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42. Filippi A, Sabatini A, Badioli L, Samani F, Mazzaglia G, Catapano A, Cricelli C. Effects of
an Automated Electronic Reminder in Changing the Antiplatelet Drug-Prescribing
Behavior Among Italian General Practitioners in Diabetic Patients: An interven-
tion trial.
Diabetes Care 2003;26:1497-1500.
ABSTRACT. OBJECTIVE: To evaluate whether an electronic reminder integrated into a
routine computer system increases the use of antiplatelet drugs for diabetic patients
among Italian general practitioners (GPs). RESEARCH DESIGN AND METHODS: A ran-
domized controlled trial was carried out among 300 GPs and their patients selected
from the Health Search Database. Among these, 150 GPs (intervention group) received
instructions to activate an electronic reminder plus a letter summarizing the beneficial
effects of antiplatelet drugs in diabetic patients with at least one additional cardiova-
scular risk factor ("high risk"), whereas the other 150 GPs (control group) received only
the letter. The electronic reminder, integrated into a standard software system for the
management of the daily clinical practice, was displayed when every participating GP
opened the medical record of diabetic patients aged > or =30 years. Only high-risk dia-
betic patients were included in the analysis. Patients were considered under antiplatelet
treatment if they received two or more prescriptions at baseline and during the follow-
up. RESULTS: We selected 15,343 high-risk diabetic patients, 7,313 belonging to GPs of
the control group and 8,030 belonging to GPs of the intervention group. Overall, 1,672
patients (22.9%) of the control group and 1,886 (23.5%) patients of the intervention
group received antiplatelet drugs at baseline (P = N.S.). At the end of the follow-up, the
number of treated patients was significantly increased in the intervention group (odds
ratio 1.99, 95% CI 1.79-2.22) versus the control group. The effect of the electronic
reminder was more relevant among those patients with one or more cardiovascular risk
factors but without previous cardiovascular diseases (CVDs), compared with those with
CVDs. CONCLUSIONS: These findings provide evidence for the effect of an electronic
reminder in affecting the prescriptive behavior of GPs.
43. Filippi A, Bignamini AA, Sessa E, Samani F, Mazzaglia G. Secondary prevention of stro-
ke in Italy: a cross-sectional survey in family practice. Stroke. 2003;34:1010-4.
ABSTRACT. BACKGROUND: Hypertension control and antiplatelet or oral anticoagulant
drugs are the basis for secondary prevention of cerebrovascular events. Family physicians
(FPs) are usually involved in both aspects of prevention, but no research has been carried
out in Italy to evaluate the behavior of FPs in this field of prevention. METHODS: Data con-
cerning 318 Italian FPs and 465,061 patients were extracted from the Health Search Da-
tabase. Patients with coded diagnoses of stroke and transient ischemic attack (TIA) were
selected. Demographic records and information regarding presence of concurrent disease
and medical records were also obtained. Logistic regression analyses were carried out to
assess whether conditions exist that make appropriate control of blood pressure (BP) and
prescription of antiplatelet or anticoagulant drugs more likely. RESULTS: We selected 2555
patients with diagnosis of stroke and 2755 with TIA. Among all of the subjects, 32.6%
had no BP recorded. Among the remaining subjects, 58.7% reported uncontrolled BP.
Isolated systolic hypertension has been shown in 68.8% of patients with uncontrolled BP.
Antiplatelet and anticoagulant drugs were prescribed in 72% of these cases. Factors that
made the prescription significantly more unlikely were diagnosis of TIA (odds ratio [OR],
0.47; 95% confidence interval [CI], 0.41 to 0.54), total invalidity (OR, 0.66; 95% CI 0.56
to 0.78), and time from event of 5 years or more (OR, 0.81; 95% CI, 0.70 to 0.94). CON-
CLUSIONS: Italian FPs could improve secondary prevention of cerebrovascular accidents.
The primary target of intervention should be the control of systolic BP, and the group of
patients with unacceptably high BP should be given priority. All of these patients should
have been prescribed antiplatelet drugs or anticoagulant agents, except in cases of extre-
mely short life expectancy or substantial contraindications.