Use of margarine enriched in phytosterols by patients at high cardiovascular risk and treated by hypolipidemic drugs.

BACKGROUND AND AIMS: The use of phytosterol-enriched margarines (PEM) in patients at cardiovascular risk has not been thoroughly explored. We determined the proportion of users of PEM in a population at high cardiovascular risk, and their characteristics. In addition, the correlates of using at least 25 g/d of PEM were identified. METHODS AND RESULTS: Patients with at least two cardiovascular risk factors in addition to dyslipidemia (primary prevention) or with past cardiovascular disease (secondary prevention) were recruited by general practitioners (GPs). Baseline characteristics were collected from a computerized GP database linked to a survey. GPs recorded patterns of PEM use. First, users were compared with non-users. Then, analyses were conducted to identify characteristics of patients using PEM at a recommended dose (>or=25 g/d). Among 1631 patients with documented consumption, a minority used PEM (15.2%), and only 36.4% of consumers used it at recommended level. Overall, PEM users did not differ from non-users as to general characteristics, nor as to the level of cardiovascular risk in primary prevention. However, PEM users reported significantly more cardiovascular events among their parents (OR=1.4; 95% CI=[1.0-1.9]). Consumers who used at least 25 g/d of PEM were more likely to be men (OR=3.1; 95% CI=[1.6-5.8]), to be aged 60-74 (OR=3.0; 95% CI=[1.4-6.4]), or 75 or older (OR=4.0; 95% CI=[1.5-10.6]). Again, no difference was observed regarding the level of cardiovascular risk. CONCLUSIONS: The level of use of PEM was low in this population of high cardiovascular risk patients. In addition, only a third of users consumed margarine at the recommended level. Our data suggest that pattern of use of PEM is not related to the level of cardiovascular risk.

Influence of patients' characteristics and disease management on asthma control.

BACKGROUND: Although asthma control is a major outcome in disease management, little is known about its determinants. OBJECTIVES: We sought to study the relationships between asthma control and patient characteristics or asthma management. METHODS: Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis. RESULTS: The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m2 were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting beta-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96). CONCLUSION: Asthma control varied according to both the patients' characteristics and therapy. CLINICAL IMPLICATIONS: Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.

Primary care physicians' behaviors towards risk of iatrogenesis in elderly patients.

OBJECTIVES: Iatrogenesis is common in elderly patients. This phenomenon could be reduced by improving awareness of general practitioners (GPs). We studied GPs' prescribing behavior to elderly patients, to identify GP and patient characteristics related to cautious prescribing behaviors. METHODS: The observational study sampled 106 GPs who had consecutively recruited, on average, 12 patients over 75 years of age. GPs completed a questionnaire on their practice and a questionnaire for each patient they recruited, describing their usual care of elderly patients, and criteria for prescribing therapy. GPs' behaviors were studied with five scores and a global prescribing behavior (adequate/inadequate). The relationship between patients' risk of iatrogenesis and GPs' behaviors was studied with hierarchical logistic models. RESULTS: A total of 106 GPs recruited 1,318 patients (mean age 80.7 years, 36% males). A wide variety of behaviors was observed among GPs. Only 40% of GPs had specific prevention-oriented visits, while only 19.2% considered that prevention was optimally implemented in their practice. On average, GPs had behaviors considered adequate in about half of encounters. GPs' global behaviors were more likely to be adequate for patients at higher risk (OR=1.47, 95%CI: 1.10-1.95). Likewise, before prescribing to patients at higher risk of iatrogenesis, GPs were more likely to collect data on financial autonomy, on clinical/biological data, and to adopt good prescription practices, while less attention was paid to patients' physical and psychological autonomy. CONCLUSIONS: GPs tended to be more cautious when prescribing to patients at higher iatrogenesis risk. However, overall prescribing behaviors were not optimal. Efforts are needed to improve the quality of care in elderly patients.