Lilisbeth Perestelo-Pérez

The Diabetes Mellitus Medication Choice Decision Aid: A Randomized Trial

BACKGROUND Patient involvement in the choice of antihyperglycemic agents could improve adherence and optimize glycemic control in patients with type 2 diabetes mellitus. METHODS We conducted a pilot, cluster randomized trial of Diabetes Medication Choice, a decision aid that describes 5 antihyperglycemic drugs, their treatment burden (adverse effects, administration, and self-monitoring demands), and impact on hemoglobin A(1c) (HbA(1c)) levels. Twenty-one clinicians were randomized to use the decision aid during the clinical encounter and 19 to dispense usual care and an educational pamphlet. We used surveys and video analysis to assess postvisit decisional outcomes, and medical and pharmacy records to assess 6-month medication adherence and HbA(1c) levels. RESULTS Compared with usual care patients (n = 37), patients receiving the decision aid (n = 48) found the tool more helpful (clustered-adjusted mean difference [AMD] in a 7-point scale, 0.38; 95% confidence interval [CI], 0.04-0.72); had improved knowledge (AMD, 1.10 of 10 questions; 95% CI, 0.11-2.09); and had more involvement in making decisions about diabetes medications (AMD, 21.8 of 100; 95% CI, 13.0-30.5). At 6-month follow-up, both groups had nearly perfect medication use (median, 100% of days covered), with better adherence (AMD, 9% more days covered; 95% CI, 4%-14%) and persistence (AMD, 12 more days covered; 95% CI, 3-21 days) in the usual care group, and no significant impact on HbA(1c) levels (AMD, 0.01; 95% CI, -0.49 to 0.50). CONCLUSION An innovative decision aid effectively involved patients with type 2 diabetes mellitus in decisions about their medications but did not improve adherence or HbA(1c) levels. Trial Registration clinicaltrials.gov Identifier: NCT00388050.

Social-economic costs and quality of life of Alzheimer disease in the Canary Islands, Spain

Objectives: To examine the economic burden (direct and indirect costs) of Alzheimer disease (AD) and to analyze the impact on health-related quality of life (HRQOL) for patients with AD and caregivers in 2001 in the Canary Islands, Spain. Methods: Two hundred thirty-seven patients (61% of those contacted) were recruited from the Alzheimer’s Disease Association in the Canary Islands. Demographic, health resources utilization, informal care, indirect costs, and quality of life data were collected from primary caregivers of patients as proxy respondents. HRQOL was measured for patients and caregivers with the generic questionnaire EQ-5D. Results: The average annual cost per patient with AD was 28,198 (US

Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis

36,144). The most important categories of costs were for informal care and drugs. Costs increased with cognitive impairment with an average annual cost of 14,956 (US

Outcomes of surgical treatment for nonfunctioning pituitary adenomas

19,171) for mild, 25,562 (US

Social economic costs and health-related quality of life in patients with amyotrophic lateral sclerosis in Spain

32,765) for moderate, and 41,669 (US

Meta-Review of CSF Core Biomarkers in Alzheimer’s Disease: The State-of-the-Art after the New Revised Diagnostic Criteria

53,411) for severe patients. The total cost of patients with AD in Canary Islands was 259 (US

The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain

332) million. The HRQOL with the EQ-5D social tariff was 0.29 for patients and 0.67 for caregivers. The EQ-5D VAS (thermometer) score was 42 for patients and 62 for caregivers. Conclusions: Direct health care costs of AD represented 2.4% of the total public health care expenditure in the Canary Islands. Across all severity levels, we estimated a total annual cost of 10 (US

Sociodemographic and clinical predictors of compliance with antidepressants for depressive disorders: systematic review of observational studies

13) billion for AD patients older than 65 years in Spain. The degree of severity of the patients with AD substantially influenced the quality of life of the patients but not that of the caregivers.

Shared decision making in psychiatric practice and the primary care setting is unique, as measured using a 9-item Shared Decision Making Questionnaire (SDM-Q-9)

Background  Surgery is commonly used in the management of pituitary nonfunctioning adenomas (NFPA). The goal of this systematic review and meta‐analysis is to evaluate the effect of surgery on mortality, surgical complications, pituitary function and vision.

Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.

Background  Surgery is commonly used in the management of pituitary nonfunctioning adenomas (NFPA). The goal of this systematic review and meta‐analysis is to evaluate the effect of surgery on mortality, surgical complications, pituitary function and vision.