Percorrer por autor "Pinto, Daniel"
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- Acidente Vascular Cerebral: evolução e tendência da taxa de incidência na população sob observação da rede Médicos-Sentinela de 1990 a 2012Publication . Sousa Uva, Mafalda; Antunes, Liliana; Rodrigues, Ana; Pinto, Daniel; Nunes, Baltazar; Dias, Carlos MatiasO Acidente Vascular Cerebral (AVC) tem sido descrito como uma das principais causas de morte em Portugal (em 2012 128,6/105). Embora tenha vindo a ser realizada a monitorização das taxas de mortalidade por AVC em Portugal, permanece escassa a informação relativa a outras relevantes medidas epidemiológicas de frequência desta doença, designadamente, a prevalência e a incidência. A Rede de Médicos Sentinela é o único sistema de observação em saúde que tem permitido o cálculo anual das taxas de incidência de AVC, na população sob observação da rede que inclui, exclusivamente, indivíduos inscritos nas listas de utentes dos cuidados de saúde primários. O objectivo do presente trabalho foi Descrever a evolução e analisar as tendências das estimativas de incidência de AVC entre 1990 e 2012, na população sob observação pela Rede Médicos- Sentinela (MS). Observou-se que a taxa de incidência de AVC não tem sofrido alterações significativas no período estudado e tem-se mantido sempre superior nos homens, o que se poderá dever à maior prevalência de hipertensão arterial e à maior prevalência de consumo de tabaco neste sexo.
- Initial therapeutic choices for hypertension in the Portuguese Sentinel Practice NetworkPublication . Pinto, Daniel; Rodrigues, Ana Paula; Nunes, BaltazarIntroduction and Objectives: Finding out which drugs are chosen to treat incident cases of hypertension may help in interpreting prevalent use of antihypertensive agents. We aimed to determine the proportion of patients who begin treatment with each antihypertensive drug class, which physicians initiate treatment and whether family physicians alter prescriptions initiated by others, and to compare the prescribing patterns of family physicians and other specialists. Methods: In this cohort-nested cross-sectional study between 2014 and 2015 within the Portuguese Sentinel Practice Network, family physicians notified incident cases of hypertension, reporting treatment, who issued the initial prescription and whether treatments initiated by other physicians were changed. Results: A total of 681 incident cases were notified. The initial prescription was issued by the patient’s family physician in 86.9% of cases (95% CI: 84.2-89.3%). The most frequently used agents were angiotensin-converting enzyme inhibitors (51.3% of patients, 95% CI: 47.5-55.0%), thiazide and thiazide-like diuretics (32.2%, 95% CI: 28.8-35.8%), and angiotensin receptor blockers (21.4%, 95% CI: 18.5-24.7%). Compared to other specialists, family physicians used less beta-blockers (20.4 vs. 5.9%, p<0.001) and loop diuretics (8.2 vs. 0.8%, p=0.003). Prescriptions initiated by other specialists were changed by family physicians in 11.6% of cases (95% CI: 6.0-19.6%). Conclusion: Angiotensin-converting enzyme inhibitors were the most frequently prescribed antihypertensive class. Most diagnoses were made by the patient’s own family physician. Prescriptions initiated by other specialists were usually continued by family physicians. Prescribing patterns were similar between family physicians and other specialists, except for lower use of beta-blockers and loop diuretics.
- Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice NetworkPublication . Pinto, Daniel; Rodrigues, Ana Paula; Nunes, BaltazarIntroduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists. Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed. Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%). Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists. Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists.