Identification of major cardiovascular events in patients with diabetes using primary care data

Pouwels, Koen B; Voorham, Jaco; Denig, Petra

doi:10.1186/s12913-016-1361-2

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…For depression in males, our data (15.8) is higher than other European countries (4.4–12.7). Compared to other European research studies, our findings are comparable to Sweden for anxiety, higher for depression but lower for dementia (5.6% cognitive disorders compared to 16% dementia in Sweden) [ 10 ], and higher for depression compared to Wales (17.1 compared to 9.3) [ 22 ] The rate of diagnosed depression is considerably higher in our study population (17.1%) than that reported in Ireland’s National Longitudinal Study on Ageing (5%) [ 6 ]. Previous attempts to estimate the prevalence of alcohol misuse in older people have proven difficult for a variety of reasons, including a tendency on the part of study respondents to under-report usage [ 23 ].…”

Section: Discussionsupporting

confidence: 70%

Identified mental disorders in older adults in primary care: A cross-sectional database study

McCombe

Fogarty

Swan

et al. 2018

European Journal of General Practice

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Introduction: Identifying and managing mental disorders among older adults is an important challenge for primary care in Europe. Electronic medical records (EMRs) offer considerable potential in this regard, although there is a paucity of data on their use for this purpose. Objectives: To examine the prevalence/treatment of identified mental disorders among older adults (over 55 years) by using data derived from EMRs in general practice. Methods: We utilized data from a cross-sectional study of mental disorders in primary care, which identified patients with mental disorders based on diagnostic coding and prescribed medicines. We collected anonymized data from 35 practices nationally from June 2014 to March 2015, and secondary analysis of this dataset examined the prevalence of mental disorders in adults aged over 55 years. Results: 74,261 patients aged over 55 years were identified, of whom 14,143 had a mental health disorder (prevalence rate of 19.1%). There was considerable variation between practices (range: 3.7–38.9%), with a median prevalence of 23.1%. Prevalence increased with age, from 14.8% at 55–59 years to 28.9% at 80–84 years. Most common disorders were depression (17.1%), panic/anxiety (11.3%), cognitive (5.6%), alcohol (3.8%) and substance use (3.8%). Conclusions: Examining mental disorders among older adults using data derived from EMRs is feasible. Mental disorders are common among older adults attending primary care and this study demonstrates the utility of electronic medical records in epidemiological studies of large populations in primary care.

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Section: Discussionsupporting

confidence: 70%

Identified mental disorders in older adults in primary care: A cross-sectional database study

McCombe

Fogarty

Swan

et al. 2018

European Journal of General Practice

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“…The proxy used in our study showed a sensitivity of 85% and a specificity of 75% in identifying patients with a history of major CVD. [18] Although this is rather low from a diagnostic perspective, the use of drug proxies is still useful to identify patients who may be less adherent to their medication. A small number of patients (0.9%) switched to other antihypertensive drug classes that were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Type of prevention was defined as primary or secondary based on the prescription of a proxy indicating a previous cardiovascular event. [18] Patients who were dispensed at least two prescriptions of a platelet aggregation inhibitor, organic nitrate and/or a vitamin K antagonist in the year before the index date were categorized as secondary prevention patients. All others were considered primary prevention patients.…”

Section: Methodsmentioning

confidence: 99%

Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands

2019

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BackgroundAdherence to antihypertensive drugs in patients with diabetes is important. To support adherence, attention should be paid to the dynamic process of implementation, persistence and reinitiation of these drugs. We assessed non-adherence, non-persistence and reinitiation patterns for antihypertensive drugs in patients on oral diabetes drugs and identified pharmacy-based predictors of these processes.MethodsWe conducted a cohort study in patients on oral diabetes drugs who initiated antihypertensive drugs between 1995–2015, as registered in the IADB.nl pharmacy database. Non-adherence was defined as a medication possession ratio < 80% and non-persistence as a gap > 180 days. We defined reinitiation as the dispensing of an antihypertensive drug within one year following discontinuation. We provide descriptive statistics for different time periods and applied logistic and Cox regressions to assess associations with sociodemographic and drug-related factors.ResultsOf 6,669 initiators, non-adherence rates in persistent patients decreased from 11.0% in the first year to 8.5% and 7.7% in the second and third years, respectively. Non-persistence rates decreased from 18.0% in the first year to 3.7% and 2.9% in the second and third years, respectively. Of the 1,201 patients who discontinued in the first year, 22.0% reinitiated treatment within one year. Non-adherence and non-persistence rates were lower in the more recent time period. Predictors of non-adherence were secondary prevention (OR: 1.45; 95% CI: 1.10–1.93) and diuretics as initial drug class (OR: 1.37; 95% CI: 1.08–1.74). Predictors of non-persistence were female gender (HR: 1.18; 95% CI: 1.05–1.32), older age (HR: 1.33; 95% CI: 1.08–1.63) and diuretics, beta-blocking agents or calcium channel blockers as initial drug class. Longer duration of persistence was a predictor of reinitiation.ConclusionsAdherence to antihypertensive drugs in patients on oral diabetes drugs has improved over time. The first year after initiation is the most crucial with regard to non-adherence and non-persistence, and the risk groups are different for both processes. Early non-persistence is a risk factor for not reinitiating treatment.

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“…Stratified (to take into account matching) Cox proportional hazard regression was used to evaluate the risk of receiving antibiotic treatment during periods that statins are used compared with non‐use periods. The following variables were considered as potential (proxies for) risk factors for receiving antibiotic treatment: cardiovascular drugs, antithrombotic agents, systemic corticosteroids, immunosuppressants, antivirals, antineoplastics, and drugs for obstructive airway diseases, acid‐suppresive drugs, number of antibiotic prescriptions in the previous year, and duration of diabetes. All potential risk factors were included in the final multivariate model.…”

Section: Methodsmentioning

confidence: 99%

Association between statins and infections among patients with diabetes: a cohort and prescription sequence symmetry analysis

Pouwels

Widyakusuma

Bos

2016

Pharmacoepidemiology and Drug

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PurposeA previous meta‐analysis of randomized trials did not confirm findings from observational studies that suggested that statins reduce the risk of infection. However, animal experiments indicate that statins may be more effective in reducing the risk and/or the severity of infection among patients with diabetes. Hence, we evaluated the effect of statins on antibiotic prescriptions (a proxy for infections) among patients with drug‐treated type 2 diabetes using two confounding‐reducing observational designs.MethodsWe conducted a prescription sequence symmetry analysis and a cohort study using the IADB.nl pharmacy prescription database. For the prescription sequence symmetry analysis, a sequence ratio was calculated. The matched cohort study, comparing the time to first antibiotic prescription between periods that statins are initiated and non‐use periods, was analyzed using stratified Cox regression.ResultsPrescription sequence symmetry analysis of 4684 patients with drug‐treated type 2 diabetes resulted in an adjusted sequence ratio of 0.86 (95% confidence interval [CI]: 0.81 to 0.91). Corresponding figures for the cohort analysis comparing 9852 statin‐initiation with 4928 non‐use periods showed similar results (adjusted hazard ratio: 0.88, 95%CI: 0.83 to 0.95).ConclusionsThese findings suggest that statins are associated with a reduced risk of infections among patients with drug‐treated type 2 diabetes. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd.

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Identification of major cardiovascular events in patients with diabetes using primary care data

Cited by 15 publications

References 25 publications

Identified mental disorders in older adults in primary care: A cross-sectional database study

Identified mental disorders in older adults in primary care: A cross-sectional database study

Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands

Association between statins and infections among patients with diabetes: a cohort and prescription sequence symmetry analysis

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