24-h urine test application in patients with kidney stone disease: a population-based study in a primary care setting.

Background: Kidney stone formation is driven by an imbalance between lithogenic substances and crystallization inhibitors. Current guidelines recommend a 24-h urine collection in patients with kidney stone disease to assess the risk of stone formation and monitor therapy compliance. However, real-world data on adherence to these guidelines remain limited and outdated.

A Cluster Randomized Study to Explore Case Definitions, Clinical Course and Consequences of RSV in Community-Dwelling Adults Aged ≥ 50 Years.

Introduction: In Europe, surveillance of respiratory syncytial virus (RSV) has been recently incorporated into existing influenza monitoring platforms that are based on influenza-like illness (ILI) or acute respiratory infection (ARI) case definitions. This study aims to compare RSV rates captured by ARI versus ILI case definitions and to describe the clinical and economic trajectories of RSV in older adults.

Methods: The study was conducted in Italy during the 2023/2024 and 2024/2025 seasons.

To create an algorithm assessing the risk of ovarian cancer in primary care using generalized additive model (GAM) and traditional methods.

Objectives: We aimed to evaluate models designed to support the exploration and early detection of potential Ovarian Cancer (OC) using either Machine Learning (ML) techniques or traditional methodologies, using primary care data. This evaluation aimed to facilitate appropriate and timely referrals to specialists.

Methods: The Health Search database, containing healthcare records of 1 million adults, was used to predict OC cases among patients aged 18+ without prior OC diagnosis from 1 January 2002, to June 2021.

Treatment choice for adult patients with moderate-to-severe asthma: the TAILOR study.

Background: In patients with uncontrolled asthma treated with medium dose inhaled corticosteroid/long-acting β-agonist (ICS/LABA), the Global Initiative for Asthma (GINA) recommends to increase to high-dose ICS/LABA or to start therapy consisting of medium-dose ICS/LABA+LAMA (long-acting muscarinic antagonist). Adding LAMA on top of high-dose ICS/LABA is not recommended for Step 4 asthma patients, yet it is used in the real world. Patient characteristics influencing treatment step-up are unknown.

The burden of some of the most common zoonoses in primary care: a population-based study in Italy.

Background: Preventing and managing zoonoses mandate the combined efforts of physicians, veterinarians, and environmental and social scientists. The systematic recording of zoonoses in humans is rarely carried out through dedicated surveillance systems, and there is a need to boost awareness among general practitioners about these diseases. Companion animals, especially dogs and cats which constitute a reservoir for zoonotic infective agents, are frequently present in Italian families.

To enhance the detection of aplastic anemia in primary care settings: a population-based study in Italy.

Background: Aplastic Anemia (AA) is a rare, life-threatening condition featured by hypocellular bone marrow without leukemia or myelodysplastic syndromes. Early diagnosis is vital because of the effectiveness of the existing treatments. This study examined AA epidemiology and clinical correlates to aid general practitioners (GPs) in recognizing potential AA cases.

Relative effectiveness and gastrointestinal safety of NSAIDs being prescribed for upper respiratory tract infections: an explorative cohort study in primary care.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to control pain, inflammation, and fever in upper respiratory tract infections (URTIs).

Aim: To explore the relative effectiveness and gastrointestinal (GI)-related safety of individual NSAIDs to control symptoms of URTIs.

Method: Using an Italian primary care data source, we identified patients aged ≥ 15 years who were newly prescribed NSAIDs for URTIs between 2013 and 2022.

Exploring case definitions and the natural history of respiratory syncytial virus in adult outpatients: First-season results of the RESPIRA-50 study.

Background: Data on the natural history of the community-acquired RSV in adult outpatients are limited. It is also unclear whether the existing influenza surveillance platforms based on influenza-like illness (ILI) case definitions are efficient for RSV. The two-season RESPIRA-50 study was established in 2023 to identify an optimal RSV case definition and to explore the natural history of RSV.

Assessing the risk of heart failure in type 2 diabetes: a prediction algorithm to sustain the evaluation of NT-proBNP in primary care.

Purpose: Heart failure (HF) is a disease that leads to approximately 300,000 fatalities annually in Europe and 250,000 deaths each year in the United States. Type 2 Diabetes Mellitus (T2DM) is a significant risk factor for HF, and testing for N-terminal (NT)-pro hormone BNP (NT-proBNP) can aid in early detection of HF in T2DM patients. We therefore developed and validated the HFriskT2DM-HScore, an algorithm to predict the risk of HF in T2DM patients, so guiding NT-proBNP investigation in a primary care setting.

Frailty, comorbidity, and multimorbidity and their relation with medications adherence in primary care older adults.

Purpose: To assess and compare, through a retrospective cohort study, the relationships between frailty, comorbidity, multimorbidity, and levels of adherence to lipid-lowering drugs (LLDs), antihypertensives and antidepressants.

Methods: In a primary care database, we selected a cohort of patients aged 60 or older on December 31, 2022. The date of the first prescription of the aforementioned medications was the study index date.

Pertussis Notification Rate and Tdpa Vaccine/Booster Coverage in Adults: An Opportunity for an Epidemiological Observatory in Primary Care.

: In recent years, Europe has experienced a significant increase in pertussis cases. One reason behind this rise is the decline in diphtheria-tetanus-pertussis (dTap) booster coverage among adults. Currently, Italy lacks a reliable monitoring system to track pertussis infections and vaccine coverage among adults.

Perception and knowledge of general practitioners on COPD management according to the GOLD23 document and reimbursement criteria for drugs prescription: an e-Delphi study.

Background: COPD management and therapy have been periodically revised to support a more patient-specific approach. Several concerns remain in primary care, such as the proper choice of initial treatment, medication adherence, and missing values for spirometry investigations. These concerns may be exacerbated by inconsistencies between the GOLD23 report and reimbursement criteria, as per the Italian NOTA99, especially for what concerns the assessment of disease severity and related treatment choice.

Epidemiology and clinical correlates of hidradenitis suppurativa in primary care in Italy.

Background: Hidradenitis suppurativa (HS) is a persistent skin disorder that is characterized by painful lesions or pus-filled lumps, mostly occurring in areas where the skin flexes. It is a disfiguring condition that significantly reduces the quality of life of those affected. Developing new, effective treatments for HS is crucial, but it is important that it be recognized and diagnosed early, especially in primary care settings.

Declining number of general practitioners can impair influenza vaccination uptake among Italian older adults: Results from a panel analysis.

Background: Seasonal influenza vaccination coverage in Italian older adults is insufficient and well below the minimum target of 75%. In Italy, most influenza vaccine doses are administered by general practitioners (GPs), whose number has been declining. In parallel, the number of patients per GP and GP workload increased dramatically, which theoretically may impair vaccination counselling.

Supporting vaccine (co)-administration decisions: Development and validation of a tool for assessing the risk of severe outcomes due to lower respiratory tract infections.

Objective: To develop and validate a score to predict the 90-day risk of hospitalization/death in patients with low respiratory tract infections (LRTIs) with the aim to support clinical decision making on vaccine (co)-administration.

Methods: We formed a cohort of patients aged 18 years or older being diagnosed with LRTIs in the period between January 1, 2012 and December 31, 2022. Each patient was followed until occurrence of respiratory-related hospitalization/death up to the end of the study period (December 31, 2022).

Development and validation of a predictive score for diagnosing prostate cancer in primary care.

Background: Prostate cancer (PCa) represents the fifth cause of death in the male population worldwide. The prostate-specific antigen (PSA) test demonstrated poor accuracy to assess the presence of PCa. Thus, the PSA testing paradigm should be moved from the systematic screening approach to the early identification of men who are harbouring clinically significant disease.

Chronic Kidney Disease Eligible for SGLT2 Inhibitors Through the Integration of Italian Administrative and Primary Care Data.

Patients with chronic kidney disease (CKD) can be successfully treated with sodium-glucose cotransporter-2 inhibitors (SGLT2-Is), regardless of diabetes. Fondazione Ricerca e Salute's (ReSD) administrative and Health Search's (HSD) primary care databases were combined in the Database Consortium ReS-HS to quantify and describe patients with CKD potentially eligible for SGLT2-Is and assess costs charged to the Italian National Health Service (SSN). Patients aged ≥18 with CKD and estimated glomerular filtration rate (eGFR) <60 ml/min in 2018, without dialysis and/or renal transplantation, were included.

The use of C-reactive protein testing and antibiotic prescribing in Italy: A population-based study in primary care.

Testing serum C-reactive protein (CRP) levels can help determine whether there is a need for antibiotics and can limit prescribing of antibiotics for illnesses that are likely viral or non-infectious in origin. Using Health Search, an Italian primary care database, we identified all patients, aged 15 years or older, being registered in the period between 1 January 2000 and 31 December 2019 and newly diagnosed with upper respiratory tract infections (URTIs) or COPD- or asthma-related exacerbations. From the date of these diagnoses, patients were followed up until occurrence of antibiotic prescription (for these indications) up to 31 December 2019.

Development and validation of a prediction score to assess the risk of incurring in COPD-related exacerbations: a population-based study in primary care.

Background: Chronic obstructive pulmonary disease (COPD) is the fourth most important cause of death in high-income countries. Inappropriate use of COPD inhaled therapy, including the low adherence (only 10 %-40 % of patients reporting an adequate compliance) may shrink or even nullify the proven benefits of these medications. As such, an accurate prediction algorithm to assess at national level the risk of COPD exacerbation might be relevant for general practictioners (GPs) to improve patient's therapy.

Development and validation of a score assessing the risk of severe asthma in primary care.

Objective: To develop and validate the Asthma Severity-Health Search (AS-HScore), predicting severe asthma risk in Italian primary care. According to the current asthma treatment guidelines, the AS-HScore intended to serve as a clinical decision support system (CDSS) for General Practitioners (GPs).

Methods: Using the Health Search Database (HSD), a cohort of 32,917 asthma-diagnosed patients between 2013 and 2021 was identified.

Temporal validation of a Generalized Additive Model (GAM) to assess the risk of Chronic Kidney Disease (CKD).

Objective: To assess the temporal validity of a model predicting the risk of Chronic Kidney Disease (CKD) using Generalized Additive Models (GAM).

Materials: We adopted the Italian Health Search Database (HSD) with which the original algorithm was developed and validated by comparing different machine learnings models.

Methods: We selected all patients aged >=15 being active in HSD in 2019.

Development and validation of a prediction score to assess the risk of depression in primary care.

Background: Major depression is the most frequent psychiatric disorder and primary care is a crucial setting for its early recognition. This study aimed to develop and validate the DEP-HScore as a tool to predict depression risk in primary care and increase awareness and investigation of this condition among General Practitioners (GPs).

Methods: The DEP-HScore was developed using data from the Italian Health Search Database (HSD).

A Vulnerability Index to Assess the Risk of SARS-CoV-2-Related Hospitalization/Death: Urgent Need for an Update after Diffusion of Anti-COVID Vaccines.

: There are algorithms to predict the risk of SARS-CoV-2-related complications. Given the spread of anti-COVID vaccination, which sensibly modified the burden of risk of the infection, these tools need to be re-calibrated. Therefore, we updated our vulnerability index, namely, the Health Search (HS)-CoVulnerabiltyIndex (VI)d (HS-CoVId), to predict the risk of SARS-CoV-2-related hospitalization/death in the primary care setting.

How to support general practitioners to better detect sarcopenia among older adults: a nested case-control analysis.

Purpose: This study explores correlations of sarcopenia and its proxies, such as history of falls, asthenia, and ambulation issues, with frailty levels among older adults in primary care.

Methods: In a cohort of 546,590 patients aged 60 years or older, "definite" sarcopenia cases were operationally defined through the use of non-specific diagnostic codes coupled with inspection of free-texts. Proxies of sarcopenia, such as falls history, asthenia, and ambulation issues were considered as well.