Search PubMed⌕ Search

Biomedical subjects

Corrado Barbui

Publications and source records attributed to Corrado Barbui.

At least 73 records · Page 4Linked to original sources
PubMed2003

Cross-sectional database analysis of antidepressant prescribing in Italy.

Antidepressant drug trials have been criticised because they study atypical populations of depressive patients. The present cross-sectional database analysis was designed to define what constitutes a typical population of patients receiving antidepressants. From a database covering a population of 1,057,053 residents in Piedmont, Italy, and including all community (i.e. outside hospitals) prescriptions reimbursed by the National Health System, all prescriptions of antidepressant drugs dispensed during the first six months of 2000 were extracted. Using the general practice patient code all records were attributed to a sample of patients receiving antidepressants. During the study period 22,135 patients were dispensed one or more prescriptions, yielding a prevalence of use of 27.6 (CI 27.1, 28.0) per 1,000 females and 13.7 (CI 13.4, 14.0) per 1,000 males (female/male ratio 2.01). The prevalence of use progressively increased with age, with the highest rates in subjects over 75 years. The distribution of patients by number of antidepressant prescriptions showed that nearly 50% received only one or two prescriptions over the six months surveyed. Moreover, 18,676 subjects (84%) were prescribed antidepressants together with other medications. These data suggest shifting the focus of antidepressant drug trials from selected to non-selected populations of patients, including the elderly and patients with medical comorbidity, enrolled using entry criteria as close as possible to those adopted in everyday clinical practice. The high proportion of occasional antidepressant users suggests that clinical trials should follow all patients, without excluding those who fail to continue the study medication.

Adolescent↗
PubMed2003

Economic evaluation of antidepressive agents: a systematic critique of experimental and observational studies.

The purpose of this study was to examine whether experimental and observational pharmacoeconomic analyses of antidepressant drugs support the choice of one of the selective serotonin reuptake inhibitors or newer antidepressants as first-line treatment for patients with major depression. We systematically reviewed economic evaluations of two or more antidepressants completed in clinical practice. A systematic electronic search yielded 38 studies meeting the inclusion criteria, of which 23 were administrative database analyses, 12 were observational studies, and 3 were randomized clinical trials. Experimental data indicated that tricyclic antidepressants are equivalent to selective serotonin reuptake inhibitors in terms of total expenditure. While the database analyses are susceptible to bias and confounding variables, they provided an added dimension based on observations from everyday clinical practice. The majority of these studies failed to show any significant difference. Taken together, available pharmacoeconomic studies indicate that tricyclic drugs and selective serotonin reuptake inhibitors have similar cost effectiveness in the health care systems where these comparisons have been made.

Antidepressive Agents↗
PubMed2003

Discharges of patients from public psychiatric hospitals in Italy between 1994 and 2000.

BACKGROUND: Psychiatric hospitals in Italy had to be closed under a law dated 1994. AIMS: To investigate the discharge of patients from public psychiatric hospitals. METHODS: A total of 4492 patients from 22 psychiatric hospitals were described at recruitment and followed during the period 1994-2000. Their characteristics were investigated as determinants of discharge to community residential facilities for psychiatric patients versus other settings. RESULTS: All 22 psychiatric hospitals closed between 1994 and 2000; 678 patients had died, and the remainder were discharged. Of these, 39% went to nursing homes, 29% to community residential facilities for psychiatric patients, 2% joined their family, less than 1% were settled in private independent accommodation, and 29% remained in the psychiatric hospital, although defined as discharged. Ten patients were recorded as missing when still in the psychiatric hospitals, none after discharge. Younger, more educated patients and patients from two of the four regions studied were more likely to be discharged to community residential facilities. CONCLUSIONS: The majority of patients were discharged to highly supervised settings. The potential risk of abandonment due to deinstitutionalization was not observed in this population. The wide use of highly supervised settings can be explained by the patients' old age, but different local policies may have affected the discharge process.

Adult↗
PubMed2003

Clinical interventions for treatment non-adherence in psychosis: meta-analysis.

BACKGROUND: Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice. AIMS: To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence. METHOD: Systematic review and meta-regression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence. RESULTS: We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% CI 2.21-3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% CI 0.06-0.66) for continuous outcomes. CONCLUSIONS: Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.

Community Mental Health Services↗
PubMed2003

Cost and outcome implications of using typical and atypical antipsychotics in ordinary practice in Italy.

BACKGROUND: It is uncertain whether atypical antipsychotic agents, as prescribed in ordinary practice, are a cost-effective alternative to conventional agents. This study examined the financial and clinical implications of using atypical antipsychotics in the context of community psychiatric care in Italy. METHOD: Service costs and outcome data over a 24-month period (June-November 1999 to June-November 2001) were compared between 2 cohorts of ICD-10-diagnosed subjects, the first including patients receiving atypical and the second typical antipsychotics, according to the type of treatment received at the beginning of the study. RESULTS: At baseline, 183 subjects were under treatment with antipsychotic drugs, of whom 73 were treated with atypical agents. Most patients had a diagnosis of schizophrenia and only a minority were first-contact patients. Conventional antipsychotics were used in more chronic and elderly patients, while atypicals were prescribed in more severe and recently diagnosed cases. After background group differences were controlled for, the use of atypical agents was neither predictive of higher total health care costs nor of better patient outcome. Predictors of higher costs and better outcome were severity of illness at baseline and first-contact patients. CONCLUSIONS: The introduction of atypical agents had a small impact in terms of total health care costs and outcome, and more important than the agent prescribed was the severity of illness.

Adult↗
PubMed2002

Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review.

OBJECTIVE: To compare the effects and side effects of low dosage tricyclic antidepressants with placebo and with standard dosage tricyclics in acute phase treatment of depression. DESIGN: Systematic review of randomised trials comparing low dosage tricyclics (< or =100 mg/day) with placebo or with standard dosage tricyclics in adults with depression. MAIN OUTCOME MEASURES: Relative risk of response in depression (random effects model), according to the original authors' definition but usually defined as 50% or greater reduction in severity of depression. Relative risks of overall dropouts and dropouts due to side effects. RESULTS: 35 studies (2013 participants) compared low dosage tricyclics with placebo, and six studies (551 participants) compared low dosage tricyclics with standard dosage tricyclics. Low dosage tricyclics, mostly between 75 and 100 mg/day, were 1.65 (95% confidence interval 1.36 to 2.0) and 1.47 (1.12 to 1.94) times more likely than placebo to bring about response at 4 weeks and 6-8 weeks, respectively. Standard dosage tricyclics failed, however, to bring about more response but produced more dropouts due to side effects than low dosage tricyclics. CONCLUSIONS: Treatment of depression in adults with low dose tricyclics is justified. However, more rigorous studies are needed to definitively establish the relative benefits and harms of various dosages.

Adult↗
PubMed2002

Fluoxetine dose and outcome in antidepressant drug trials.

OBJECTIVE: One potential for bias in the evaluation of a new drug is the dose used, both for the new compound and for the reference drug. The present study compared fluoxetine dose and outcome in trials in which fluoxetine was the experimental drug with trials in which it was the comparator. METHODS: Systematic review of randomised controlled trials comparing fluoxetine with any other antidepressant in depressive patients. Studies were allocated to one of the following two groups: group 1 = fluoxetine was the experimental drug; group 2 = fluoxetine was the control drug. Trials were located by searching the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Controlled Trials Register. RESULTS: The systematic search yielded 103 randomised trials. Studies in which fluoxetine was the experimental drug adopted a higher dose regimen than group-2 studies. In the efficacy analysis, the weighted rate of fluoxetine responders was 70.1% (confidence interval 67.4%, 72.8%) in group-1 studies and 57.9% (57.2%, 58.7%) in group-2 studies. In the effectiveness analysis, the weighted rate of fluoxetine responders was 56.4% (55.3%, 57.6%) in group-1 studies and 51.9% (51.2%, 52.7%) in group-2 studies. The weighted rate of fluoxetine dropouts was higher in group-1 studies. CONCLUSION: . Fluoxetine dose and outcome changed according to whether this drug was used as a new compound or as a reference.

Antidepressive Agents, Second-Generation↗
PubMed2002

Update of suicide trends in Italy from 1986 to 1996.

BACKGROUND: In some Western countries increasing suicide rates have been observed among males, especially young men, with a decline of female suicides. The present study analysed age-specific and age-standardised suicide rates in Italy. METHOD: From 1986 to 1996 national statistics on numbers of suicides in each sex and age group were examined. RESULTS: Overall, suicides have remained substantially stable from 1986 to 1996. Among males over 45 years of age rates progressively decreased, and among subjects below 15 years rates remained stable. In the 15-24 and 25-44 age groups rates progressively rose: an overall increase of 2.76/100,000 and 1.60/100,000 was recorded, respectively. Among females over 45 years of age suicide rates progressively decreased, while rates in the other age groups remained fairly stable. CONCLUSION: The present analysis documents a rise in suicides among young men, and highlights the need for age-specific suicide prevention programmes.

Adolescent↗
PubMed2002

Clinical databases of patients receiving antidepressants. The missing link between research and practice?

BACKGROUND: In the last 10 years the use of antidepressants has increased drastically. Unfortunately, the epidemiology of these compounds has shown significant gaps between recommendations derived from randomised controlled trials and current clinical practice. METHODS: We argue for the need to develop and maintain clinical databases of patients receiving antidepressants as a way of bridging this situation. RESULTS: In addition to experimental data generated in selected patients and settings, observational databases of large cohorts of typical patients, followed in typical settings, should be developed and maintained. Clinical databases could collect information on patient social and demographic characteristics, clinical symptoms, diagnosis and pharmacological and non-pharmacological treatments. In addition, they can provide accurate estimates of probabilities of different outcomes and on factors that affect outcome. CONCLUSION: Clinical databases should not be seen as another expensive administrative task for busy doctors. Clinical databases should be developed, organised and utilised only by clinicians who are interested in monitoring their clinical practice and want to provide patients, relatives and the public with information on prognosis and outcome in their specific context of care. Maintaining clinical databases is a routine process, nested in everyday clinical activity, which aims at constituting a permanent link between research and practice.

Antidepressive Agents↗
PubMed2002

Monitoring community psychiatric services in Italy: differences between patients who leave care and those who stay in treatment.

BACKGROUND: Continuity of care has been monitored rarely in Italian community mental health centres. AIMS: To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out. METHOD: All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as 'drop-outs'. RESULTS: During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P =0.004) and personality disorders (P=0.029) were more likely to drop out. CONCLUSIONS: In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian out-patient facilities to tackling the needs of patients with more severe disorders.

Adolescent↗
PubMedDate not supplied

[Systemic review of clinical interventions for reducing treatment non-adherence in psychosis].

AIMS: Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains very common in clinical practice. This systematic review was carried out to investigate the efficacy of clinical interventions that community psychiatric services can implement to reduce non-adherence in patients with psychosis. METHOD: Systematic review of randomised clinical trials, controlled clinical trials and observational studies assessing the efficacy of adherence enhancing interventions. RESULTS: Forty-seven studies met the inclusion criteria and were included in this systematic review. Data suitable for re-analysis were reported in 24 studies; from the remaining 23 studies, with no data suitable for re-analysis, outcome data were extracted according to what study authors reported. In the group of studies included in the meta-analysis educational and psychotherapeutic interventions were more effective than usual care in reducing patient non-adherence. The remaining 23 studies reported contrasting findings regarding the efficacy of educational strategies. Case management models improved the adherence in half of studies, while other interventions were effective in the majority of studies reported. CONCLUSIONS: Community psychiatric services can arrange effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.

Antipsychotic Agents↗
PubMedDate not supplied

Health status, resource consumption, and costs of dysthymic patients in Italian primary care.

AIMS: To describe the health status, resource consumption and costs of patients with dysthymic disorder in the Italian primary care setting. METHODS: A total of 79 general practitioners (GPs) participated the study. Diagnosis was based on each GP's clinical assessment. At entry the Mini-International Neuropsychiatric Interview (MINI) was used as a supporting diagnostic aid. Health status was measured with the SF-36 questionnaire. Resource consumption and costs regarded the six months before enrolment. RESULTS: Out of 598 patients enrolled by GPs according to their clinical assessment, 503 fulfilled the MINI criteria and 95 did not. The latter had a better perception of their health than the former. Resource consumption was similar in the two groups; and the total per patient six-month costs did not differ significantly. CONCLUSIONS: The study confirms there may be a gap between standardised criteria for defining dysthymia and everyday clinical practice. All dysthymic patients diagnosed by GPs might be considered together from a health policy perspective.

Adolescent↗