-4.51), p<0.05]. Other variables also associated with the ischaemic event were a family history of premature vascular disease [OR 3.38 (95% CI 1.35-8.49), p<0.05] and uncontrolled hypertension [OR 2.35 (95% CI 1.02-5.43), p<0.05]. The TI in high-risk hypercholesterolaemic patients in primary prevention in Spanish primary care centres doubled the risk of an ischaemic event in the short term.

Comorbidity of dementia: a cross-sectional study of primary care older patients

BackgroundThe epidemiologic study of comorbidities of an index health problem represents a methodological challenge. This study cross-sectionally describes and analyzes the comorbidities associated with dementia in older patients and reviews the existing similarities and differences between identified comorbid diseases using the statistical methods most frequently applied in current research.MethodsCross-sectional study of 72,815 patients over 64 seen in 19 Spanish primary care centers during 2008. Chronic diseases were extracted from electronic health records and grouped into Expanded Diagnostic Clusters®. Three different statistical methods were applied (i.e., analysis of prevalence data, multiple regression and factor analysis), stratifying by sex.ResultsThe two most frequent comorbidities both for men and women with dementia were hypertension and diabetes. Yet, logistic regression and factor analysis demonstrated that the comorbidities significantly associated with dementia were Parkinson’s disease, congestive heart failure, cerebrovascular disease, anemia, cardiac arrhythmia, chronic skin ulcers, osteoporosis, thyroid disease, retinal disorders, prostatic hypertrophy, insomnia and anxiety and neurosis.ConclusionsThe analysis of the comorbidities associated with an index disease (e.g., dementia) must not be exclusively based on prevalence rates, but rather on methodologies that allow the discovery of non-random associations between diseases. A deep and reliable knowledge about how different diseases are grouped and associated around an index disease such as dementia may orient future longitudinal studies aimed at unraveling causal associations.

Overuse of bronchodilators and steroids in bronchiolitis of different severity: Bronchiolitis-study of variability, appropriateness, and adequacy

BackgroundIn the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. MethodsThis is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference. ResultsThere was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases. ConclusionsIn acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.

Evaluación del impacto de la utilización de medicamentos en dosis unitarias en 2 centros de atención primaria

ObjectiveTo evaluate the economical impact of using medications packaged in a single dose non-reusable container (Onedose®), compared to prescribing preparations in the usual multidose containers. DesignWe performed a cost-minimization analysis from a prescribing center's perspective. The observational study design is retrospective and analyzes 23 products in prescriptions made between January and April 2012. SettingTwo Spanish Primary Care Centers located in the province of Barcelona. The first covered an urban area with a population of 24.500 people, and the second a semi-urban area with 10.000 people. Primary outcome measuresEach examined product was measured between January and April 2012 and extrapolated annually, based on the defined substitution scenarios results of total Euro savings in non-prescribed doses and price differences. ResultsThe Savings related to the substitution of the prescribed packaging presentations with Onedose® were 45.000 Euros (24%) in the months of analysis and 133.000 Euros annually, avoiding the use of 212.000 doses (14%) in the period analyzed and 669.000 doses annually. ConclusionsThe use of single dose non-reusable container packaging (Onedose®) in the analyzed health centers reduced prescription-related expenses without increasing dispensing costs, thus reducing the household stock of those medicines which are not objectively suitable to be used without a previous diagnosis.

Do Patients With High Vascular Risk Take Antihypertensive Medication Correctly? Cumple-MEMS Study

Introduction and objectivesTo assess compliance with treatment inhibit the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) in uncontrolled hypertension in patients at high cardiovascular risk. MethodsProspective, longitudinal, multicenter study, carried out in 102 Spanish primary care centers. We included 808 uncontrolled hypertensive patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers who were at high vascular risk; 4 visits were conducted: baseline and 1, 3, and 6 months later. Compliance was measured by electronic monitors. We calculated the mean percentage compliance, the overall percentage of compliers, once-daily compliers, compliers with the prescribed time frame, and antihypertensive coverage. We considered a patient to be a complier when the percentage compliance was 80%-100%. ResultsIn all, 701 patients completed the study (mean age, 63.7 [11.1] years). The systolic and diastolic blood pressures decreased significantly (P<.0001) to 18.8mmHg and 9.8 mmHg, respectively. The control rate was 70% (95% confidence interval, 65.6%-74.4%) (P=.0001). The rate of control was significantly higher among compliers than noncompliers (P<.05). The mean percentage of doses taken was 87.9% (95% confidence interval, 84.8%-91%) and the mean therapeutic coverage was 82.4% (95% confidence interval, 78.7%-86.1%). Overall, 73.3% of the patients were compliers (95% confidence interval, 69%-77.6%), 52.8% (95% confidence interval, 48%-57.6%) were once-daily compliers, and 46.5% (95% confidence interval, 41.9%-51.1%) complied with the prescribed time frame. Noncompliance was associated with a higher number of drugs prescribed (P<.001). ConclusionsIn hypertensive patients at high vascular risk, the rate of therapeutic noncompliance was very high, mainly when they took 5 or more pills daily.

¿Los pacientes con alto riesgo vascular toman correctamente la medicación antihipertensiva? Estudio Cumple-MEMS

Introduction and objectivesTo assess compliance with treatment inhibit the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) in uncontrolled hypertension in patients at high cardiovascular risk. MethodsProspective, longitudinal, multicenter study, carried out in 102 Spanish primary care centers. We included 808 uncontrolled hypertensive patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers who were at high vascular risk; 4 visits were conducted: baseline and 1, 3, and 6 months later. Compliance was measured by electronic monitors. We calculated the mean percentage compliance, the overall percentage of compliers, once-daily compliers, compliers with the prescribed time frame, and antihypertensive coverage. We considered a patient to be a complier when the percentage compliance was 80%-100%. ResultsIn all, 701 patients completed the study (mean age, 63.7 [11.1] years). The systolic and diastolic blood pressures decreased significantly (P<.0001) to 18.8mmHg and 9.8 mmHg, respectively. The control rate was 70% (95% confidence interval, 65.6%-74.4%) (P=.0001). The rate of control was significantly higher among compliers than noncompliers (P<.05). The mean percentage of doses taken was 87.9% (95% confidence interval, 84.8%-91%) and the mean therapeutic coverage was 82.4% (95% confidence interval, 78.7%-86.1%). Overall, 73.3% of the patients were compliers (95% confidence interval, 69%-77.6%), 52.8% (95% confidence interval, 48%-57.6%) were once-daily compliers, and 46.5% (95% confidence interval, 41.9%-51.1%) complied with the prescribed time frame. Noncompliance was associated with a higher number of drugs prescribed (P<.001). ConclusionsIn hypertensive patients at high vascular risk, the rate of therapeutic noncompliance was very high, mainly when they took 5 or more pills daily.Full English text available from:www.revespcardiol.org

Trends in chronic complications of type 2 diabetic patients from Spanish primary health care centres (GEDAPS study): Ten year-implementation of St. Vincent recommendations

AimsTo assess the implementation of St. Vincent recommendations in Catalonia (Spain) between 1993 and 2003 following a program of Continuous Quality Improvement. Methods65 health centres (433 health professionals) took part in the study. From 1993 to 2003, 34 workshops on consensus guidelines and feedback referring to the variables that needed to be improved were carried out. Data collection was obtained concerning, socio-demographic information, and disease characteristics and complications from patients with type 2 diabetes mellitus (DM). ResultsMost cardiovascular risk factors improved: glycosilated haemoglobin (HbA1c) was reduced by 0.7% (95% CI: −0.49:−0.90); total cholesterol by 0.54mmol/L (95% CI: −0.53:−0.55); non-high density lipoprotein cholesterol by 0.81mmol/L (95% CI: −0.80:−0.82); systolic blood pressure (SBP) by 6.02mmHg (95% CI: −5.79:−6.25), and diastolic blood pressure (DBP) by 2.65mmHg (95% CI: −2.4:−2.9), with the exception of smoking and obesity, which increased by 2.1% and 5.9%, respectively.Retinopathy and albuminuria decreased by 40.7% and 46% (p<0.001), respectively. The incidence of diabetic foot lesions and amputations decreased by 65.7% and 61.1% (p<0.001), respectively. The prevalence of macrovascular complications showed a slight reduction (p=0.037). Ischemic cardiomyopathy and cerebrovascular accidents decreased by 7.7% and 17.6%, respectively. ConclusionsOur Continuous Quality Improvement program based on St. Vincent recommendations, had a positive impact on cardiovascular risk factors. We observed a reduction of chronic complications in type 2 DM patients.

Lessons Learned from Implementation of Information and Communication Technologies in Spain’s Healthcare Services

Spain's health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population's needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type. To better understand the success criteria, the difficulties encountered and certain issues that must be kept in mind to ensure successful implementation of ICT projects in health organizations, based on Spain's experiences in this field. The projects' results are analyzed using the criteria of compliance with the expected scope, cost and time frame. The results can be considered satisfactory in primary care facilities, where almost 90% of Spain's general practitioners, pediatricians and primary care nurses are using electronic health record (EHR) systems. In hospitals EHR implementation is more uneven. Over 40% of Spanish primary care centers and 42% of pharmacies are using electronic prescription (the information system that connects the physician to the dispensing pharmacy and the dispensing pharmacy to the payer). All of Spain's health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR.

Factibilidad de la medición en atención primaria de la fracción exhalada de óxido nítrico en niños con asma. Estudio CANON

Aim Asses the feasibility of exhaled nitric oxide (FeNO) measurement in asthmatic children using a hand-held device in the primary care setting. Methods Multicentre study performed in the paediatric clinics in seven Spanish primary health care centres. Each centre consecutively included 6–14 year-old children with doctor-diagnosed asthma. Children were asked to obtain two valid measurements of FeNO with the hand-held device NIOX MINO ® (Aerocrine AB, Solna, Sweden). Feasibility analysis included: (a) percentage of children able to perform the manoeuvre, (b) time required to obtain a successful determination, (c) number of attempts needed, and (d) acceptability of the technical procedure by clinical personnel involved in their guidance. Results The Study enrolled 151 children. A total of 149 (98.7%) were able to perform the FeNO manoeuvre. The majority (55%) of children had previous experience of using the hand-held device. The Overall median (and Interquartile Range, IQR) of attempts needed to reach a first valid measurement was 2 (1–3) and median (IQR) of time taken was 4 min (3–5). Nurses considered the overall procedure was very easy or easy in 87.8% (teaching) and 86.5% (performing) of children. Children with previous experience performed the manoeuvre in less attempts, less time and more easily than children without experience. Conclusions Measurement of FeNO using NIOX MINO ® device is technically feasible and acceptable for children and staff in the clinical context of asthma management in primary health care. Previous experience had a positive, learning effect, in teaching and performing the FeNO manoeuvre.

Adequacy of Antidepressant Treatment in Spanish Primary Care: A Naturalistic Six-Month Follow-Up Study

This study evaluated the adequacy of pharmacological antidepressant treatment in major depressive episodes prescribed in 16 Spanish primary care centers, both during the acute phase of treatment and after the first three months of the continuation phase, under real-world naturalistic conditions (usual care). Factors that could be associated with adequacy of care also were explored. A total of 333 patients from primary care who began pharmacological antidepressant treatment were followed up for six months. Treatment adequacy and associated factors were evaluated. Between 27% and 32% of patients received adequate antidepressant treatment during the acute phase. Percentages of adequacy were between 21% and 25% when considering the acute phase and the first three months of the continuation phase. Psychiatric consultations were found to be associated with treatment adequacy. In state-funded Spanish primary care centers, antidepressant treatment adequacy was poor during both the acute phase and the first three months of the continuation phase. Primary care physicians prescribed suggested antidepressants, mostly as recommended (99%) and at adequate dosages. However, they did not perform the recommended number of follow-up sessions and treated patients with depressive disorders other than major depression as if they had a major depressive episode. Collaborative interventions between primary and specialized care could improve treatment adequacy.

Estimación de la prevalencia, incidencia, comorbilidades y costes directos asociados en pacientes que demandan atención por ictus en un ámbito poblacional español

To determinate the prevalence, incidence, co-morbidities and therapeutic objectives and costs of stroke among Spanish population. A retrospective study was performed based on data from patients attended for stroke, aged > 30 years, from five Spanish primary care centres and two hospitals in 2006. Comparative group: patients without stroke. Main analysed variables were: age, sex, co-morbidity (cardiovascular/others), clinical parameters and direct costs (pharmacy, derivations, visits, emergencies, procurement, and hospitalisation). An ANCOVA analysis and logistic regression were used to fit the model. A 4.5% of 57.026 patients (n = 2.585; CI 95% = 4.3-4.7%) suffered stroke. The incidence of stroke was 220 new-cases/100.000 populations. Main differences between patients suffering stroke/control group were: age (72.5 vs. 53.5), men (58.2% vs. 44.6%), episodes/year (7,9 vs. 4,8), visits/year (15,8 vs. 8,1), p < 0,001. Stroke had an independent relation with age (OR = 1,4), male (OR = 2,3), diabetes (OR = 1,6), hypertension (OR = 1,5), smoking (OR = 1,5), alcohol (OR = 1,4), depression (OR = 1,4), dyslipidemia (OR = 1,3) and dementia (OR = 1,2). Some of the results were: systolic pressure (134.1 vs. 127.6 mmHg) and LDL-cholesterol (116.4 vs. 126.2 mg/dL), in presence/absence of stroke, p < 0,001. The average of annual costs of stroke was 2,590.36 vs. 985.26 euros, p < 0.001. After the correction of the logistic model results did not change: 1,774.33 (CI 95% = 1,720.10-1.828.55) vs. 1,021.98 euros (CI 95% = 1,010.92-1,033.03), p < 0,001. All components of costs were higher in the stroke group. Patients that demanded assistance for stroke had a higher number of co-morbidities and a higher total cost/patient/year. Therapeutic objectives could be improved, mainly in primary prevention of cardiovascular risk factors.

Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain

The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; P<0.001). The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

Differences in Blood Pressure Control and Stroke Mortality Across Spain

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG-left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=-0.42; P<0.05) and prevalence of ECG-left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

Effective Ambulatory Blood Pressure Control in Medical Practice

A large number of studies has addressed the question of how effective is blood pressure (BP) control in the hypertensive population,1–3 with a consistent and unequivocal answer. That is, BP control is disappointingly low, because only a small fraction of patients diagnosed as having a BP elevation show on-treatment BPs <140 mm Hg systolic and 90 mm Hg diastolic, which are the target values for treatment recommended by international guidelines.4,5 This is the case regardless of whether patients are followed by general practitioners or specialists6,7 and have a low or high cardiovascular risk profile,8–10 the latter condition making the need of BP control even more compelling given the imminent risk of a cardiovascular event. Reality is obviously even worse when the lower BP targets that have been shown to be additionally protective in high-risk hypertensive patients, that is, <130/80 mm Hg, are considered.4,5 In a recent study performed in Italy, for example, we have shown that in diabetic (and, thus, high risk) hypertensive patients followed by general practitioners, an on-treatment BP <130/80 mm Hg was achieved in only 3% of the sample,7 the conclusion being that …

116 Heart failure in hypertensive patients managed in Spanish primary care centres. The HICAP study

116 Heart failure in hypertensive patients managed in Spanish primary care centres. The HICAP study

Treatment of hypertension in Spanish primary care centres: is it evidence based?

One of the problems with medical prescriptions is that the evidence upon which many professional decisions are made is scarce and poor. In this sense there are numerous forms of prevention diagnostics and therapeutics performed by physicians indifferent clinical environments. Furthermore, over recent years, the development of new drugs has accelerated, and the control of multiple risk factors, including cholesterol, has become a critical factor in preventing primary and secondary coronary events. Despite the compelling evidence of the benefits of statin therapy, many surveys carried out over the past decade to monitor both diagnosis and treatment of the risk factors involved have revealed that a wide gap in treatment exists during the implementation of evidence-based medicine. The purpose of the World Health Organization Drug Utilization Research Group-Spain (DURG-E) is to secure advances in drug utilization research. However, such efforts remain insufficient, mainly due to the little interest shown by the healthcare services in applying suitable methods to evaluate both new procedures and those already established in the healthcare system. Physician surveys and practice audits have shown that the approach to the diagnosis, investigation and treatment of hypertension differs not only among geographic areas, but also among physicians in one given geographic area, and also with the course of time. This variation may have a detrimental effect on the effectiveness and efficiency of care. Various data have been published about the proportion of medical practice that is evidencebased medicine: 82% according to Ellis (of which 53% is based on clinical trials and 29% on nonexperimental studies), 21%, 15%, and 25.4 and 41.8% (based on clinical trials and non-experimental studies, respectively). From all the consultations made during visits to primary care physicians in Spain, and in other countries, the diagnosis of hypertension is the most common. The way in which physicians treat hypertension affects both hypertension control Public Health (2004) 118, 594–598

Management pattern for patients with osteoarthritis treated with traditional non-steroidal anti-inflammatory drugs in Spain prior to introduction of Coxibs

SUMMARYObjectives: To investigate the use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in the management of osteoarthritis (OA) in primary care in Spain and to quantify patient and physician satisfaction with tNSAID therapy.Methods: A 6-month retrospective, observational study conducted in 29 Spanish primary-care centres shortly before the first introduction of selective COX-2 inhibitors (Coxibs).Results: A total of 897 patients with a mean age 66 ± 9 years and radiologically documented OA were included: most (76%) were women. Three-quarters of the patients had primary generalised OA, with the knees (>60% of cases) and lumbar spine (>50% of cases) being the sites most commonly affected. Pain was an almost universal feature of the clinical presentation.More than 96% of patients had been prescribed tNSAIDs during the observation period, predominantly for pain relief. The most commonly prescribed agents were diclofenac, aceclofenac and piroxicam.Twenty-six per cent of discontinuations of tNSAIDs during the observation period were due to limited effectiveness of these drugs, making this the largest single cause of discontinuation apart from prescription expiry. Almost half of patients and physicians (46% in both categories) were not satisfied with OA treatment and only one patient in six regarded their overall health status during tNSAID therapy as satisfactory.Gastroprotective medications (GPMs) were prescribed for just over half the participating patients (51%), but use of these drugs appeared haphazard: 25% of those who received GPMs had no compelling indications for this therapy whereas more than half of the patients at high risk for gastrointestinal complications on the basis of clinical criteria were not receiving GPMs.Conclusions: There is a high level of dissatisfaction with tNSAID therapy of OA, arising in large part from a perception among many patients and physicians that these drugs are not always adequately effective in relieving the symptoms of this disease. These findings, together with the low patient perceptions of general health, indicate the need for new therapeutic approaches to OA.

Experience of rofecoxib in patients with osteoarthritis previously treated with traditional non-steroidal anti-inflammatory drugs in Spain:results of phase 2 of theVICOXX study

SUMMARYObjectives: To compare patient and physician attitudes to osteoarthritis (OA) treatment with rofecoxib or traditional non-steroidal anti-inflammatory drugs (tNSAIDs).Methods: A 6-month prospective study involving 562 OA patients enrolled at 29 Spanish primary-care centres. Patients were continued on established tNSAID therapy for the first 3 months then switched to rofecoxib 12.5 or 25 mg/day.Results: Both patients and physicians were significantly more likely to be satisfied with rofecoxib treatment than with tNSAIDs (p < 0.001) and assessments of overall health status improved significantly during rofecoxib therapy (p < 0.001). Adherence to therapy was significantly better with rofecoxib than during tNSAID treatment (p < 0.001). Use of rofecoxib was associated with a significant reduction in the proportion of discontinuations attributed to lack of effectiveness (p < 0.001) or gastrointestinal (GI) adverse events (p < 0.001 compared with tNSAIDs). Rofecoxib was also associated with a >60% reduction in the proportion of patients experiencing a GI adverse event and a halving in the proportion of patients who received GI co-medications; concomitant analgesic use decreased by one-third during rofecoxib therapy.Conclusions: Use of rofecoxib was associated with marked improvements in several indices of treatment effectiveness and tolerability, and in patient and physician satisfaction and perception of general health status compared with tNSAIDs. Rofecoxib is a valuable additional medication for relieving the symptoms of OA and its use in place of tNSAIDs may lead to a reduction in the prescription of concomitant medications.

Cardiovascular risk factors, drug treatment and hypertension control among pharmacologically treated hypertensive patients in SPANISH primary care centers

Cardiovascular risk factors, drug treatment and hypertension control among pharmacologically treated hypertensive patients in SPANISH primary care centers