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Author: Karel Kostev (153)


Feb
2018

The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016.
The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month.

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Feb
2018

The goal of this study was to analyze the frequency of thyroid-stimulating hormone (TSH) monitoring in thyroidectomy patients followed by general practitioners in Germany.
This study included all individuals ≥18 years who had undergone a thyroidectomy between 2000 and 2015 in 258 general practices in Germany. Another inclusion criterion was a minimum of three medical visits between 2015 and 2016, following thyroidectomy.

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Feb
2018

The aim of this study was to analyze the prevalence and treatment of sexually transmitted diseases (STDs) in gynecological practices in Germany.
This study included women who were followed in gynecological practices in Germany between 2013 and 2015. The first outcome was the prevalence of women diagnosed with STDs during this time period.

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Feb
2018

The goal of the present retrospective work was to study the impact of depression on persistence with antihypertensive drugs in general practices in Germany.
This study included adults with hypertension and depression who initially received antihypertensive drugs from physicians in 1,262 general practices in Germany between January 2013 and December 2015. Hypertension controls without depression were matched (1:1) to the hypertension cases with depression based on age, gender, physician, and initial antihypertensive therapy, using a propensity score method.

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Jan
2018

The aim of this study was to analyze the frequency of blood pressure (BP) and estimated glomerular filtration rate (eGFR) monitoring in hypertension patients followed in primary care practices in Germany.
This study included patients who had received at least two hypertension diagnoses (ICD-10: I10) in 2016. The primary outcome of this study was the frequency of BP and eGFR monitoring in patients with hypertension in the year 2016.

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Mar
2018

The aim was to investigate the association between diabetes duration and depressive symptoms in type 2 diabetes. The DIAREG registry used data of a nationwide general medicine practice database (Disease Analyzer, Germany) augmented by prospective data from patient reported outcomes (PRO) including Center of Epidemiological Studies Depression Scale (CES-D: <16 vs. ≥16) and the SF-36.

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Dec
1969

The goal of this study was to identify potential risk factors for ectopic pregnancy in women followed in German gynecological practices.The present study included pregnant women diagnosed with ectopic pregnancy and pregnant women without ectopic pregnancy followed in 262 gynecological practices between January 2012 and December 2016. The effects of demographic and clinical variables on the risk of developing ectopic pregnancy were estimated using a multivariate logistic regression model.

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Jan
2018

20-year risk of breast cancer recurrence.

Breast Cancer Res Treat 2018 Jan 3. Epub 2018 Jan 3.
Karel Kostev, Matthias Kalder

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Jan
2018

The objectives were to examine long-term changes in type 2 diabetes patient characteristics, diabetes treatment, control and complications in general practices.
All type 2 diabetes patients were identified in a representative general practice database (Disease Analyser, Germany) in three periods (01/2008-12/2008: n = 90.866, 818 practices, mean age (SD): 67.

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Mar
2018

The goal of the present work was to study the impact of depression on persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus (T2DM) patients followed in general practices in Germany. We included T2DM patients who were treated with oral antihyperglycemic drugs and had an initial diagnosis of depression from 1262 general practices in Germany between January 2013 and December 2015. T2DM controls without depression were included and matched (1:1) to T2DM cases with depression based on age, sex, physician, and initial antihyperglycemic therapy, using a propensity score method.

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Dec
2017


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Dec
2017

European clinical guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL. Statin use varies and past studies suggest low rates of real-world goal attainment. This study describes LDL-C goal attainment among atherosclerotic CV disease (ASCVD) patients with various utilization patterns of moderate- or high-intensity statins in routine care.

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Dec
2017

The aim of this study is to identify the prevalence and risk factors of documented delirium in general practices in Germany.
The present study includes 2,194 patients over the age of 65 years with delirium and 2,194 controls without delirium from a sample of 6,180,042 patients from 1,262 general practices. Multivariate logistic regression models were fitted with delirium as a dependent variable and other disorders and drugs as potential predictors.

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Dec
2017

Guideline-based, risk-adjusted therapy with anticoagulants reduce thromboembolic stroke risk in patients with atrial fibrillation (AF).
This study analyzed use of oral anticoagulation in German AF-patients. Access to anonymized patient records was made via IMS Health Disease Analyzer database (sample size: 113,619 patients with ICD-10 Code I48.

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Jan
2018

The aim of this study was to analyze tramadol prescription patterns in acute pain patients followed by general practitioners and orthopedists in Germany.
This study included patients ≥18 years diagnosed with acute pain who received at least one tramadol prescription each in one of 1,129 general or 179 orthopedic practices in Germany between January and December 2015 (index date). Patients were excluded if they had received a prescription for another analgesic in the year prior to the index date, had a follow-up of less than 15 months after the index date, or were prescribed tramadol for a period of more than three months.

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Oct
2017

The goal of the present study was to analyze the prevalence and risk factors of suspected cancer diagnoses made by general practitioners (GP) in a population with subsequently confirmed cancer diagnoses in Germany. This study included patients aged 18 years or older who received an initial documentation of a confirmed cancer diagnosis from 1,262 German GP between January and December 2016 (index date). The main outcome measure of the study was the rate of suspected cancer diagnoses made by GP within one year prior to the index date.

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Nov
2017

In 2013 and 2014 dementia diagnoses in general practitioner (GP) practices dramatically increased, a phenomenon most likely caused by monetary incentives.
Which GP practice-dependent indicators are associated with the increase in dementia diagnoses and are thus decisive factors for the way in which physicians in GP practices respond to monetary incentives?
We performed a retrospective, longitudinal analysis of 856 GP practices. The increase in dementia diagnoses was calculated by comparing the number of newly diagnosed persons with dementia (PWD) per GP practice in 2012 and 2014.

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Jan
2018

The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK.
This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016.

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Oct
2017

 This retrospective study aims to measure the effect of the disease management program (DMP) for type 2 diabetes mellitus (T2DM) patients on HbAvalue within Germany. This study is based on patient data from the Disease Analyzer panel (IMS Health). An adequate control group was created using 2:1 propensity score matching.

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Dec
1969

Hypertension, a chronic disease resulting from aging and its related physiopathological dysregulations, is often associated with dementia.
The goal was to analyze the persistence with antihypertensive drugs in patients affected by both hypertension and dementia in Germany.
This study included hypertension patients who were initially treated with antihypertensive drugs in 1,262 general practices in Germany between January 2013 and December 2015 (index date).

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Dec
2017

The aim of this study was to analyze the prevalence of depression, anxiety, and adjustment disorders in women within the year following miscarriage in Germany. This study included women between the ages of 16 and 45 with a first pregnancy terminated by spontaneous abortion between January 2007 and December 2015 (index date). These women were followed in 262 gynecological practices.

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Oct
2017

Breast cancer (BC) and genital organ cancers (GOC) are known to have a major impact on the quality of life of patients. The aim of this study was to analyze the risk of depression, anxiety, and adjustment disorders in women in Germany with a suspected but unconfirmed diagnosis of BC or GOC in their medical history.
This study included women who received a suspected diagnosis of BC or GOC and were followed between 2007 and 2015 (index date).

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Aug
2017

In 2013, the incidence of patients with dementia (PwD) in primary care practices (PCP) drastically increased.
(1) Is the increase also detectable in a subsample, (2) was there a comparable increase in specialist practices (SP), and (3) did the increase affect diagnostics and therapy?We analyzed billing data from 874 PCP and 141 SP (2011 to 2015) pertaining to more than 14,000 PwD/year with regard to the incidence of dementia diagnoses (ICD-10: G30, F01, F03) and antidementia prescriptions.The incidence abruptly increased by 47 % (2013) and 73 % (2014) compared to 2012.

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Oct
2017

The goal of this study was to analyze adherence to antiepileptic drugs (AED) in children and adolescents treated in pediatric practices in Germany.
The present study included patients aged between 2 and 17years who were diagnosed with epilepsy (ICD-10: G40) and had received at least two prescriptions of AED between January 2006 and December 2015 in 243 pediatric practices in Germany. The medication possession ratio (MPR) was used to estimate adherence, and patients with a MPR greater than 80% were considered adherent.

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Jul
2017

The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany.
This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016.

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Sep
2017

To analyze compliance with vaccination against hepatitis A virus (HAV) in patients followed in general and pediatric practices in Germany.
The present study included 7,323 patients from 575 general practices and 3,962 patients from 111 pediatric practices. Patients were included if they had received the first dose of one of the two following vaccines against HAV: Havrix® or Vaqta®, between 2011 and 2014.

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Jan
2018

The aim of this study was to analyze the persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus (T2DM) patients with dementia in Germany.
This study included adults with T2DM who were treated with oral antihyperglycemic drugs and were diagnosed with dementia in 1262 German general practices between January 2013 and December 2015 (index date). Dementia cases were matched (1:1) to controls without dementia by age, gender, type of practice, type of residence, physician, and initial antihyperglycemic therapy, using a propensity score method.

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Aug
2017

The goal of this study was to analyze the persistence with antiepileptic drugs (AED) and associated factors in patients followed in neurological practices in Germany.
This study included patients aged 18years or over who received two initial diagnoses of epilepsy and a first prescription of AED between 2007 and 2015 in a neurological practice (index date). The main outcome measure was the rate of AED persistence within five years of the index date.

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Jun
2017

 The aim of the present study was to examine inpatients as well as patients living at home with respect to the frequency of antipsychotic medication use and to determine the factors leading to initial use of antipsychotics following dementia diagnosis. This study included patients aged 60 years and over with an initial diagnosis of all-cause dementia (index date) by German psychiatrists in Disease Analyzer database (IMS Health). The main outcome measure was the proportion of patients who initially received an antipsychotic prescription after the index date.

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Dec
2017

During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues.
The aim of this study was to determine the risk factors associated with the high cesarean section rates in Lebanon.

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Jun
2017

Hypercholesterolemia is a causal risk factor for cardiovascular diseases, which is recommended to be treated at least in high-risk patients. Yet, currently there is a lack of epidemiological data on the number of high-risk patients in Germany who do not respond adequately to high-dose statin monotherapy or statin therapy in combination with other lipid-lowering agents.
Of a total of over 2.

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Jan
2018

The aim of this study was to analyze prescription patterns and disease control in patients with type 2 diabetes mellitus (T2DM) in nursing home and home care settings in Germany.
The present study is based on data from the Disease Analyzer database (QuintilesIMS). Patients with an initial diagnosis of T2DM and documented HbA1c values between January 2011 and December 2015 were included in the analysis.

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May
2017

Did the diagnostic and treatment behavior of general practitioners and specialists in patients with dementia (PWD) change in Germany over a period of 11 years (2005 vs. 2015)?We performed a retrospective, database-based evaluation of diagnostic and prescription data from more than 398 general practices (GP) and 50 specialist practices (SP).Compared to 2005, in 2015, the number of PWD had increased by 40.

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Dec
1969

Only few authors have analyzed the impact of workplace conflicts and the resulting stress on the risk of developing cardiovascular disorders. The goal of this study was to analyze the association between workplace conflicts and cardiovascular disorders in patients treated by German general practitioners.Patients with an initial documentation of a workplace conflict experience between 2005 and 2014 were identified in 699 general practitioner practices (index date).

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Jun
2017

To identify differences and similarities in benzodiazepine (BZD) prescribing patterns in elderly patients reported in two separate and independent investigations, one from Germany for the year 2014 and the other from Korea for the year 2013.
Data on patients over 65 years, who were prescribed at least one BZD, were obtained from population databases. The design and characteristics of the two studies were similar.

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Sep
2017

Seasonality in insulin sensitivity has been the focus of controversial literature in the past decades. The aim of this study was to analyze seasonality of insulin use in patients with diabetes who were followed in German general practices.
This study included patients affected by type 1 (T1DM) or type 2 diabetes mellitus (T2DM) who received intensified conventional insulin therapy over a period of at least 12 months between 2013 and 2015.

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Jun
2017

The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP).
This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively.

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Dec
1969

High adherence and persistence are important for the efficacy of anti-dementia treatments.
The goal of this study was to analyze the association between anti-dementia treatment persistence and daily dosage of the first prescription in patients treated in neuropsychiatric practices in Germany.
This study included patients aged 60 years or over who were diagnosed with Alzheimer's disease and received anti-dementia prescriptions (galantamine, donepezil, memantine, and rivastigmine) for the first time between 2005 and 2014.

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Mar
2017

 Hypercholesterolemia plays a causal role in the development of cardiovascular diseases. Patients are affected differently. There is a lack of epidemiological data about the frequence and characteristics of patients in Germany, especially about those who do not respond sufficiently to high intensity statins with or without other lipid modifying therapies.

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Jun
2017

Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. The goal of this study was to analyze the risk of depression in patients diagnosed with RA and treated by general practitioners in the UK.
The present study included patients first diagnosed with RA between 2000 and 2014 (index date).

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Mar
2017

[The Influence of Caseload on Continuous Treatment with Antidementia Drugs].

Fortschr Neurol Psychiatr 2017 Mar 20;85(3):156-162. Epub 2017 Mar 20.
Jens Bohlken, Karel Kostev
 The goal of this study is to investigate the impact of the number of dementia cases in general and specialist practices on the continuity of treatment with antidementia drugs. Period between 2004 and 2013: 1116 general practices, 200 specialist practices, 37 178 dementia cases; observation period: 36 months. Practice groups with 1 - 9, 10 - 20, 21-s49, and ≥ 50 dementia cases.

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May
2017

The aim was to compare changes in HbA1c and body weight after initiation of dapagliflozin or basal insulin supported oral therapy (BOT) in type 2 diabetes patients in primary care practices.
Patients from 983 primary care practices who started dapagliflozin or BOT between December 2012 and July 2015 (index date, ID) were retrospectively analyzed (Disease Analyzer; Germany). Changes in HbA1c (%) and body weight (kg) were evaluated 90-270 days after ID.

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Jul
2017

The present retrospective study examines the influence of disease management programs on nonfatal stroke in type 2 diabetes mellitus (T2DM) patients in Germany.
The evaluation is based on retrospective patient data from the Disease Analyzer (IMS Health). The analysis included 169 414 T2DM patients aged 40 years and older with an initial prescription of antihyperglycemic therapy between January 2004 and December 2014.

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May
2017

The aim was to compare the prescribed and calculated daily insulin dosages based on prescription data in type 2 diabetes patients in a general practice database.
A total of 17 782 type 2 diabetes patients (age: 70.0 ± 11.

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Aug
2017

The aim of this study is to estimate the prevalence and potential predictors of the prescription of antibiotics in pregnant women treated by gynecologists in Germany.
The current study included 90,312 women aged between 18 and 45 years with a full-term documented pregnancy during the index period (2005 - 2014). The primary outcome was the proportion of pregnant women with antibiotic prescriptions.

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May
2017

The purpose of this study was to investigate differences of insulin therapy regimens in five European countries.
Proportions of basal bolus therapy (intensified insulin therapy (ICT), basal insulin supported oral therapy (BOT), conventional therapy (CT), and short-acting prandial insulin (SIT) among insulin-treated diabetes patients in Germany (n = 64,055), the UK (n = 6,740), and France (n = 4,779) were estimated using representative general medicine practice databases (Disease Analyzer: 2014). Insulin regimens in Hungary (n = 40,769) and Poland (n = 68,136) were analyzed based on nationwide prescription databases (LRx: 2014).

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Dec
1969

The purpose of this study was to analyze the prevalence of depression, anxiety, adjustment disorders, and somatoform disorders in patients diagnosed with age-related macular degeneration (AMD) in Germany.This study included 7,580 patients between the ages of 40 and 90 diagnosed with AMD between January 2011 and December 2014 in 1,072 primary care practices (index date). The last follow-up was in July 2016.

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Dec
1969

Dementia is a chronic disease associated with numerous cardiovascular disorders.
To analyze the prevalence of cardiovascular drug use in dementia patients treated in general practices in Germany.
The present study included patients who were diagnosed with dementia (Alzheimer's disease, vascular dementia, or unspecified dementia) in 2015.

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Jun
2017

The aim of this paper is to analyze the impact of prior breast cancer (BC) on mode of delivery and pregnancy-associated disorders.
A database from 262 German gynecological practices including 289,712 women between the ages of 18 and 45 with documented pregnancies between 2000 and 2014 was used to search for patients with a history of BC up to 10 years prior to pregnancy. A total of 165 patients with a history of BC were found and matched with 165 patients without a history of any cancer (1:1) by age, physician, obesity, and documented referral to a fertility center up to 12 months before the index pregnancy.

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Mar
2018

To contain pharmaceutical spending, drug budgets have been introduced across health systems. Apart from analyzing whether drug budgets fulfill their overall goal of reducing spending, changes in the cost and quality of prescribing and the enforcement mechanisms put in place need evaluation to assess the effectiveness of drug budgets at the physician level. In this study, we aim to analyze the cost and quality of prescribing conditional on the level of utilization of the drug budget and in view of varying levels of enforcement in cases of overspending.

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