Aims
The aim was to assess the impact of a campaign for general practitioners (GPs) to reduce clinically‐important drug–drug interactions (DDIs) in poly‐treated elderly patients.
Methods
We compiled a list of 53 DDIs and analyzed reimbursed prescriptions dispensed to poly‐treated (≥four drugs) elderly (>65 years) patients in the Emilia Romagna region during January 2011–June 2011 (first pre‐intervention period), January 2012–June 2012 (second pre‐intervention period) and January 2013–June 2013 (post‐intervention period). Educational initiatives to GPs were completed in July 2012–December 2012. Pre‐test/post‐test analysis (2013 vs. 2012) was performed, also using predicted 2013 data (P < 0.01 for statistical significance).
Results
Despite the slight increase in poly‐therapy rate (16% in 2013, +1.5% from 2011), we found a stable or slightly declining number of potential DDIs for each elderly poly‐treated patient (~1.5). In 2013, 11 DDIs exceeded 5% of prevalence rate: antidiabetics‐β‐adrenoceptor blockers ranked first (20.3%), followed by ACE Inhibitors (ACEIs)/sartans‐non steroidal anti‐inflammatory drugs (NSAIDs) (16.4%), diuretics‐NSAIDs (13.6%), selective serotonin re‐uptake inhibitors (SSRIs)‐NSAIDs/acetyl salicylic acid (ASA) (12.7%) and corticosteroids‐NSAIDs/ASA (9.7%). A remarkable reduction emerged for NSAID‐related DDIs (diuretics‐NSAIDs peaked −14.5%; P < 0.01), whereas prevalence of antidiabetics‐β‐adrenoceptor blockers increased (+7.9%; P < 0.01). When using predicted values, the statistical significance disappeared for antidiabetics‐β‐adrenoceptor blockers (+1.3%; P = 0.04), whereas it persisted for almost all NSAIDs‐related DDIs: ACEIs/sartans‐NSAIDs (−3.0%), diuretics‐NSAIDs (−6.0%), SSRIs‐NSAIDs/ASA (−5.9%).
Conclusions
This campaign contained the burden of DDIs in poly‐treated elderly patients by 1) reducing most prevalent DDIs, especially NSAIDs‐related DDIs and 2) balancing the observed rise in poly‐therapy rate with stable rate in overall prescriptions of potentially interacting drugs per patient.
Introduction: Ethics committees are considered very important in the discussion of ethical questions and clinical research, but little information is available in its representation with respect to the society. World Health Organization stated that the composition of an ethics committee should be representative and balanced.Objective: To describe the proportions of males and females in a sample of 170 Italian ethics committees.
Materials and methods:We examined gender distribution in ethics committees by analysis of the data-base available on the institutional free access website of the National Monitoring Centre for Clinical Trials. The findings were compared to a similar sample collected in 2008, and with the percentages of females and males who graduated between 1959-1968 and between 1979-1990, obtained from the National Statistics Institute.
Results:In 2010 ethics committees had 69% male and 31% female members. This imbalance only in part reflects the male/female ratio among graduates in the two ranges of years considered. The greatest differences are among medical doctors, with 83% males and 17% females. It contrasts with predominance of women among nurses and volunteers (males 34%, females 66%).
Conclusions:We found two kinds of gender imbalance: one among medicine graduates where males predominate and one among nurses and volunteers, with mostly females. This situation is discussed in relation to the representativeness and roles in ethics committees decision making. Progress is needed towards a more equal representation.
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