zens, are involved in the project. Unique queries cannot be performed across different
databases because of their heterogeneity: Medical record and Claims databases, four
different terminologies for coding diagnoses, and two languages for the information
described in free text. The aim of our study was to provide database owners with a
common basis for the construction of their queries. Using the UMLS, we provided a list
of medical concepts, with their corresponding terms and codes in the four terminolo-
gies, which should be considered to retrieve the relevant information for the events of
interest from the databases.
nical records, it has been observed that among the 617,280 subjects registered with 400
Italian GPs, 15,229 (2.47%) patients were suffering from chronic obstructive pulmonary
disease (COPD). Of these, 67.7% had a chest radiograph at least once in a period of 10
years (1997-2006), while in the same period only 31.9% had a spirometry, 29.9% had a
visit to a specialist, and 0.94% had a visit to an allergologist. From 1997 to 2006, 7.5%
of patients with COPD, especially the oldest ones, were hospitalized at least once for the
disease, although 44.0% of all patients with COPD were hospitalized for other patholo-
gies. With regard to treatment, in 2006, 10,936 (71.1%) of COPD patients received at
least one drug for their disease (drugs classified within the R03 therapeutic pharmaco-
logical subgroup of the Anatomical Therapeutic Chemical Classification). In particular,
salmeterol/fluticasone was prescribed 6441 times, tiotropium 4962, theophylline 3142,
beclomethasone 2853, salbutamol 2256, formoterol 2191, salbutamol/beclomethasone
2129, oxitropium 1802 and formoterol/budesonide 1741 times. Based on these findings,
the level of COPD management in Italy seems to fall short of recommended international
COPD guidelines. In particular, it appears that GPs usually prescribe treatment without the
use of spirometry, and/or without taking into account the severity of airway obstruction.
It must also be noted that, in general, patients with COPD are undertreated.
primary care. J Cardiovasc Med (Hagerstown). 2009;10:714-8.
infarction (AMI) is strictly recommended because of its great efficacy. Little is known about
long-term utilization of drugs related to cardiovascular secondary prevention in everyday
practice. DESIGN: A population-based cohort study on the basis of an Italian general prac-
tice database. METHODS: Searching a large primary-care Italian database (Health Search),
we selected five cohorts of patients with first occurrence of AMI from 2001 to 2005, re-
spectively, and analyzed prescriptions of antithrombotic agents, beta-blockers, statins and
angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
from 2001 to 2006 (follow-up ranging from 1 to 5 years). RESULTS: We identified 4764
patients (mean age 67; 35% female) discharged from hospital after first-ever AMI. The
prescription rate in the first year after AMI was suboptimal (beta-blockers 35.1%, aspirin
or warfarin 75.0%, ACE-inhibitors or ARBs 61.6%, statins 52.8%) but showed a conti-
nuous improvement from 2001 to 2005. The prescription rate decreased slightly during
the follow-up, but showed a complex pattern with a variable but significant number
of patients discontinuing or resuming the therapy. CONCLUSIONS: The prescription of
recommended drugs after AMI has increased from 2001 to 2006 in Italy, but the prescrip-
tion rate remains largely unsatisfactory. Therapeutic continuity is also suboptimal.