Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual / A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions

Objetivo. Evaluar la persistencia terapéutica, el coste sanitario y las reacciones adversas en pacientes tratados con oxibutinina y mirabegrón para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Pacientes y métodos. Se diseñó un estudio observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes pertenecientes a 3 áreas geográficas distintas (Barcelona, Girona, Asturias). Se analizaron los 2 grupos de estudio (oxibutinina y mirabegrón). El seguimiento se realizó durante un año. La persistencia se definió como el tiempo (meses) sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 60 días después de la prescripción inicial. Principales medidas: comorbilidad, uso de recursos sanitarios y reacciones adversas. Programa SPSSWIN; p<0,05. Resultados. Se analizaron 1.277 sujetos. La media de edad fue de 69,3 años y el 53,2% fueron mujeres. Por grupos: 42,9% oxibutinina y 57,1% mirabegrón. Las características demográficas y la morbilidad fueron parecidas. Los pacientes en tratamiento con oxibutinina en comparación con mirabegrón presentaron una similar persistencia al tratamiento (35,0 vs. 32,2%, p=0,294), aunque menores costes (1.151,2 vs. 1.809,6€, p<0,001). Las diferencias mayores se observaron en el precio de la medicación (279,2 vs. 692,3€, p<0,001; diferencia: −4131,€) y en las reacciones adversas (9,7 vs. 4,9%, p<0,001). Conclusiones. Los pacientes en tratamiento con oxibutinina frente a mirabegrón para la vejiga hiperactiva se asociaron a una parecida persistencia al tratamiento, menores costes sanitarios y mayores tasas de reacciones adversas de oxibutinina frente a mirabegrón

Objective. To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. Patients and methods. An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. Results. Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: −€413.1); and adverse events (9.7 vs. 4.9%, P<.001). Conclusions. Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates (AU)

[A retrospective, observational and multicentre study on patients with hyperactive bladder on treatment with mirabegron and oxybutinine under usual clinical practice conditions]. / Estudio observacional retrospectivo multicéntrico de pacientes con vejiga hiperactiva en tratamiento con mirabegrón y oxibutinina en condiciones de práctica clínica habitual.

OBJECTIVE: To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. PATIENTS AND METHODS: An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. RESULTS: Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. €1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. €692.3, P<.001; a variation of: -€413.1); and adverse events (9.7 vs. 4.9%, P<.001). CONCLUSIONS: Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates.

Persistencia y medicación concomitante en pacientes con vejiga hiperactiva tratados con antimuscarínicos en atención primaria: estudio de base observacional / Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study

Objetivo: Evaluar la persistencia terapéutica y su relación con la medicación concomitante en pacientes tratados con fesoterodina frente a tolterodina y solifenacina para el tratamiento de la vejiga hiperactiva en condiciones de práctica médica habitual. Material y métodos: Se efectuó un diseño observacional, multicéntrico, retrospectivo, realizado a partir de registros médicos de pacientes seguidos en atención primaria. Se analizaron los 3 grupos de estudio. La persistencia se definió como el tiempo (meses), sin abandono del tratamiento inicial o sin cambio a otra medicación al menos 30 días después de la prescripción inicial. La medicación concomitante fue: antidepresivos, ansiolíticos/hipnóticos, antibióticos, antisépticos, laxantes y productos-dermatológicos. Se utilizó el programa SPSSWIN versión 17 (significación estadística: p < 0,05). Resultados: Se seleccionaron para el estudio 3.094 pacientes. La media de edad fue de 54,0 años y el 62,2% fueron mujeres. Los pacientes tratados con fesoterodina mostraron mayor persistencia al tratamiento (12 meses) en comparación con solifenacina y tolterodina (40,2% frente al 34,7% y 33,6%; p = 0,008), respectivamente. Además, también mostraron un menor uso de medicación concomitante (1,1 frente a 1,2 y 1,2 fármacos; porcentajes: 61,6% frente a 67,1% y 70,1%; p < 0,03). Conclusiones: Los pacientes en tratamiento con fesoterodina frente a solifenacina y tolterodina para la vejiga hiperactiva se asociaron a una mayor persistencia al tratamiento, con una reducción de la medicación concomitante

Objective: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. Material and methods: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P < .05). Results: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P = .008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P < .03). Conclusions: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication

Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study.

OBJECTIVE: To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. MATERIAL AND METHODS: An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P<.05). RESULTS: We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P=.008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P<.03). CONCLUSIONS: The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication.

Uso de recursos sanitarios y costes asociados en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva tratados con antimuscarínicos en la práctica médica habitual / Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice

Objetivo: Evaluar el uso de recursos y costes sanitarios en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva (VH) tratados con fesoterodina, solifenacina o tolterodina en la práctica médica habitual. Material y métodos: Estudio multicéntrico, retrospectivo, realizado a partir de los registros de pacientes atendidos durante 2008-2010 en 3 localidades geográficas y que iniciaron tratamiento con antimuscarínicos (fesoterodina, solifenacina y tolterodina) para la VH. El atributo de vulnerabilidad se basó en reunir, al menos, 3 de los criterios del Vulnerable-Elders Survey-13; edad > 75 años, salud pobre/normal para la edad y alguna dificultad en al menos una actividad física diaria. Principales medidas: comorbilidad, persistencia y uso de recursos y costes. El seguimiento de los pacientes se realizó durante 52 semanas. Se utilizó un modelo lineal general con covariables y remuestreo (1.000) aleatorio para construir el IC 95% de las diferencias de costes entre fármacos. Resultados: Se analizaron registros de 552 pacientes (50,8% mujeres, edad media: 80,2 años), tratados con fesoterodina (n = 58), solifenacina (n = 252) o tolterodina (n = 212). El uso de absorbentes fue del 20,7, 29,4 y 33,0% (p = 0,186), respectivamente. La persistencia al tratamiento fue ligeramente mayor con fesoterodina. Los costes sanitarios paciente/año fueron inferiores con fesoterodina, 1.775 euros (1.550-2.014) vs. solifenacina 2.062 euros (1.911-2.223) y tolterodina 2.149 euros (1.978-2.307), p = 0,042, como consecuencia de una menor utilización de visitas y medicación concomitante. Conclusiones: A pesar de las posibles limitaciones del estudio, los pacientes ancianos vulnerables no institucionalizados con VH tratados con fesoterodina, en comparación con solifenacina o tolterodina, se asociaron a una menor utilización de recursos y costes sanitarios

Objective: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. Material and methods: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age > 75 years, poor/average age for health and difficulty in at least one daily physical activity. Main measures: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. Results: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N = 58), solifenacin (N = 252) or tolterodine (N = 212). The use of absorbent was 20.7%, 29.4% and 33.0% (p = 0.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, euros 1775 (1550-2014) vs. solifenacin euros 2062 (1911-2223) and tolterodine euros 2149 (1978-2307), p = 0.042, as a result of lower utilization visits and concomitant medication. Conclusions: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs

Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice.

OBJECTIVE: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. MATERIAL AND METHODS: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. MAIN MEASURES: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. RESULTS: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1,775 (1550-2014) vs. solifenacin €2,062 (1911-2223) and tolterodine €2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. CONCLUSIONS: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.

Morbilidad y coste asociado a los trastornos neurológicos / Morbidity and costs associated with neurological disorders

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[Family practice and diagnosis of cancer]. / El médico de atención primaria y el diagnóstico de los pacientes con cáncer.

OBJECTIVES: To describe the types of cancer identified in primary health care, their clinical presentation, management until diagnosis and delay in diagnosis. DESIGN: Descriptive study based on secondary information from medical records. SETTING: Two urban health care centres in Mallorca, Spain. PARTICIPANTS: Patients over 14 years old diagnosed with cancer between 1994 and 1998. MEASUREMENTS: Age, sex, location of tumour, symptoms, role of family doctor, specialist referral, care environment, time from first symptom to diagnosis, and stage of tumour. RESULTS: We identified 408 cancers. Mean age at diagnosis was 66.5 years (95% CI, 65.3-67.7); 237 (58.1%) were male. The most frequent tumours were colorectal, lung, prostate, breast and bladder, and the most common symptom was pain (33.1%; 95% CI, 28-38.3). The family doctor was involved in 63% of diagnoses (95% CI, 58.2-67.8). Mean delay from first symptom until diagnosis was 90 days, of which 26 were attributed to the patient and 55 to primary health care services. For colorectal, lung and prostate cancers, delay was shorter. The tumour was less advanced at diagnosis when family doctors were involved. CONCLUSIONS: Family doctors are involved in the diagnosis of most cancers. In colorectal, lung and prostate cancers, their contribution could improve prognosis. More studies are needed to confirm these findings.

El médico de atención primaria y el diagnóstico de los pacientes con cáncer / Family practice and diagnosis of cancer

Objetivos. Describir los tipos de cáncer identificados en atención primaria, su forma de presentación clínica, el proceso asistencial seguido hasta su diagnóstico y los tiempos de demora diagnóstica. Diseño. Estudio descriptivo basado en la recogida de información secundaria a partir de la historia clínica. Emplazamiento. Dos centros de salud urbanos de Mallorca. Participantes. Cánceres diagnosticados, entre 1994 y 1998, en usuarios mayores de 14 años. Mediciones. Edad, sexo, localización, desencadenantes, intervención del médico de familia, tipo de derivación, ámbito de actuación, intervalos de tiempo desde el inicio de síntomas hasta el diagnóstico y estadio. Resultados. Se identificaron 408 cánceres. La media de edad en el momento del diagnóstico fue de 66,5 años (intervalo de confianza [IC] del 95%, 65,3-67,7), 237 (58,1%) en varones. Los más frecuentes fueron colorrectal, pulmón, próstata, mama y vejiga. El síntoma más frecuente fue el dolor, que se presenta en el 33,1% (IC del 95%, 28-38,3). El médico de familia intervino en el 63,0% (IC del 95%, 58,2-7,8). La demora total fue de 90 días de mediana, mientras que en atención primaria fue de 55 días y la debida al paciente de 26 días. En los casos en que intervino el médico de familia, la demora fue menor y se llegó al diagnóstico en estadios más precoces para el cáncer colorrectal, de pulmón y de próstata, pero no en el resto de las localizaciones. Conclusiones. El médico de AP interviene en el diagnóstico de la mayoría de los cánceres. Su intervención podría mejorar el pronóstico en el cáncer colorrectal, de pulmón y de próstata. Deben realizarse estudios que confirmen estos hallazgos

Objectives. To describe the types of cancer identified in primary health care, their clinical presentation, management until diagnosis and delay in diagnosis. Design. Descriptive study based on secondary information from medical records. Setting. Two urban health care centres in Mallorca, Spain. Participants. Patients over 14 years old diagnosed with cancer between 1994 and 1998. Measurements. Age, sex, location of tumour, symptoms, role of family doctor, specialist referral, care environment, time from first symptom to diagnosis, and stage of tumour. Results. We identified 408 cancers. Mean age at diagnosis was 66.5 years (95% CI, 65.3-67.7); 237 (58.1%) were male. The most frequent tumours were colorectal, lung, prostate, breast and bladder, and the most common symptom was pain (33.1%; 95% CI, 28-38.3). The family doctor was involved in 63% of diagnoses (95% CI, 58.2-67.8). Mean delay from first symptom until diagnosis was 90 days, of which 26 were attributed to the patient and 55 to primary health care services. For colorectal, lung and prostate cancers, delay was shorter. The tumour was less advanced at diagnosis when family doctors were involved. Conclusions. Family doctors are involved in the diagnosis of most cancers. In colorectal, lung and prostate cancers, their contribution could improve prognosis. More studies are needed to confirm these findings