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1.
Isr Med Assoc J ; 10(3): 207-13, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18494234

RESUMO

BACKGROUND: Bisphosphonates are effective in the prevention and treatment of osteoporosis, yet their use is suboptimal. OBJECTIVES: To measure bisphosphonate compliance among first-time users and identify factors associated with compliance. METHODS: We conducted a prospective follow-up of all women aged 45+ in the second largest health management organization in Israel who were prescribed bisphosphonates for the first time. The 4448 women were classified by drug dosage. Persistence and adherence measures of compliance were calculated for each woman over a 1 year period. RESULTS: Mean bisphosphonate persistence over a year was 216 days, with a mean medication possession ratio of 66%. Women whose medication was changed, whether from weekly to daily or daily to weekly, always had better persistence rates than those who consistently took the original dose. Persistence rates were as follows: 264 days for women who switched back and forth between daily and weekly doses, 229 days for those who switched from daily to weekly, 222 days for those who took the dosage weekly only, 191 days for those who switched to daily dosage, and 167 days for those who took the dosage daily only (P < 0.001). Switchers were also more likely to have adequate adherence rates (MPR > or = 80%): 81.3%, 76.6%, 67.5%, 61.3% and 52.2% respectively (P < 0.001). More than 20% of women stopped taking their medication within the first month. Women with higher supplemental insurance (offering significant discounts for weekly dose medications) had better persistence rates: 221 vs. 208 days (P = 0.03). Younger women and women on national pension insurance had the lowest persistence rates: 204 and 209 days respectively. CONCLUSIONS: While weekly bisphosphonate takers had better compliance rates, persistence and adherence rates were inadequate for all groups. Changing medication to meet the needs of the patient, discounting weekly medications, and providing follow-up within the first months of prescription may promote compliance.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Difosfonatos/administração & dosagem , Osteoporose/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Idoso , Estudos de Coortes , Bases de Dados Factuais , Esquema de Medicação , Feminino , Sistemas Pré-Pagos de Saúde , Humanos , Cobertura do Seguro , Seguro de Serviços Farmacêuticos , Israel , Pessoa de Meia-Idade , Fatores Socioeconômicos
2.
Br J Gen Pract ; 55(512): 218-21, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15808038

RESUMO

BACKGROUND: Acute pharyngitis is a frequent and well-documented complaint in general practice but the associated suffering has remained largely unaddressed in the literature. Evidence, however, from five randomised controlled trials suggests that corticosteroids may be useful in relieving pain and discomfort arising from the condition. AIM: To determine if short-acting oral therapy with prednisone was more effective than placebo in alleviating the suffering from acute pharyngitis in adults in a general practice setting. DESIGN OF STUDY: Randomised placebo-controlled trial. SETTING: General practice in Israel. METHOD: Patients with acute pharyngitis were randomised to receive 60 mg prednisone orally for 1 or 2 days, or identical placebo treatment. The main outcome measures were throat pain, measured by a visual analogue scale at 12, 24, 48 and 72 hours after presentation, time off work, fever, dysphagia, recurrence of symptoms and bacterial recurrence. RESULTS: Patients treated with prednisone experienced more rapid throat pain resolution than those in the placebo group. No adverse effects were reported nor any differences between the two groups regarding either symptom or positive bacterial culture recurrence. CONCLUSION: Short-acting oral steroid therapy is effective for shortening throat pain duration in acute pharyngitis.


Assuntos
Anti-Inflamatórios/uso terapêutico , Faringite/tratamento farmacológico , Prednisona/uso terapêutico , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante , Relação Dose-Resposta a Droga , Medicina de Família e Comunidade , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Medição da Dor , Recidiva , Resultado do Tratamento
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