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males, significant associations were found only for COPD (R2 = 0.81; p = 0.001) and gastroduodenal ulcer (R2 = 0.93;
p < 0.001). CONCLUSIONS: The difference between population and primary care morbidity is affected by disease under
investigation and patients' demographic characteristics. Therefore, in choosing the more cost-effective approach to
collect data such evidence should be taken into account, and results should be interpreted with great caution.
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 intervention trial.
Diabetes Care 2003; 26:1497-500
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 randomized 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
cardiovascular 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 diabetic
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.
Filippi A, Bignamini AA, Sessa E, Samani F, Mazzaglia G. Secondary prevention of stroke 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
concerning 318 Italian FPs and 465,061 patients were extracted from the Health Search Database. 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). CONCLUSIONS: 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 extremely short life
expectancy or substantial contraindications.