Years In General Practice Research Articles

Trends in hypertension and hypertension treatment in primary care in general practices in Germany between 2013 and 2022.

There is a scarcity of data on the epidemiology of hypertension and its treatment in Germany in recent years. The present study aimed to investigate trends in the number of adults diagnosed with hypertension and those being prescribed antihypertensive drugs each year in general practices from this country between 2013 and 2022. This retrospective cohort study used data of adults aged ≥18 years continuously collected from 336 general practices in Germany (IQVIA) during 2013-2022. The diagnosis of hypertension and the prescription of antihypertensive drugs were coded using the ICD-10 and the EphMRA classification, respectively. Covariates included the total number of patients, mean (SD) age of patients, and proportion of women per practice. Trends in hypertension diagnosis and treatment were studied using linear regression models. The mean (SD) total number of patients per practice ranged from 2,235 (1,055) in 2013-2,845 (2,090) in 2021 (p-value < 0.001). The mean (SD) age of patients per practice was between 48.4 (21.5) and 50.5 (21.4) years, while the proportion of women was 52.1%-53.9% (p-values < 0.001). After adjusting for covariates, there was a significant decrease in the number of patients diagnosed with hypertension (beta coefficient = -7.91, p-value < 0.001) and treated with any antihypertensive drug per practice per year between 2013 and 2022 (beta coefficient = -5.40, p-value < 0.001). This study identified decreasing trends in the diagnosis and treatment of hypertension in general practices in Germany in the last decade. These data may suggest that the prevention of hypertension has improved in this country in recent years.

Longer in primary care: a mixed-methods study of the Welsh GP training model.

A new model of GP training was introduced in Wales, whereby trainees spend 1 year in hospital and 2 years in general practice (the 1+2 model), a change from the previous model of 18 months in each setting. To evaluate the 1+2 model of GP training in Wales. Longitudinal mixed-methods evaluation via repeated surveys and focus groups with GP trainers and trainees across the Welsh training schemes. Yearly surveys and focus groups were undertaken between June 2020 and December 2022. Quantitative survey data were analysed in SPSS. Qualitative survey data and focus group transcripts were analysed thematically. Spending more time in general practice was seen as a major benefit. The consensus was that general practice is the best place to learn essential consultation skills. Furthermore, general practice was viewed as a flexible educational setting where knowledge gaps can be addressed. The main concern about the 1+2 model was that trainees would miss experience of key specialties. However, as trainees progressed through the training programme, this concern diminished. All trainees and most trainers thought that the benefits of the 1+2 model outweighed drawbacks. Spending more time in general practice during GP training appears to improve how prepared trainees felt for practice. Future changes should explore options to enhance hospital experience without reducing time spent in general practice.

H18 James Clark White: a pioneer of American dermatology

Abstract James Clark White, a chemist, botanist and eminent dermatologist, was a born to a shipbuilder in Boston in 1833 and from a young age was fascinated by the natural world around him. White proceeded to study medicine at Harvard and spent a further year at the University of Vienna. He was taught by renowned dermatologists, including Ferdinand Von Hebra, whose detailed drawings and lectures in dermatology were pivotal to White’s interest in the field. White’s varied background in both chemistry and botany translated into his prolific academic work on environmental dermatoses. His famous Dermatitis Venenata: An Account of External Irritants Upon the Skin was the first to provide a collective resource of contact dermatitis, before the pathogenesis of these conditions was truly understood. Another instrumental piece, ‘A case of keratosis (ichthyosis) follicularis’ is now recognized as the first description of Darier disease, which was subsequently named Darier–White disease. White authored eight books and over 100 original articles that covered many areas of cutaneous disease. White returned to Massachusetts General Hospital where, after spending a few years in general practice, he devoted his career to skin disease. He developed the dermatology department into a centre of excellence and was ultimately appointed the first chair of dermatology. A founding member of the American Dermatology Society, and twice its chairman, he progressed to become the first full professor of dermatology in the USA. White spearheaded dermatological education at Harvard, extending the specialty training from 2 to 4 years and introduced an exit examination for residents. White is regarded as part of the vanguard that elevated American dermatology to European standards in the late nineteenth century. In his personal time, White was ardent collector of fine wines and china. He devoted much time reading and listing species of birds and plants that he encountered around his residence in Belfast, Maine. He died in September 1916. His family also had distinguished careers, including his son Charles J. White, who took over his practice to also become a professor of dermatology at Harvard Medical School; and a grandson, also named James C. White, a professor of neurosurgery at the same institution. Almost two centuries after his birth, White’s lifelong dedication to dermatology has produced many works that remain relevant and inspire the dermatologists of today.

Skinfold-based-equations to assess longitudinal body composition in children from birth to age 5 years

In order to identify children at risk for excess adiposity, it is important to determine body composition longitudinally throughout childhood. However, most frequently used techniques in research are expensive and time-consuming and, therefore, not feasible for use in general clinical practice. Skinfold measurements can be used as proxy for adiposity, but current anthropometry-based-equations have random and systematic errors, especially when used longitudinally in pre-pubertal children. We developed and validated skinfold-based-equations to estimate total fat mass (FM) longitudinally in children aged 0-5 years. This study was embedded in the Sophia Pluto study, a prospective birth cohort. In 998 healthy term-born children, we longitudinally measured anthropometrics, including skinfolds and determined FM using Air Displacement Plethysmography (ADP) by PEA POD and Dual energy X-ray Absorptiometry (DXA) from birth to age 5 years. Of each child one random measurement was used in the determination cohort, others for validation. Linear regression was used to determine the best fitting FM-prediction model based on anthropometric measurements using ADP and DXA as reference methods. For validation, we used calibration plots to determine predictive value and agreement between measured and predicted FM. Three skinfold-based-equations were developed for adjoined age ranges (0-6 months, 6-24 months and 2-5 years), based on FM-trajectories. Validation of these prediction equations showed significant correlations between measured and predicted FM (R: 0.921, 0.779 and 0.893, respectively) and good agreement with small mean prediction errors of 1, 24 and-96g, respectively. We developed and validated reliable skinfold-based-equations which may be used longitudinally from birth to age 5 years in general practice and large epidemiological studies.

One year of general practice during the COVID-19 pandemic - presentation and evaluation of digital medical education.

Background and teaching situation: The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture “General Practice” was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic.Methodology: Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis.Results: In terms of overall impression, the students (N=199) rated the lecture on average as “very good” (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work.Discussion and implications: The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students’ time investment and practical relevance of digital self-learning mechanisms.

Exploring a novel method for optimising the implementation of a colorectal cancer risk prediction tool into primary care: a qualitative study

BackgroundWe developed a colorectal cancer risk prediction tool (‘CRISP’) to provide individualised risk-based advice for colorectal cancer screening. Using known environmental, behavioural, and familial risk factors, CRISP was designed to facilitate tailored screening advice to patients aged 50 to 74 years in general practice. In parallel to a randomised controlled trial of the CRISP tool, we developed and evaluated an evidence-based implementation strategy.MethodsQualitative methods were used to explore the implementation of CRISP in general practice. Using one general practice in regional Victoria, Australia, as a ‘laboratory’, we tested ways to embed CRISP into routine clinical practice. General practitioners, nurses, and operations manager co-designed the implementation methods with researchers, focussing on existing practice processes that would be sustainable. Researchers interviewed the staff regularly to assess the successfulness of the strategies employed, and implementation methods were adapted throughout the study period in response to feedback from qualitative interviews.The Consolidated Framework for Implementation Research (CFIR) underpinned the development of the interview guide and intervention strategy. Coding was inductive and themes were developed through consensus between the authors. Emerging themes were mapped onto the CFIR domains and a fidelity checklist was developed to ensure CRISP was being used as intended.ResultsBetween December 2016 and September 2019, 1 interviews were conducted, both face-to-face and via videoconferencing (Zoom). All interviews were transcribed verbatim and coded. Themes were mapped onto the following CFIR domains: (1) ‘characteristics of the intervention’: CRISP was valued but time consuming; (2) ‘inner setting’: the practice was open to changing systems; 3. ‘outer setting’: CRISP helped facilitate screening; (4) ‘individual characteristics’: the practice staff were adaptable and able to facilitate adoption of new clinical processes; and (5) ‘processes’: fidelity checking, and education was important.ConclusionsThese results describe a novel method for exploring implementation strategies for a colorectal cancer risk prediction tool in the context of a parallel RCT testing clinical efficacy. The study identified successful and unsuccessful implementation strategies using an adaptive methodology over time. This method emphasised the importance of co-design input to make an intervention like CRISP sustainable for use in other practices and with other risk tools.

On the Road from Books to Thomas Lilti's Screen: Where Are the Country Doctors Heading?

On the Road from Books to Thomas Lilti's ScreenWhere Are the Country Doctors Heading? Peter I. Barta (bio) "L'homme est un apprenti, la douleur est son maître" —alfred de musset: "la nuit d'octobre"1 Thomas Lilti (1976–), the French physician and internationally renowned film director, has attained significant recognition for three thematically related films on doctors, offering a kaleidoscopic cinematic representation of the state of medicine in contemporary France and beyond.2 The films are thematically linked and form a trilogy about the training of physicians, life in a large teaching hospital in the metropolis, and general practice in the country. They have elicited an unprecedentedly high level of engagement from the junior physicians in internal medicine on our courses in medical humanities at Texas Tech University Health Sciences Center. Lilti's cinema focuses on the physician as a vulnerable human subject. The first in the trilogy, the film Hippocrate (Hippocrates)—released in 2014—traces the fortunes of a junior doctor (Benjamin Barois, played by Vincent Lacoste) doing his residency in a large Parisian teaching hospital where his own father is the statutory professor and medical director. Actors in the main roles carry over to the two subsequent films. Marianne Denicourt (Dr. Denormandy in Hippocrate) plays the female lead—Dr. Nathalie Delezia—in the second film, Médecin de Campagne (Irreplaceable, 2016)3 and Vincent Lacoste is cast as the central character both in Hippocrate and the third film, Première Année (The Freshmen, 2018).4 The educational aspect dominates not only Hippocrate but the other two films as well: the plot of [End Page 54] Médecin de Campagne involves an established male general practitioner and a junior female doctor joining his practice in a rural area, and Première Année relates the friendship of two first-year medical students at a university in Paris. The specific focus of this article will be on Médecin de Campagne, the artistically most successful piece in the trilogy. Thematically it connects the village doctor with both the world of the hospital and the concerns about training junior physicians. Furthermore, the film unpacks problems related to the gradual disappearance of general practice, especially in remote rural areas. The title alludes to earlier literary texts about the physical and emotional life of "country doctors" whose profession obliges them constantly to be at the service of others in order to prolong lives and remove or minimize pain. Lilti updates these concerns with a clear view of today's shifting paradigm in the medical world where new technologies and corporate business interests keep diminishing the role of the physician. With this in mind, my purpose here will be to assess the place of Lilti's film in its literary context. Lilti's excellent knowledge of his subject matter has been discussed in multiple interviews, including my own with Marianne Denicourt in this issue. Lilti did his residency in a large teaching hospital after he had obtained his medical qualifications. Then he spent many years in general practice. His creation of the characters in Médecin de Campagne undoubtedly draws upon close familiarity with the work they do. "I like having direct contact with patients, and the idea of taking care of several generations of one family. That appealed more to me than surgery, for instance," he said in an interview.5 The trilogy's focus on apprenticeship, professional conflicts at work, and problematic family relations has been the subject of televised and published conversations with Lilti. From these it emerges that Lilti's father is a physician specializing in obstetrics and gynecology and that evidently, he was not especially keen for his son to pursue a career in the arts.6 Lilti comments: "I have always felt the lack of paternal recognition. I grew up feeling constantly deprecated by the doctor father of whom I felt unworthy. I had the impression of never being sufficiently handsome, cultured or intelligent."7 Lilti, unlike his two brothers, became a physician to demonstrate that he does not lack his father's abilities to pursue a career in medicine. The father-son [End Page 55] rivalry and the bad relations between the...

Association between osteoarthritis and the incidence of Parkinson’s disease in the United Kingdom

BackgroundLittle is known on the potential relationship between osteoarthritis and Parkinson’s disease. ObjectiveTherefore, the objective of this retrospective cohort study was to analyze the association between osteoarthritis and the incidence of Parkinson’s disease in patients followed up for up to 10 years in general practices in the United Kingdom. MethodsThis study included patients diagnosed for the first time with osteoarthritis in one of 256 general practices in the United Kingdom between 2000 and 2016 (index date). Patients without osteoarthritis were matched (1:1) to those with osteoarthritis using propensity scores based on sex, age and index year. In individuals without osteoarthritis, index date corresponded to a randomly selected visit date. The outcome of this study was the 10-year cumulative incidence of Parkinson’s disease in patients with and without osteoarthritis. Cox regression analyses were adjusted for common comorbidities. ResultsThis study included 260,224 patients (62.0% women; mean [SD] age 66.4 [12.7] years). The 10-year cumulative incidence of Parkinson’s disease was 1.2% in patients with osteoarthritis and 0.6% in their counterparts without osteoarthritis (log-rank p-value < 0.001). The adjusted Cox regression model further showed a positive and significant association between osteoarthritis and the incidence of Parkinson’s disease (HR = 1.82, 95% CI: 1.63–2.02). Similar results were obtained in all sex and age subgroups. ConclusionsIn this retrospective cohort study conducted in the United Kingdom, there was a positive association between osteoarthritis and the incidence of Parkinson’s disease. More research is warranted to confirm or refute these findings in other settings and countries.

The economic and health burdens of diseases caused by group A Streptococcus in New Zealand

ObjectivesIn preparation for the future arrival of a group A Streptococcus (GAS) vaccine, this study estimated the economic and health burdens of GAS diseases in New Zealand (NZ). MethodsThe annual incidence of GAS diseases was based on extrapolation of the average number of primary healthcare episodes managed each year in general practices (2014–2016) and on the average number of hospitalizations occurring each year (2005–2014). Disease incidence was multiplied by the average cost of diagnosing and managing an episode of disease at each level of care to estimate the annual economic burden. ResultsGAS affected 1.5% of the population each year, resulting in an economic burden of 29.2 million NZ dollars (2015 prices) and inflicting a health burden of 2373 disability-adjusted life years (DALYs). Children <5 years of age were the most likely age group to present for GAS-related healthcare. Presentations for superficial throat and skin infections (predominantly pharyngitis and impetigo) were more common than other GAS diseases. Cellulitis contributed the most to the total economic and health burdens. Invasive and immune-mediated diseases disproportionately contributed to the total economic and health burdens relative to their frequency of occurrence. ConclusionPreventing GAS diseases would have substantial economic and health benefits in NZ and globally.

PMH27 Burn Injury Is Associated with the Incidence of Psychiatric Disorders in German Primary Care Patients

The goal of this study was to investigate the association between burn injury and the incidence of psychiatric disorders in men and women without any pre-existing psychiatric comorbidity who were followed for up to five years in general practices in Germany This study included patients receiving an initial diagnosis of burn injury in one of 1,178 general practices in Germany between 2015 and 2018 (index date). Individuals without burn injury were matched (1:1) to those with burn injury by sex, age, index year, and general practice. For patients without burn injury, the index date corresponded to a randomly selected visit date between 2015 and 2018. Study variables included burn injury with body region, psychiatric disorders (i.e. depression, anxiety disorders, reaction to severe stress and adjustment disorders, and somatoform disorders), sex, age, and the Charlson Comorbidity Index. The association between burn injury and the incidence of psychiatric disorders was studied using Kaplan-Meier curves and multivariable Cox regression models. There were 9,099 patients with and 9,099 patients without burn injury included in the study (53.8% of women; mean [standard deviation] age 45.4 [18.5] years). After five years of follow-up, 29.4% of patients with burn injury and 26.2% of those without burn injury were diagnosed with any psychiatric disorder (log-rank p-value<0.001). Furthermore, there was a positive and significant association between burn injury and the incidence of psychiatric disorders (hazard ratio=1.32, 95% confidence interval=1.22-1.43). Burn injury was positively associated with the incidence of psychiatric disorders in individuals followed for up to five years in general practices in Germany. Taking these findings together, general practitioners and other health professionals involved in the management of burn injury survivors should be aware of the fact that this population is at a particular risk of being subsequently diagnosed with psychiatric disorders.

A new diagnostic work-up for defining anemia etiologies: a cohort study in patients \u2265 50 years in general practices

BackgroundTo study etiologies of anemia using an extensive laboratory analysis in general practices.MethodAn extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results.ResultsBlood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA.ConclusionExtensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.

Burn injury and incidence of psychiatric disorders: A retrospective cohort study of 18,198 patients from Germany

AimsThe goal of this study was to investigate the association between burn injury and the incidence of psychiatric disorders in patients followed for up to five years in general practices in Germany. MethodsThis study included patients receiving an initial diagnosis of burn injury in one of 1178 general practices in Germany between 2015 and 2018 (index date). Individuals without burn injury were matched (1:1) to those with burn injury by sex, age, index year, and general practice. For patients without burn injury, the index date was a randomly selected visit date between 2015 and 2018. Study variables included burn injury with body region, psychiatric disorders (i.e. depression, anxiety disorders, reaction to severe stress and adjustment disorders, and somatoform disorders), sex, age, and the Charlson Comorbidity Index. The association between burn injury and the incidence of psychiatric disorders was studied using Kaplan–Meier curves and multivariable Cox regression models. ResultsThe study included 9099 patients with and 9099 patients without burn injury (53.8% of subjects were women; mean [standard deviation] age was 45.4 [18.5] years). After five years of follow-up, 29.4% of patients with burn injury and 26.2% of those without burn injury were diagnosed with any psychiatric disorder (log-rank p-value < 0.001). Furthermore, there was a positive and significant association between burn injury and the incidence of psychiatric disorders (hazard ratio = 1.32, 95% confidence interval = 1.22–1.43). ConclusionsBurn injury was positively associated with the incidence of psychiatric disorders in individuals followed for up to five years in general practices in Germany.

James Fraser Taylor

Having experienced six years of general practice in Aberdeen, James Fraser Taylkor (“Jim”) took up a career in industrial medicine. He was to become chief medical officer to …

Cancer risk in stroke survivors followed for up to 10years in general practices in Germany.

The goal of this study was to analyze cancer risk in stroke survivors followed for up to 10years in general practices in Germany. The current study sample included patients who received an initial stroke diagnosis in one of 1262 general practices in Germany between 2006 and 2015 (index date). Patients without stroke were matched (1:1) to patients with stroke by age, gender, index year, and 16 comorbidities diagnosed in the 12months prior to the index date using a propensity score method. The main outcome of the study was the risk of cancer as a function of stroke within 10years of the index date. The stroke and non-stroke groups included 9579 men and 9089 women. After 10years of follow-up, 29.3% of men with stroke and 23.8% of those without stroke developed any of the included types of cancer (log-rank p value < 0.001). During the same time, the prevalence of cancer was 25.0% in women with stroke and 20.5% in women without stroke (log-rank p value < 0.001). There was a positive association between stroke and any cancer in men (hazard ratio [HR] = 1.18, 95% confidence interval [CI] 1.09-1.28) and in women (HR = 1.22, 95% CI 1.12-1.34). This association was significant for cancers of respiratory and intrathoracic organs in men and women and for cancers of digestive organs in men. This study, including more than 37,000 patients from Germany, found that stroke was associated with an increased cancer risk.

What proportion of initially prescribed antidepressants is still being prescribed chronically after 5 years in general practice? A longitudinal cohort analysis

ObjectivesAntidepressant prescribing almost doubled in the Netherlands between 1996 and 2012, which could be accounted for by longer continuation after the first prescription. This might be problematic given a growing...

INTERVIEW: Charlotte Stilwell: 'The prosthodontic spectrum is very wide now'

Charlotte Stilwell is a specialist in prosthodontics. She qualified from the Royal Dental College in Copenhagen in 1983 and moved to London to pursue her interest in removable prosthodontics. After five years of post-graduate training in the Prosthetic Department, Royal London Hospital Dental School she practised for nine years in general practice in West Wickham, Kent. She then moved to her current practice position as a referral specialist in Harley Street in London. Charlotte has an interest in conventional and implant prosthodontics and management of occlusion. She is also a lecturer at the Division of Gerodontology and Removable Prosthodontics, University of Geneva, and an examiner for the Royal College of Surgeons Edinburgh.

Which primary care practitioners have poor human papillomavirus (HPV) knowledge? A step towards informing the development of professional education initiatives.

BackgroundPrimary care practitioners (PCP) play key roles in cervical cancer prevention. Human papillomavirus (HPV) knowledge is an important influence on PCPs’ cervical cancer prevention-related behaviours. We investigated HPV knowledge, and associated factors, among general practitioners (GPs) and practice nurses.MethodsA survey, including factual questions about HPV infection and vaccination, was mailed to GPs and practice nurses in Ireland. Multivariable logistic regression was used to determine which PCPs had low knowledge (questions correctly answered: infection ≤5/11; vaccination: ≤4/10). Questions least often answered correctly were identified.Results697 PCPs participated. For HPV infection, GPs and practice nurses answered a median of nine and seven questions correctly, respectively (p<0.001). Significantly associated with low HPV infection knowledge were: being a practice nurse/male GP; working fewer hours/week; not having public patients; and having never taken a cervical smear. For HPV vaccination, both GPs and practice nurses answered a median of six questions correctly (p = 0.248). Significantly associated with low HPV vaccination knowledge were: being a practice nurse/male GP; working more years in general practice, fewer hours/week, in a smaller practice or in a practice not specialising in women’s health; and having never taken a smear. Six HPV infection questions, and seven HPV vaccination questions, were not answered correctly by >⅓ of PCPs.ConclusionsThere are important limitations in HPV infection and vaccination knowledge among PCPs. By identifying factors associated with poor knowledge, and areas of particular uncertainty, these results can inform development of professional education initiatives thereby ensuring women have access to uniformly high-quality HPV-related information and advice.

Continuous Increasing Prevalence of Chronic Lymphocytic Leukemia (CLL) with an Estimated Future Rise—a Nationwide Population-Based Study from Sweden

RationaleData on the prevalence of chronic lymphocytic leukemia (CLL) are scarce, and reliable population-based data as well as estimates of future changes in prevalence are neededAimsTo investigate previous and current prevalence of CLL in Sweden, the time it takes for new treatments to be implemented in clinical practice and to estimate the future prevalence of CLL.Patients and MethodsIndividuals in Sweden diagnosed with CLL (ICD7 and ICD9 204.1 and ICD10 C91.1) during 1958-2015 were identified through the National Cancer Registry. Background population sizes, prediction of future population sizes, death rates and data on emigration and immigration were obtained from Statistics Sweden. Clinical data on all cases diagnosed 2007-2015 (n=4742), including type of treatment for those requiring therapy (n=1459), were obtained from the Swedish National CLL-registry to which all healthcare units (n=73) diagnosing and treating CLL send reports.The number of prevalent cases at the end of each year was calculated from the total number of individuals diagnosed with CLL still alive and living in Sweden. Future age-specific incidence rates were assumed to be equal to the average age-specific incidence rates in the previous ten years. To estimate the proportion of individuals still alive many years into the future, estimates of relative survival along with expected mortality rates were calculated. These estimates were used in conjunction with predictions of future expected background mortality to predict overall survival among prevalent cases. Using a flexible parametric model (Lambert, Wilkes et al. 2017) with age at diagnosis included as a restricted cubic spline, relative survival was estimated for all ages.To create a “best case” scenario of future prevalence, a sensitivity analysis was performed assuming an increase in survival of newly diagnosed patients based on hazard ratios from randomized trials comparing new treatments with old. From the Swedish National CLL-registry we gathered data on treatments used and made assessments within three age groups (<65 years, 65-79 years and >80 years) on the proportion of patients that would benefit from a change to a more efficient treatment.ResultsIn 2015, the age-standardized incidence of CLL in Sweden was approximately 3/100 000 among males and 1.5-2/100 000 among females. This level had been stable since 1980.During the period 2000 to 2015 there was a continuous improvement in survival. In parallel there was a 42% increase in point prevalence from 33.3/100 000 to 47.4/100 000, corresponding to a 58% increase in the absolute number of prevalent cases from 2954 to 4668 (fig. 1A).Novel treatments were implemented in <5 years in general practice (fig. 1B).Using this information, we calculated a “best-case” scenario, applying survival figures based on recent published studies on novel treatments, and assuming that the maximum proportion of patients receiving the novel drugs would be reached within 5 years.Assuming unchanged relative survival, we estimated a 15% rise in the point prevalence to 54.6/100 000 in 2025 and a 26% rise to 59.5/100 000 in 2035, corresponding to an increase in the absolute number of cases with 28% (n=5980) and 49% (n=6938) during the same period of time.Based on the “best case” scenario, we estimated a 21% rise in the point prevalence to 57.3/100 000 in 2025 and a 45% rise to 68.9/100 000 in 2035. This corresponding to an increase in the absolute number of cases during the same period with 35% (n=6280) and 72% (n=8016), respectively. (fig. 1C)ConclusionUsing data from well-established national, population-based registries in Sweden, focusing on the time period 2000-2015, we found that there has been a continuous increase in the prevalence of CLL from 33.3/100 000 (2000) to 47.4/100 000 (2015). We also describe a fast implementation of new treatments. In parallel we observe a striking increase in survival. Using a model in which we assume further improvements in survival due to the introduction of novel and more efficient treatments, we estimate that the absolute number of cases may increase with as much as 72% in 20 years. These findings have important implications for health economy and planning.AcknowledgmentsThe Swedish Regional Cancer Centers and all hematologists reporting patients to the National CLL Registry. The Swedish CLL-group for their valuable support.FundingThis work was supported by funding from the Swedish CLL-group. [Display omitted] DisclosuresKimby:AbbVie: Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Janssen: Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria; Roche: Honoraria.

Impact of Osteoporosis on the Risk of Dementia in Almost 60,000 Patients Followed in General Practices in Germany.

There has been in recent decades a growing interest in the relationship between osteoporosis and cognitive decline. The goal of this study was to analyze the impact of osteoporosis on the risk of dementia in patients followed for up to 20 years in general practices in Germany. This study included patients who received an initial diagnosis of osteoporosis and were followed by 1,215 general practitioners in Germany between January 1993 and December 2012 (index date). Controls were matched (1:1) to osteoporosis patients using propensity scores based on age, gender, index year, comorbidities, and co-therapies. Kaplan-Meier curves were performed to study the development of dementia separately in men and women with or without osteoporosis within 20 years of the index date. Cox proportional regression models were used to estimate the relationship between osteoporosis and dementia in men and women. The present study included 29,983 cases and 29,983 controls. After 20 years of follow-up, 20.5% of women with osteoporosis and 16.4% of controls had been diagnosed with dementia (log-rank p-value <0.001). At the end of the follow-up period, dementia was found in 22.0% of men previously diagnosed with osteoporosis and 14.9% of men without this chronic condition (log-rank p-value <0.001). Osteoporosis was associated with a 1.2-fold increase in the risk of being diagnosed with dementia in women and a 1.3-fold increase in the risk of being diagnosed with dementia in men. There was a positive association between osteoporosis and dementia in patients followed in general practices in Germany.

Potentially Inappropriate Prescribing to Older Patients: Criteria, Prevalence and an Intervention to Reduce It: The Prescription Peer Academic Detailing (Rx-PAD) Study - A Cluster-Randomized, Educational Intervention in Norwegian General Practice.

Potentially inappropriate prescriptions (PIP) is drug treatment, which in general, at the group level for a median/mean patient, can be considered unfavourable meaning that the risks commonly may outweigh the benefits. This MiniReview reports and discusses the main findings in a large cluster-randomized educational intervention in Norwegian general practice, aimed at reducing the prevalence of PIPs to patients ≥70 years (The Rx-PAD study). Targets for the intervention were general practitioners (GPs) in continuing medical education (CME) groups receiving educational outreach visits (i.e. peer academic detailing). A Delphi consensus process, with a panel of medical experts, was undertaken to elaborate a list of explicit criteria defining PIPs for patients ≥70 years in general practice. Agreement was achieved for 36 explicit PIP criteria, the so-called Norwegian General Practice (NorGeP) criteria. Using a selection (n = 24) of these criteria during a 1-year baseline period on the prescribing practice of 454 GPs (i.e. those enrolled to participate in the intervention trial), we found a prevalence rate of 24.7 PIPs per 100 patients ≥70 years per year. In the Rx-PAD study, 449 GPs completed an educational intervention (96.6% of the included GPs), 250 in the intervention group and 199 in the control arm. Following the intervention, PIPs were reduced by 13% (95% CI 8.6-17.3), and the number of patients who were no longer exposed to one or more PIPs was reduced by 1173 (8.1%). The GPs who responded most strongly to the educational intervention were the oldest GPs (57-68 years), and these were the GPs with the highest prevalence of PIPs at baseline before the intervention.