BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors a...BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.AIM To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and diabetes.METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes.Control of reversible risk factors was assessed by a new composite measure,the PAD-medical score.This score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an anti-platelet.Participants were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and stroke.RESULTS Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)years.Only 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of five.There were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk factors.CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.展开更多
Background:The association between multimorbidities and polypharmacy among elderly individuals is well documented,and polypharmacy has been shown to increase the risk of adverse drug events(ADEs).However,little inform...Background:The association between multimorbidities and polypharmacy among elderly individuals is well documented,and polypharmacy has been shown to increase the risk of adverse drug events(ADEs).However,little information is available about the risks associated with the lifelong use of medications to treat chronic multimorbidities.Objective:To determine the prevalence and nature of high-risk prescriptions among primary-care patients with chronic multimorbidities.Methods:We studied a weighted stratified random sample of 105 prescriptions for different patients with chronic multimorbidities taken from the Polychrome database established using information from the French primary-care record database(Observatoire de la Médecine Générale).A medication review was conducted to identify contra-indications and potential drug-drug interactions for each prescription.Results:Contra-indications were identified for 60(57.1%)prescriptions,potential drug-drug interactions for 70(66.7%),absolute contra-indications for 9(8.6%),and inadvisable drug combinations for 11(10.5%).In all,19(18.1%)different patients were at risk for major ADEs.Cardiovascular and nervous-system drugs contributed 66.2% of contra-indications and 69.3% of potential drug-drug interactions.Conclusions:This exploratory study confirms the high prevalence and potential seriousness of prescriptions at risk for ADEs in a population of primary-care patients with chronic multimorbidities.The high prevalence of interactions involving the cardiovascular and nervous systems indicates that efforts to improve prescription practices should target these two categories of conditions and drugs in patients with chronic multimorbidities.展开更多
目前全国各地积极探索多种形式的医保支付方式,合理有效的医保费用支付方式是医药卫生体制改革的重点内容和关键环节,也是控制医疗费用快速增长和科学有效地使用医保资金的关键所在。研究通过分析对比我国目前已经开展的按项目付费、按...目前全国各地积极探索多种形式的医保支付方式,合理有效的医保费用支付方式是医药卫生体制改革的重点内容和关键环节,也是控制医疗费用快速增长和科学有效地使用医保资金的关键所在。研究通过分析对比我国目前已经开展的按项目付费、按单元付费、按人头付费、按疾病病种付费(diagnosis related groups,DRGs)、总额预付费等医保费用支付方式的不同特点和政策要求,同时对比分析欧美西方发达国家的医保支付管理经验,以求探索、总结先进管理经验,为我国的支付方式改革提供可参考的样本。通过国内外医保付费方式的对比分析发现对我国的启示主要包括探索实施多元复合式医保支付制度、根据病种和诊疗特点实行不同支付方式、实施全面总额控制下的医保支付方式、全面推行以按疾病诊断相关分组(diagnosis related group,DRG)/病种分值付费(diagnosis intervention packet,DIP)为主的多元付费方式。通过对国际改革的政策及实践经验总结分析,进而对我国深化医改和推进医保费用支付方式改革的管理实践起到促进作用。展开更多
基金The National Health and Medical Research Council,No.1063476 and No.1022752James Cook University and Queensland Government supported this work.JG holds a Practitioner Fellowships from the National Health and Medical Research Council,No.1117061.
文摘BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.AIM To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and diabetes.METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes.Control of reversible risk factors was assessed by a new composite measure,the PAD-medical score.This score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an anti-platelet.Participants were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and stroke.RESULTS Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)years.Only 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of five.There were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk factors.CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.
文摘Background:The association between multimorbidities and polypharmacy among elderly individuals is well documented,and polypharmacy has been shown to increase the risk of adverse drug events(ADEs).However,little information is available about the risks associated with the lifelong use of medications to treat chronic multimorbidities.Objective:To determine the prevalence and nature of high-risk prescriptions among primary-care patients with chronic multimorbidities.Methods:We studied a weighted stratified random sample of 105 prescriptions for different patients with chronic multimorbidities taken from the Polychrome database established using information from the French primary-care record database(Observatoire de la Médecine Générale).A medication review was conducted to identify contra-indications and potential drug-drug interactions for each prescription.Results:Contra-indications were identified for 60(57.1%)prescriptions,potential drug-drug interactions for 70(66.7%),absolute contra-indications for 9(8.6%),and inadvisable drug combinations for 11(10.5%).In all,19(18.1%)different patients were at risk for major ADEs.Cardiovascular and nervous-system drugs contributed 66.2% of contra-indications and 69.3% of potential drug-drug interactions.Conclusions:This exploratory study confirms the high prevalence and potential seriousness of prescriptions at risk for ADEs in a population of primary-care patients with chronic multimorbidities.The high prevalence of interactions involving the cardiovascular and nervous systems indicates that efforts to improve prescription practices should target these two categories of conditions and drugs in patients with chronic multimorbidities.
文摘目前全国各地积极探索多种形式的医保支付方式,合理有效的医保费用支付方式是医药卫生体制改革的重点内容和关键环节,也是控制医疗费用快速增长和科学有效地使用医保资金的关键所在。研究通过分析对比我国目前已经开展的按项目付费、按单元付费、按人头付费、按疾病病种付费(diagnosis related groups,DRGs)、总额预付费等医保费用支付方式的不同特点和政策要求,同时对比分析欧美西方发达国家的医保支付管理经验,以求探索、总结先进管理经验,为我国的支付方式改革提供可参考的样本。通过国内外医保付费方式的对比分析发现对我国的启示主要包括探索实施多元复合式医保支付制度、根据病种和诊疗特点实行不同支付方式、实施全面总额控制下的医保支付方式、全面推行以按疾病诊断相关分组(diagnosis related group,DRG)/病种分值付费(diagnosis intervention packet,DIP)为主的多元付费方式。通过对国际改革的政策及实践经验总结分析,进而对我国深化医改和推进医保费用支付方式改革的管理实践起到促进作用。
