Background and Objective: The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. Methods: Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV1 as percent predicted [FEV1 (% pred.)] , active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. Results: The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1.24–3.14) and FEV1(% pred.) (OR = 0.72; 0.58–0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1.21; 1.01–1.44; for every 10 years of increasing age), FEV1 (% pred.) (OR = 0.82; 0.70–0.96, for every 10 units) and CMH (OR = 1.54; 1.11–2.14) and also well calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). Conclusions: Our results suggest that FEV1 impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD.
The objective of this paper is to perform a cost-effectiveness analysis of the oral antibiotics used in Spain for the ambulatory treatment of community-acquired pneumonia. Our analysis takes into account the influence of bacterial resistances on the cost-effectiveness ratio of antibiotic alternatives from the viewpoint of the public insurer. A deterministic decision analysis model is used to simulate the impact of treatment alternatives on both patients' health and resource consumption. Amoxicillin 1 g may be the most efficient therapy for treating typical pneumonia, as long as the physician is able to discriminate clinically the aetiology of the process with a high degree of reliability. However, for those pathological pictures in which the aetiology cannot be discriminated clinically, and for those in which the consequences of incorrect diagnosis are serious according to clinical criteria, moxifloxacin is the most effective and efficient option.
Our purpose was to assess the quality of life of functional dyspepsia patients using the SF-36 generic scale and the Gastrointestinal Symptoms Rating Scale (GSRS). In all, 328 dyspeptic patients were included in a multicenter, prospective, observational study. Both scales were filled out at baseline and one and three months after a prokinetic agent was given as a single-drug therapy. A total of 250 patients completed the study. An improvement in all SF-36 dimensions was observed, although the final scores were lower than the population reference values. Physical role (27% change), emotional role (20%), and physical pain (16%) dimensions showed the greater change. The GSRS total and domain scores also showed significant decreases. The best predictors of quality of life improvement were certain basal symptoms, drug compliance, and the absence of idiopathic dyspepsia. In conclusion, both the generic and the specific scales provide useful and sensitive measures of quality of life in functional dyspepsia patients on single-drug treatment.
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