Antibiotic prescriptions in the paediatric population in the Lazio Region of Italy: association with children's and physician's characteristics.

BACKGROUND: Estimating prevalence rates for antibacterial use in 0-14 year old children in 2009 in Lazio (Italy). METHODS: Antibiotic prescriptions has been selected as drugs belonging to the J01 main therapeutic of the Anatomical Therapeutic Chemical system. Prevalence data by sex and age were calculated. The proportion of children who underwent 1, 2 or ≥ 3 treatments was calculated. Relation between use of antibiotics and incidence of influenza cases was evaluated. The association of children's and physician's characteristics with prescription was assessed by multi-level Poisson regression model. RESULTS: 45% of children received one antibiotic with a peak in the 1-2 age. Penicillins combinations and beta-lactamase inhibitors were the most frequently prescribed group. Multilevel model highlighted prescription rate decreases with doctor's increasing age, if the doctor is a paediatrician and female. Contrarily, doctors with >900 patients present higher probability to prescribe antibiotics. CONCLUSIONS AND DISCUSSION: The study highlights the variability in antibiotic use and the fact that several children's and primary care doctors' characteristics are associated with antibiotic prescription. Paper findings appear to be coherent with other Italian studies but prevalence rate is definitively higher comparing to other countries.

[Atrial fibrillation: use of healthcare resources and expenditures in the Lazio region (Italy)]. / Fibrillazione atriale: attività assistenziale e assorbimento di risorse nella Regione Lazio.

Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia and is an important risk factor for mortality and morbidity related mainly to an increased risk of cerebrovascular events and heart failure.An observational cross-sectional study was performed to evaluate the use of healthcare resources (including hospital and outpatient care) by patients with AF in the Lazio region (central Italy), from 1 January 2006 to 31 December 2008.Atrial fibrillation is an important source of healthcare resource utilization because of repeated emergency room visits, hospital admissions, outpatient consultations and procedures and extensive use of laboratory tests and pharmacological treatments.Results show that 55% of costs are attributable to hospital admissions and Emergency Room visits, 37% to pharmacological treatment and the remaining 8% to outpatient care. These results are consistent with the international literature.The impact of AF in terms of cost is not negligible and it is therefore desirable to implement an organizational scheme that safeguards the appropriateness of care, taking charge of the patient as early as possible. The aims of early diagnosis of AF are to improve the appropriateness of care and optimize the use of specialized tests, thereby reducing hospital admissions for complications or recurrences of AF.

Influenza like Illness (ILI): prescribing behaviour of 83 sentry doctors in Lazio region in the period 2001-2002. Is it adherent to Italian ILI guidelines?

To describe different doctors' attitudes in drug prescribing in case of influenza-Like-Illness during 2001-2002 influenza season in Lazio region, with regard to consumption and expenditure and its adherence to Italian Guidelines on ILI Management. Prospective study aimed to assess doctors' behaviour in prescribing in respect with the following events: (a) ILI and subsequent controls after diagnosis, (b) complications, (c) adverse events to influenza vaccine. 7,629 subjects, have been identified and only 17% presents one or more comorbidities. There are totally 7,766 cases of ILI: 23% are complicated and out of the remaining 77%, only 14% presents comorbidities. Almost all elderly people have been vaccinated. Antibiotics were prescribed to complicated cases (82%) with comorbidities (55%); 1,075 patients (12%) had second or third contact with doctors in a period longer than 7 days and about 65% of them received antibiotics in case of acute bronchitis; children received mainly ibuprofen and paracetamol for fever control; acetylsalicylic acid in children group has been delivered only in 1% of cases. Overall, doctors' attitude in prescribing is generally coherent with Italian Guidelines on ILI even though a high variability still persists.

How do Italian pharmacoeconomists evaluate indirect costs?

OBJECTIVES: To investigate how indirect costs are evaluated in pharmacoeconomic studies in Italy and the attitude of Italian pharmacoeconomists toward indirect costs. METHODS: A literature review was conducted, specifically focused on pharmacoeconomic studies including indirect costs carried out in Italy, and a suevey among Italian pharmacoeconomics experts. RESULTS: Nineteen studies were available for review. Although the methods used to calculate the value of production loss due to morbidity were all based on the Human Capital Approach (HCA), there was a wide variability among studies in practical methods. The parameters used to value production losses varied widely too. Of the 25 survey responders, 20 considered it important to include indirect costs in pharmacoeconomic studies; 56% of those interviewed stated that health authorities should require indirect cost evaluations. Most of these experts would include indirect cost estimates in drug-pricing calculation. CONCLUSIONS: In Italy studies evaluating indirect costs are still only few, although there is evidence of an increase. Italian pharmacoeconomists are far from reaching any consensus on methods for evaluating these costs. Methods need to be standardized particularly with respect to the parameters used to quantify productive time lost in monetary terms.