Family Medicine Update

Treatment Interruption in a Primary Care Antiretroviral Therapy Program in South Africa: Cohort Analysis of Trends and Risk Factors.

J Acquir Immune Defic Syndr. 2010 Sep 8;

Authors: Kranzer K, Lewis JJ, Ford N, Zeinecker J, Orrell C, Lawn SD, Bekker LG, Wood R

OBJECTIVE:: To investigate antiretroviral treatment (ART) interruption in a long-term treatment cohort in South Africa. METHODS:: All adults accessing ART between 2004 and 2009 were included in this analysis. Defaulting was defined as having stopped all ART drugs for more than 30 days. Treatment interrupters were patients who defaulted and returned to care during the study, whereas loss to follow-up was defined as defaulting and not returning to care. Kaplan-Meier estimates and Poisson regression models were used to analyze rates and determinants of defaulting therapy and of treatment resumption. RESULTS:: Overall rate of defaulting treatment was 12.8 per 100 person-years (95% confidence interval: 11.4 to 14.4). Risk factors for defaulting were male gender, high baseline CD4 count, recency of ART initiation, and time on ART. The probability of resuming therapy within 3 years of defaulting therapy was 42% (event rate = 21.4 per 100 person-years). Factors associated with restarting treatment were female gender, older age, and time since defaulting. CONCLUSIONS:: Defaulting treatment need not be an irreversible event. Interventions to increase retention in care should target men, less immunocompromised patients, and patients during the first 6 months of treatment. Resumption of treatment is most likely within the first year of interrupting therapy.

20827216

– Treatment Interruption in a Primary Care Antiretroviral Therapy Program in South Africa: Cohort Analysis of Trends and Risk…

Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a primary care setting: the START study.

Expert Rev Neurother. 2010 Sep;10(9):1399-1408

Authors: Leone M, Vila C, McGown C

In a large observational general practice study (the Standardized Study with Almotriptan in Early Treatment of Migraine [START]), 12.5 mg almotriptan administered within 1 h of pain onset and when pain was mild significantly improved pain-related outcomes, compared with later treatment or when pain was more severe. Migraine triggers at baseline and during treatment were recorded, and it was examined whether trigger factors could affect almotriptan-induced headache improvement. More than 400 patients were enrolled, and 1174 attacks were assessed. At baseline, patients reported a mean of 2.6 types of triggers related to the start of their previous migraine attacks. During the trial, a mean of 1.5 trigger factors for each attack was recorded. The most frequent trigger during the study was stress (37% of migraine attacks), with poor sleep (34%), fatigue (32%) and menses (19%) also being widely reported. Stress and fatigue and/or poor sleep were the most frequent trigger combinations. Early treatment with almotriptan improved clinical outcomes, regardless of the trigger factors involved. Similar results were observed for nonearly administration, although this was less efficacious than early intervention. An exception in the nonearly group was that migraines triggered by poor sleep had better responses than attacks in which sleep disorder was not a factor. Almotriptan maintained its efficacy irrespective of trigger factors in migraine patients treated in everyday clinical practice and, as shown in other studies, it was most effective in reducing pain-free rates when administered early, when pain was still mild.

20819011

– Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a…

Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction.

J Am Med Inform Assoc. 2010 Sep 1;17(5):502-506

Authors: Wald JS, Businger A, Gandhi TK, Grant RW, Poon EG, Schnipper JL, Volk LA, Middleton B

Electronic health records (EHRs) and EHR-connected patient portals offer patient-provider collaboration tools for visit-based care. During a randomized controlled trial, primary care patients completed pre-visit electronic journals (eJournals) containing EHR-based medication, allergies, and diabetes (study arm 1) or health maintenance, personal history, and family history (study arm 2) topics to share with their provider. Assessment with surveys and usage data showed that among 2027 patients invited to complete an eJournal, 70.3% submitted one and 71.1% of submitters had one opened by their provider. Surveyed patients reported they felt more prepared for the visit (55.9%) and their provider had more accurate information about them (58.0%). More arm 1 versus arm 2 providers reported that eJournals were visit-time neutral (100% vs 53%; p<0.013), helpful to patients in visit preparation (66% vs 20%; p=0.082), and would recommend them to colleagues (78% vs 22%; p=0.0143). eJournal integration into practice warrants further study.

20819852

– Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction.