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Recording was substantially low even in patients who were prescribed with antihypertensive drugs and/or lipid-lowering
drugs: blood pressure in 80.6% of the patients, total cholesterol in 69.1%, smoking habits in 46.1%. Cardiovascular
risk factors were more frequently recorded as age increased and slightly more among women as compared to men.
Obviously, it is possible that risk factors had been assessed but not recorded. CONCLUSIONS: Cardiovascular risk factors
are substantially under-recorded among Italian general practitioners thus impairing adequate preventive treatment. A
systematic, well programmed approach may theoretically lead to evaluate the majority of the target population within
a few years.
Fabiani L, Giovannoni S, Casanica M, Scatigna M, Pulsoni R, Ventriglia G, Marchi M. Applicabilità di linee guida e
formazione: un percorso diagnostico per il mal di schiena. Rec Prog Med 2004; 95: 81-6
ABSTRACT. BACKGROUND: The Italian National Health Plan has included low back pain (LBP) among the pathologies
for which clinical guidelines should be created and disseminated. A change in the clinical behaviour of doctors requires
forms of intervention whose efficiency is not fully known. OBJECTIVES: This study proposes to evaluate the efficacy
of a multifaceted intervention, including educational materials, lectures, workshops and local consensus processes,
in order to modify the General Practitioners' (GP) clinical treatment of LBP. METHODS: Changes in diagnostic capacity
have been evaluated through a controlled (before/after) trial based on the frequency of etiological diagnoses of LBP, the
testing of clinical knowledge with multiple choice tests, and on priorities given in confronting problems of treatment
of LBP by the three GP's groups that had voluntarily adhered to the study. RESULTS: A statistically significant increase of
diagnostic capacity (the frequency of exact responses in the multiple choice test) was achieved. There was also a shifting
of priorities in confronting problems in the treatment of LBP, from the diagnosis as a primary issue before intervening,
to communication with the patient. CONCLUSIONS: Within the Italian context, the study also confirms the efficiency
of a multifaceted intervention based on a training process aimed at modifying the clinical behaviour of the GP with
respect to LBP.
Mazzaglia G, Caputi AP, Rossi A, Bettoncelli G, Stefanini G, Ventriglia G, Nardi R, Brignoli O, Cricelli C. Exploring
patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in
primary care.
Eur J Clin Pharmacol 2003 ; 59: 651-7
ABSTRACT. OBJECTIVE: To assess patient- and doctor-related variables leading physicians to prescribe antibiotics or
parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness
of antibiotic use and its predictive factors in general practice. METHODS: We conducted a cross-sectional study among
patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database.
Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific
evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic
regressions were used to identify variables associated with antibiotic use and appropriateness. RESULTS: On 67,761 cases
of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and
common cold. Significant associations with antibiotic use were found for geographic location and number of patients
under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area
were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most
common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's
gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. CONCLUSIONS: There is still
excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in
which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing
diagnostic and therapeutic behaviour are needed.
Cricelli C, Mazzaglia G, Samani F, Marchi M, Sabatini A, Nardi R, Ventriglia G, Caputi AP. Prevalence estimates for
chronic diseases in Italy: exploring the differences between self-report and primary care databases. J Public
Health Med. 2003; 25:254-7
ABSTRACT. BACKGROUND: The aim of this study was to describe population and primary care morbidity and to
examine how the differences vary across the diseases and are influenced by patients' demographic characteristics.
METHODS: A comparison of the prevalence of four chronic conditions for 432747 patients from the Health Search
Database (HSD) and 119799 individuals from a Health Interview Survey was carried out. A linear regression was
performed to study the associations between age and difference in morbidity. RESULTS: Similar prevalence was found
for diabetes and hypertension, whereas for chronic obstructive pulmonary disease (COPD) and gastroduodenal ulcer
lower HSD prevalence was reported. Among females, age was always associated with morbidity difference. Among