ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Can an Educational Program Optimize PDE5i Therapy? A Study of Canadian Primary Care Practices
ABSTRACT Introduction. The importance of patient instructions, designed to optimize therapy with phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction (ED), has recently been demonstrated.Aim. To evaluate the impact of an educational program for new sildenafil users against usual ED management in Canadian primary care practices.Methods. This multicenter, 6-month cluster randomized prospective study was conducted across Canada in general practitioners' offices where sites were randomized to receive a treatment optimization program (TOP) tool at visit 1 (TOP sites) or not to receive the TOP tool (non-TOP sites) while continuing with usual practice. Study participants were men seeking medical attention for ED and who were sildenafil naïve. The TOP tool consisted of a tear-off sheet, a brochure, and a video. Study drug was not provided to the patients. Sildenafil samples and prescriptions were dispensed as per usual care practices.Main Outcome Measures. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used to determine treatment satisfaction at visit 2 (month 3) and visit 3 (month 6). Patient and physician satisfaction with the TOP tool was assessed using self-reported questionnaires.Results. The intent-to-treat (ITT) population consisted of 2,573 patients from 231 primary care sites. At visits 2 and 3, treatment satisfaction with sildenafil was high with almost 9 patients out of 10 satisfied with treatment. No significant statistical differences were observed in the EDITS scores between the TOP and the non-TOP groups at visits 2 and 3. More than 80% of the participants were satisfied or very satisfied with the video and the brochure. More than 8 out of 10 participating physicians (84%) would use the TOP tool in their current practice if available.Conclusions. TOP is a valuable and time-efficient ED management tool providing benefits to newly diagnosed ED patients and to their physicians. Brock G, Carrier S, Casey R, Tarride J-E, Elliott S, Dugré H, Rousseau C, D'Angelo P, and Defoy I. Can an educational program optimize PDE5i Therapy? A study of Canadian primary care practices. J Sex Med 2007;4:1404–1413.
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Article: Sexual Counseling in Elderly Couples[Show abstract] [Hide abstract]
ABSTRACT: Introduction. Sexual health of the elderly has long been either a taboo or a non-medical life style luxury issue. Increasing longevity of women and men, reconceptualization of sexual health as part of general health, and the development of drugs aiming at improvement of sexual function have contributed to a change in the attitude of the elderly and the medical community, thus increasing the demands for help.Aims. To respond to these demands, caregivers need to be informed about the statistics concerning the sex life of the elderly, need to understand the biological, psychological, interaction and social factors that determine the sexual health of the aging population, need a comprehensive diagnostic and therapeutic approach, taking into account the specific characteristics of the aging male, female, and the couple.Main Outcome Measures. Diagnostic and therapeutic algorithm integrating the biopsychosocial profile of the aging male and female and the interaction characteristics of the couple.Methods. Review of the literature, analysis of cases, and review of multidisciplinary case discussions of elderly couples with sexual problems consulting the Division of Sexual Medicine at the University Hospital of Basel.Results. Sexual dysfunction is highly prevalent in the aging population, with hypoactive sexual desire disorder and pain disorders being the most frequent in women, and premature ejaculation and erectile dysfunction being the most frequent in men. The specific characteristics of the sexual ill health in elderly couples are the interactions of physical and mental morbidity including therapies, multidimensional sexual dysfunctions in both partners, dyssynchrony in personal development and sexual scripts, and a longstanding fixed interactional pattern with rigid “sexual roles.” The diagnostic approach has to integrate sexological descriptive diagnoses of both partners, their biopsychosocial profile, and the couple's history and interactional pattern. From this diagnostic framework, caregivers must design specific, multidisciplinary therapeutic strategies for the elderly couple, which include biomedical, individual psychotherapeutic, and systemic interventions in various combinations.Conclusion. The increasing demand for help of elderly couples with sexual dysfunction requires a multidisciplinary approach in diagnosis and therapy combining the knowledge and skills of urologists, gynecologists, internists, and various mental health professionals to provide individualized age-related care. Bitzer J, Platano G, Tschudin S, and Alder J. Sexual counseling in elderly couples. J Sex Med 2008;5:2027–2043.Journal of Sexual Medicine 08/2008; 5(9):2027 - 2043. · 3.51 Impact Factor
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ABSTRACT: In recent years, the availability of effective oral pharmacological treatment for erectile dysfunction (ED) has revolutionized its management; however, it is still unclear how everyday clinical practice has changed in response to this evolving scenario. The aim of this study is to describe general practitioners' (GPs) beliefs and attitudes toward the management of ED. Each GP was asked to recruit consecutive men aged >or=18 years and sexually active, with already known erectile problems or with newly diagnosed ED. A written questionnaire was used to investigate GPs' sociodemographic characteristics and their beliefs toward the management of ED. Overall, 127 GPs (53.4%) returned the questionnaire and 124 enrolled patients for the study. Only 9.5% of the GPs reported routinely inquiring about ED of patients >40 years of age, whereas 45.7% did it only when the patient raised the problem. GPs' gender and age were associated with their beliefs about ED treatment and referral to specialist care. Overall, 932 patients were enrolled, of whom 38% had newly diagnosed ED. The problem came to light for initiative of patient in 80% of cases, and 84.8% of men were prescribed a treatment. Patients who on their own initiative discussed of their condition had an almost 3-fold increased probability to be treated than those whose GP began the discussion about ED (odds ratio [OR] = 2.6, confidence interval [CI] 95% 1.5-4.5). Patients followed by female physicians were significantly more likely to be referred to a specialist than those followed by male physicians (OR = 3.3, CI 95% 1.4-5.0). The management of ED has become an integral component of clinical practice in primary care. Nevertheless, barriers in addressing sexual issues still persist. Appropriate training is needed for a proactive approach to ED screening and management in men over 40s.Journal of Sexual Medicine 12/2008; 6(4):1127-34. · 3.51 Impact Factor
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ABSTRACT: To determine, in men with erectile dysfunction (ED), the extent of improvement in erection hardness and in the rate of successful sexual intercourse (SSI) during the final intercourse attempt using sildenafil 50 mg compared with the subsequent initial attempt after a dose increase to 100 mg. This post hoc analysis used data from two randomized, double-blind, placebo-controlled studies of flexible-dose sildenafil for the treatment of men with ED, who were given sildenafil 50 mg or matching placebo, to be taken as needed before sexual intercourse. After 2 weeks, those with no tolerability concerns were titrated up to 100 mg, forming the subgroup of this analysis. The main outcome measures were event log data, including an Erection Hardness Score (EHS) and a question on SSI ("Did your erection last long enough for you to have successful sexual intercourse?"), for each attempt at sexual intercourse, analyzed by study and treatment group (sildenafil or placebo). Statistical comparisons were conducted by using the Fisher's exact test. In both studies, the sildenafil group had a larger proportion of EHS4 (completely hard and fully rigid) erections (P < 0.001) and SSI (P < 0.005) compared with the placebo group, both before and after the dose increase. Between the final 50 mg sildenafil dose and the initial 100 mg sildenafil dose, the outcomes improved and significantly so in the larger study. The improved efficacy with sildenafil 100 mg versus 50 mg, which occurs rapidly, suggests that patients should be encouraged to use 100 mg if they are unable to achieve completely hard and fully rigid erections or SSI with the 50 mg dose.International Journal of General Medicine 01/2013; 6:849-854.