Lege Artis Medicinae

[E-physicians and e-patients in Hungary - Qualitative survey about physicians’ internet use and attitudes toward their patients’ internet use]

GYŐRFFY Zsuzsa, MESKÓ Bertalan

DECEMBER 18, 2012

Lege Artis Medicinae - 2012;22(12)

[BACKGROUND - Physicians and patiensinternet use has been challenged the med-ical and the social studies as well. InHungary, approximately 100% of physi-cians use the internet, and about 80% ofpatients search for medical informationonline.METHODS - A qualitative, pilot study(N=83) was performed among practisingphysicians in Hungary. The structuredinterview was focused on medical internetuse, and the attitudes of doctors regardingtheir patients’ internet use.RESULTS - The interviewed physicians usethe internet for the daily work. However76% of them do not support their patients’intenet use: firstly because of professionalcauses, secondly because of the changes ofthe doctor-patient relationship. 24% of theresponders agreed with the use of internetof patients for medical reasons.CONCLUSIONS - Our study is a pilot forquantitative research. Our findings suggestthat Hungarian physicians start to open tothe new communication technologies.]

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[INTRODUCTION - Basal insulin analogues are essential drugs for the treatment of type 2 diabetes mellitus. Basal insulin analogues have been shown to reduce the frequency of hypoglycaemia versus NPH insulin, and thus may be beneficial in the treatment of type 2 diabetes. Here we present a cost-minimisation analysis of basal insulin analogues, comparing insulin glargine and insulin detemir available in Hungary. METHODS - A literature review was conducted to identify randomized, controlled clinical trials with a duration of 12 weeks or more in which a direct comparison of insulin glargine and insulin detemir was made in patients with type 2 diabetes. In a meta-analysis of the eligible trials, the following endpoints were investigated: metabolic status, body weight, frequency of hypoglycaemia, insulin doses administered and the number of insulin injections required. If a high heterogeneity (I2>75%) was found, meta-regression was performed to identify the underlying reasons. The funder’s perspective was applied in the cost-minimization analysis by taking into account the cost of the drug and of medical devices necessary for its administration, based on the daily number of insulin injections. RESULTS - No further studies were found in addition to those included in a metaanalysis published by The Cochrane Library. On the basis of three eligible studies, insulin detemir was injected more frequently compared with glargine (weighted mean difference: 0.42 95% CI 0.14-0.69 injections/day). High heterogeneity was present in case of two endpoints: the incidence of overall hypoglycaemia per patient-year (I2=83%), and daily basal insulin dose in units per body weight (I2=94%). The reason for the high heterogeneity in hypoglycaemia rates was not identified by meta-regression; however, the difference in insulin doses per body weight was negatively associated with body weight (-0.027 IU/kg per 1 kg, 95%CI: -0.051; -0.004). On the basis of the present meta-analysis and meta-regression, our calculations suggest that treating an average weight (90 kg) patient with type 2 diabetes with insulin glargine would result in an annual cost reduction of 93 452 HUF compared with insulin detemir by employing gross public drug prices. CONCLUSION - On the basis of the available clinical evidence, insulin glargine might be a cost-saving alternative of insulin detemir in an average-weight patient with type 2 diabetes. In an era of scarce resources, the role of therapeutic alternatives offering cost savings with the same efficacy become more important. The generalisability of our conclusions might be influenced by potential differences in the manufacturers’ claw-back rate of detemir vs glargine insulin.]

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