Le médecin généraliste face à l observance d un traitement chronique (le modèle des antiagrégants plaquettaires)

Objectif : Selon l OMS, résoudre le problème de la non-observance thérapeutique serait bien plus efficace que l avènement de n importe quel nouveau progrès médical. L objectif de l étude est de voir de quelle manière les généralistes appréhendent l observance de leurs patients sous antiagrégants plaquettaires, dont il n existe aucun paramètre pour s enquérir de la prise. Méthode : Etude qualitative, par entretiens semi-directifs de 18 médecins généralistes, réalisés d avril à juin 2012 en Isère et Savoie, puis analyse thématique des données avec triangulation par deux internes. Résultats : L inobservance des antiagrégants plaquettaires est largement sous-estimée par les généralistes. Les raisons de l inobservance selon eux, sont le manque d informations dispensées par le médecin, le manque de compréhension du patient pour ce traitement, et la polymédication. Des caractéristiques propres aux antiagrégants plaquettaires sont aussi en cause : la galénique, la prise isolée du midi, l intolérance, l absence de ressenti du bénéfice thérapeutique. Les médecins interrogés imaginent qu optimiser l observance de ce traitement passe par une meilleure information, par une relation d écoute, et par l éducation thérapeutique. Conclusion : Le généraliste doit se préoccuper quotidiennement de l observance d un traitement chronique comme les antiagrégants plaquettaires. Il est nécessaire qu il soit davantage sensibilisé à cette problématique, pour mieux la détecter, et trouver des solutions avec le patient. Vérifier que le malade adhère au traitement est une des missions du généraliste. L éducation thérapeutique semble être un outil précieux aussi bien pour le patient que pour le soignant.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

La transmission de l'information hôpital-ville à la sortie des patients ayant une maladie thromboembolique veineuse (une nécessaire amélioration)

Cette étude avait pour objectif principal d évaluer la satisfaction des médecins et des patients sur la transmission des informations concernant la MTEV et sa prise en charge. L objectif secondaire était de connaître le devenir des patients 3 mois après l introduction des anticoagulants. Une enquête a été réalisée auprès de 40 patients (et de leurs médecins) chez lesquels un traitement anticoagulant avait été introduit pour MTEV lors d une hospitalisation. Les patients étaient satisfaits des informations transmises et en avaient une bonne connaissance. Mais 25% des patients ont consulté leur médecin traitant plus de 7 jours après la sortie. Les médecins traitants ont reçu les informations trop tard (27.5% après la première consultation) et elles étaient incomplètes. Les médecins traitants pensent que l amélioration de la transmission de l information nécessite surtout un délai de transmission plus court. A 3 mois, on déplore 2 évènements indésirables des anticoagulants dont un grave. Il n y a pas eu de récidive de thrombose. Suite à ces constats, une séance d évaluation des pratiques professionnelles a été réalisée. Elle a abouti à une nouvelle procédure de sortie des patients qui comprend un appel systématique au médecin traitant avant la sortie du patient et une synthèse provisoire de sortie remise au patient, à transmettre au médecin dans un délai défini. L objectif est d obtenir une consultation du médecin traitant dans les 8 jours après la sortie pour un bon suivi du traitement et une transmission plus rapide et plus complète des informations concernant la MTEV et son traitement aux médecins traitants.The principal aim of this study is to evaluate the satisfaction of practitioners and patients concerning the transfer of information on venous thromboembolism and its handling. The secondary objective was a follow up of patients 3 months after the start of the anticoagulants. A survey was carried out on a population of 40 patients (and their practitioner's) undergoing anticoagulation treatment for their venous thromboembolism started in hospital. The patients were satisfied with the information that was given to them and had a good understanding. Unfortunately 25% of the patients consulted their General Practitioners more than 7 days after their discharge. The General Practitioners received the information too late (in 27.5% of cases - after the first consultation) and it was incomplete. The General Practitionners thought that the improvement of the transmission requires mainly being faster. After 3 months, 2 undesirable events were deplored - 1 was serious. There was no recurrence of thrombosis. The summary of these findings was the subject of a "professional practices evaluation" session. It lead to a new procedure of patient discharge, including calling systematically the General Practitioners before the discharge and giving of a provisional synthesis to the patient, to be transmitted to the General Practitioner in a defined delay. The aim is to obtain a medical consultation within 8 days of the discharge, for à good follow up of the treatment and a faster and more complete transmission of information about venous thromboembolism and its treatment to the local practitioner.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency

The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts

Clinical analysis of the corona phlebectatica

BackgroundThe corona phlebectatica (CP) is classically described as the presence of abnormally visible cutaneous blood vessels at the ankle with four components: “venous cups,” blue and red telangiectases, and capillary “stasis spots.” Previous studies showed that the presence of CP is strongly related to the clinical severity of chronic venous disorders (CVD) and the presence of incompetent leg perforators. The aim of this study was to select the most informative components of the CP in the assessment of the clinical severity of CVD patients.MethodsA multicentric series of 262 unselected patients (524 limbs) consulted for CVD were clinically evaluated using a standardized form to record the CEAP “C” items and the presence of the four CP components. Standard categorical and ordinal statistics were used to describe the external validity of the CP components as severity indexes, taking the “C” classes as reference.Results“Stasis spots” (P < .001; r = .44) and blue telangiectases (P < .01; r = .32) were linearly associated with the ascending order of “C” classes, whereas the relationship is less clear for the red telangiectases and the “venous cups.” The association pattern of the four components showed that only the blue telangiectases and the “stasis spots” were consistent with each other. Blue telangiectases were found more sensitive (0.91 vs 0.75) but less specific (0.52 vs 0.80) than “stasis spots” for advanced venous insufficiency (CEAP “C4-6”).ConclusionThis study shows that only blue telangiectases and “stasis spots” provide valuable information in patients with CVD and deserve to be taken into account in the evaluation of such patients. Further studies are needed to show the reproducibility of this data, which we regard as essential for clinical use

Discordant D-dimer results of two rapid quantitative automated assays are related to age.

International audienceNo abstract is availabl

EDUC’AVK: Reduction of Oral Anticoagulant-related Adverse Events After Patient Education: A Prospective Multicenter Open Randomized Study

International audienceBACKGROUND: Long-term oral anticoagulation treatment is associated with potential morbidity. Insufficient patient education is linked to poorly controlled anticoagulation. However the impact of a specific educational program on anticoagulation related morbidity remains unknown. OBJECTIVE: To evaluate the effect of an oral anticoagulation patient education program in reducing both hemorrhagic and recurrent thrombotic complications. DESIGN/PARTICIPANTS: We conducted a prospective, multicenter open randomized study, comparing an interventional group who received a specific oral anticoagulation treatment educational program with a control group. Eligible patients were older than 18 and diagnosed as having deep vein thrombosis or pulmonary embolism requiring therapy with a vitamin K antagonist for 3 months or more. Our primary outcome was the occurrence of hemorrhagic or thromboembolic events. RESULTS: During the 3-month follow-up the main outcome criteria were observed 20 times (6.6% of patients), 5 (3.1%) in the experimental and 15 (10.6%) in the control group. Consequently, in multivariate analysis, the cumulative risk reduction in the experimental group was statistically significant (OR 0.25, 95% CI 0.1 - 0.7, p < 0.01). CONCLUSIONS: Patient education using an educational program reduced VKA-related adverse event rates