BACKGROUND: Dyslipidaemia is a key risk factor for atherosclerotic cardiovascular disease (ASCVD), necessitating effective statin therapy. Despite statins' proven safety and efficacy, adherence remains suboptimal, with significant gaps between clinical practice and guideline recommendations. METHODS: This retrospective cohort study analysed anonymized health administrative claims data from six employee health funds in the Czech Republic, covering approximately 40% of the insured population from January 1, 2017, to December 31, 2020. We identified statin-incident as well as prevalent cohort of patients. Adherence to statin therapy was assessed using the proportion of days covered (PDC) metric, with factors such as age, gender, sequence of use, and treatment intensity considered as modifiers. RESULTS: Among the statin-prevalent cohort (SP, n = 890,180), 83.5% achieved a PDC ≥ 50%, and 61.0% reached a PDC ≥ 80%. In the statin-incident cohort (SI, n = 287,871), a clear trend of increasing adherence with age and medication sequence was observed: in adults aged 18-39 median PDC rose from 84.1% (IQR: 57-100) in the first to 94.7% (IQR: 75.6-100) in the third sequence; in those aged 80 + median PDC rose from 95.0% (IQR: 68.9-100) in the first to 100% (IQR: 78.3-100) in the third sequence. Logistic regression identified age (OR=1.011 per year), female gender (OR=0.896), high-intensity treatment (OR=0.975), and second (OR=1.267) or later treatment sequences (OR=1.704) as significant predictors of adherence (all p < 0.001). CONCLUSION: Adherence to statin therapy improves with subsequent treatment sequences and age. These findings highlight the need for targeted interventions to enhance adherence, particularly among younger patients. The PDC metric is recommended for integration into clinical practice to monitor and improve medication adherence.
- MeSH
- adherence k farmakoterapii * MeSH
- dospělí MeSH
- dyslipidemie * farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři MeSH
- statiny * terapeutické užití MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- dostupnost zdravotnických služeb MeSH
- hodnotící studie jako téma MeSH
- lidé MeSH
- řízení zdravotnictví MeSH
- ukazatele kvality zdravotní péče * organizace a řízení MeSH
- výběr pacientů MeSH
- zajištění kvality zdravotní péče metody organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- Klíčová slova
- cesta pacienta,
- MeSH
- adherence pacienta MeSH
- dodržení předchozích instrukcí MeSH
- management péče o pacienta * MeSH
- mezioborová komunikace MeSH
- plánování péče o pacienty MeSH
- prodromální symptomy MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Publikační typ
- novinové články MeSH
BACKGROUND: Inhaled corticosteroids have been widely reported as a preventive measure against the development of severe forms of COVID-19 not only in patients with asthma. METHODS: In 654 Czech and Slovak patients with asthma who developed COVID-19, we investigated whether the correct use of inhaler containing corticosteroids was associated with a less severe course of COVID-19 and whether this had an impact on the need for hospitalisation, measurable lung functions and quality of life (QoL). RESULTS: Of the studied cohort 51.4% had moderate persistent, 29.9% mild persistent and 7.2% severe persistent asthma. We found a significant adverse effect of poor inhaler adherence on COVID-19 severity (p=0.049). We also observed a lower hospitalisation rate in patients adequately taking the inhaler with OR of 0.83. Vital capacity and forced expiratory lung volume deterioration caused by COVID-19 were significantly reversed, by approximately twofold to threefold, in individuals who inhaled correctly. CONCLUSION: Higher quality of inhalation technique of corticosteroids measured by adherence to an inhaled medication application technique (A-AppIT) score had a significant positive effect on reversal of the vital capacity and forced expiratory lung volume in 1 s worsening (p=0.027 and p<0.0001, respectively) due to COVID-19. Scoring higher in the A-AppIT was also associated with significantly improved QoL. All measured variables concordantly and without exception showed a positive improvement in response to better adherence. We suggest that corticosteroids provide protection against the worsening of lungs in patients with COVID-19 and that correct and easily assessable adherence to corticosteroids with appropriate inhalation technique play an important role in preventing severe form of COVID-19.
- MeSH
- bronchiální astma * farmakoterapie MeSH
- COVID-19 * MeSH
- hormony kůry nadledvin MeSH
- kvalita života MeSH
- lidé MeSH
- usilovný výdechový objem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- zdravotnická data,
- MeSH
- analýza dat MeSH
- anonymizace dat MeSH
- důvěrnost informací * MeSH
- registrace MeSH
- výzkum * MeSH
- zdravotnické informační systémy MeSH
- Publikační typ
- novinové články MeSH
- rozhovory MeSH
Data o zdravotní péči ve správě státem řízených organizací jsou pro společnost cenným nehmotným aktivem. Jejich využití by mělo být pro jejich správce a stát prioritou. Zcela paternalistický přístup správců a státu je nežádoucí, jakkoliv má za cíl ochranu práva na soukromí osob registrovaných v databázích. V souladu s evropskou politikou a celosvětovým trendem by však tato opatření neměla převážit společenský benefit, který z analýzy těchto údajů vyplývá, existují-li technické možnosti práva osob na soukromí dostatečně chránit. Česká společnost vede k tématu intenzivní diskusi, která se však podle autorů jen nedostatečně opírá o fakta a postrádá jasně artikulovaná stanoviska odborné veřejnosti. Cílem tohoto článku je tyto mezery zacelit. Techniky anonymizace údajů představují řešení, jak chránit práva jednotlivců na soukromí a zároveň zachovat vědeckou hodnotu údajů. Riziko ztotožnění jednotlivců v anonymizovaných souborech údajů je škálovatelné a lze ho minimalizovat v závislosti na typu a obsahu údajů a jejich použití konkrétním žadatelem. Nalezení optimální formy a rozsahu deidentifikovaných údajů vyžaduje kompetence a znalosti jak na straně žadatele, tak na straně správce. Je v zájmu žadatele, správce i chráněných osob v databázích, aby obě strany projevily ochotu a měly schopnost a odborné znalosti komunikovat v průběhu žádosti a jejího zpracování.
Healthcare data held by state-run organisations is a valuable intangible asset for society. Its use should be a priority for its administrators and the state. A completely paternalistic approach by administrators and the state is undesirable, however much it aims to protect the privacy rights of persons registered in databases. In line with European policies and the global trend, these measures should not outweigh the social benefit that arises from the analysis of these data if the technical possibilities exist to sufficiently protect the privacy rights of individuals. Czech society is having an intense discussion on the topic, but according to the authors, it is insufficiently based on facts and lacks clearly articulated opinions of the expert public. The aim of this article is to fill these gaps. Data anonymization techniques provide a solution to protect individuals' privacy rights while preserving the scientific value of the data. The risk of identifying individuals in anonymised data sets is scalable and can be minimised depending on the type and content of the data and its use by the specific applicant. Finding the optimal form and scope of deidentified data requires competence and knowledge on the part of both the applicant and the administrator. It is in the interest of the applicant, the administrator, as well as the protected persons in the databases that both parties show willingness and have the ability and expertise to communicate during the application and its processing.
The pandemic caused by the SARS-CoV-2 virus is believed to originate in China from where it spread to other parts of the world. The first cluster of diseased individuals was reported in China as early as in December 2019. It has also been well established that the virus stroke Italy later in January or in February 2020, hence distinctly after the outbreak in China. The work by Apolone et al. published in the Italian Medical Journal in November 2020 and retracted upon expression of concern on 22 March 2021, however propose that the virus could have stroke people already in September 2019, possibly following even earlier outbreak in China. By fitting an early part of the epidemic curve with the exponential and extrapolating it backwards, we could estimate the day-zero of the epidemic and calculated its confidence intervals in Italy and China. We also calculated how probable it is that Italy encountered the virus prior 1 January 2020. We determined an early portion of the epidemic curve representing unhindered exponential growth which fit the exponential model with high determination >0.97 in both countries. We conservatively suggest that the day-zero in China and Italy was 8 December 2019 (95% CI: 3 Dec., 20 Dec.) and 22 January 2020 (95% CI: 16 Jan., 29 Jan.), respectively. Given the uncertainty of the very early data in China and adjusting hence our model to fit the exponentially behaved data only, we can even admit that the pandemic originated through November 2019 (95% CI: 31 Oct., 22 Dec.). With high confidence (p <0.01) China encountered the virus prior Italy. We generally view any pre-pandemic presence of the virus in humans before November 2019 as very unlikely. The later established dynamics of the epidemics data suggests that the country of the origin was China.
- MeSH
- biologické modely * MeSH
- COVID-19 * epidemiologie přenos MeSH
- lidé MeSH
- pandemie * MeSH
- SARS-CoV-2 * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Čína MeSH
- Itálie MeSH
OBJECTIVES: To provide valuable local data on the economic burden of rotavirus gastroenteritis (RVGE) for decision making on introduction of rotavirus vaccination in Central European countries. METHODS: We conducted a retrospective patient hospital chart review during the winter RVGE peak in the Czech Republic (n = 109), Hungary (n = 109), Poland, (n = 112), and Slovakia (n = 115) to estimate resource use and associated costs from the payer's perspective in children younger than 5 years with severe RVGE requiring hospitalization. Microcosting analysis was used to estimate the average costs of treating RVGE inpatients including pre- and posthospitalization costs. RESULTS: The average cost of treatment was €476, €316, €741, and €594 in the Czech Republic, Hungary, Poland, and Slovakia, respectively. Extrapolating these costs to the total number of RVGE hospitalizations gives annual cost estimates of €2.1 million, €1.5 million, €13.2 million, and €1.5 million, respectively. The main component of expenditure in all the four countries is the hospital stay, but wide variation among countries was observed (total cost of treating RVGE in hospital was almost 2.5-fold higher in Poland than in Hungary). In countries with diagnosis related group (DRG) costs available, the best agreement between real resource-use-driven costs and the DRG cost was found in the Czech Republic and Hungary, with differences of only €22 and €33, respectively. In Poland, the microcosting indicated higher overall costs incurred in hospital than the DRG cost, with a difference exceeding €190. CONCLUSIONS: Hospitalization of children with RVGE represents a substantial economic burden for the national health systems in these countries.
- MeSH
- gastroenteritida ekonomika terapie MeSH
- hospitalizace * MeSH
- lidé MeSH
- náklady na zdravotní péči * MeSH
- osobní újma zaviněná nemocí * MeSH
- retrospektivní studie MeSH
- rotavirové infekce ekonomika terapie MeSH
- Rotavirus * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Evropa MeSH
- Maďarsko MeSH
- Polsko MeSH
- Slovenská republika MeSH
- MeSH
- farmaceutický průmysl * MeSH
- léčivé přípravky MeSH
- lidé MeSH
- sběr dat MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
