________ ~I~n~t~e~T~n~a~t~t~·o~n~a~l~R~e~s~e~a~T~c~h~a~n~d~O~p~t~·n~t~·o~n~~~:_- 7 disability scores and grip strength. American College of Rheumatology functional class and the number of fibrositic tender points. Both scales were also highly correlated with the number of actively inflamed

Underuse of antiasthmatics leads to multiple ED visits

Chronic undermedication is an important issue in asthma management - it is resp::msible for an increased need for emergency services, say investigators in Canada.

During a 6-month period, patients presenting with acute asthma to the emergency departments (EDs) al 2 general hospita1s in Ottawa, Canada, completed a survey about sociodemographic factors, asthma control, eltposure to irritants, drug use. physician follow-up and asthma education. Patients who had made O!': 3 ED visits in the past year (0 = 140) were compared with those who had made only 1 visit in the past year ( 199).

Risk factors associated with multiple ED visits included: • multiple previous visits to the general practitioner

(GP) • daily disability associated with asthma • previous hospitalisations • patients' perception of severe asthma • underuse of asthma medication (the only

modifiable risk factor). Only one-third of the study group were prescribed f3,-agonislS alone, while less than half received inhaled corticosteroids. And although increased frequency of ED visits was associated with increased drug use (reflecting increased asthma severity). only 60% of patients making ~ 3 ED visits in the past year were prescribed inhaled corticosteroids.

Study findings 'are inconsistent with published asthma management guidelines'. the investigators point out. They believe that, unless physicians' prescribing habits improve. inadequate use of asthma medi cation will continue and palient education will have limited impact.

A better understanding of the risk factors for asthma in patients who make frequent ED visits, will aid in reducing asthma morbidity and healthcare costs, conclude the investigators. Oaks RE. s.:hwei~ I, KI:n" P. Gou!«JII 1.. RiviDgton R. et &1. Risk fKlon for n:cwmll erne:rgenc:y depanment visits for astIIma. Thoru SO: S2()..S24, May I99S _".

Need for both clinical and outcome measures for psoriatic arthritis

The Health Assessment Questionnaire (HAQ) may be an imponant outcome measure for evaluating functional disability and pain in patients with psoriatic arthritis; however, it may not reflect the deformity associated with the disease. according to investigators in Canada. Also, they believe that a modified version of the HAQ for spondyloarthropathy (HAQ-S) does not offer any advantages in assessing outcomes in patienls with this condition.

Their study involved 114 patients with psoriatic arthritis who completed both the HAQ and HAQ-S disability measures. The researchers found high correlations between overall HAQ and HAQ-S

joints.

Poor correlations with activity and severity However. there were poor correlations between the

HAQ and HAQ-S scores and the remaining measures of clinical functioning (i.e. finger to floor distance and chest expansion), measures of disease activity (e.g. morning stiffness and Psoriasis Area and Severity Index) and the remaining measures of disease severity (e.g. deformed joint count and American Rheumatism Association anatomic stage). Thus. clinical assess­ment of disease activity and severity 'remain important ou.tcome measures in the assessment of patients with PsA {psoriatic arthritis}', note the investigators.

A similar pattern of correlations was observed for the HAQ and HAQ-S subscales· and the measures of function . activity and severity. • Both of t~ disability scales consisted of t~ following dimensions: dressing and grooming, arising. wallcing. hygiene. reach, gn'p, and activities. The modified version incorporated :1 additional disability subscales cOlUisting of 5 activities associated with spinal invoh'emenJ. BlaI:kmcn MG. Gladman DO. HUlled J,long lA, FareweU VT. et aI. Measuring health statllS in psoriatic uthritis: the Health A$seumem Questionnaire and iu modiflCatioo.. Jownal ofRb::umatol08Y 22: 886-893. May 199' _

Is perinatal zidovudine prophylaxis cost effective?

Perinatal zidovudine prophylaxis to reduce vertical HIV transmi ssion i s cost effective. despite the high treatment cost associated with use of the antivi ral. say US-based investigators.

Over a 4-year period, they analysed hospital cost data· from 50 patients with perinatally-acquired HIV infection . The mean annual cost associated with treating HTV infection was SUSI2 257/patient. while the mean follow-up cost associated with assessing a seroreverter. HIV-exposed infant was SUS5323.

The investigators applied these cost data to results of the Pediatric AIDS Trial. Hypothetical costs of treating 100 mother-infant pairs were calculated using the mean cost of treating mv infection over a 8.9 year period. For these pairs. the cost associated with zidovudine prophylaxis totalled $USl.5 1 million - SUS 147700 for zidovudine administration to 100 patients, SUS489 716 for seroreverter assessment in 92 patients and $US872 000 for the treatment of 8 HIV-positive infants. The cost associated with no zidovudine prophylaxis totalled $US3.23 million -SUS393 902 for seroreverter assessment in 74 patients and SUS2.83 million for the treaunent of 26 HIV-positive infants. • including the costs associated with hospitalisation, outpalient clinic visits and professional fees Ohnina B1.. Sohnton GM. A 00$1 &lIalysis 0( periDataI DdovudiIX prophylaxis IOreduee vertical HlV transmission. Pediatric Research 37: 297. Pan 2. Apr I99S (SllmmariJed from an abstnctl __

PHARMACORESOURCES. Jul 11M