Measuring Public Preferences for Health Outcomes and Expenditures in a Context of Healthcare Resource Re-Allocation

Financial support for this study was provided by the French National Institute of Health and Medical Research (INSERM). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The authors (Nicolas KRUCIEN; Nathalie PELLETIER-FLEURY; Amiram GAFNI) have no conflict of interest to declare.Peer reviewedPostprin

Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

CONTEXT: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. METHODS: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. RESULTS: We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria. CONCLUSION: The two approaches yield very "similar" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Restructuring the health care and diffusion of telemedicine

International audienc

Restructuring the health care and diffusion of telemedicine

International audienc

Mise en évidence des effets anti-hypertrophiques de carabine dans le cardiomyocyte et caractérisation de ses voies de signalisation.

Les systèmes de santé accordent une attention croissante au point de vue des usagers dans l organisation de l offre de soins. L instauration d une offre de soins sensible aux besoins et préférences des patients constitue un enjeu majeur de qualité et d efficacité des soins. Ce travail analyse le point de vue des patients pour l offre de soins de médecine générale en utilisant différentes méthodes permettant d obtenir des informations complémentaires en termes d expérience de soins, de satisfaction, d importance ou encore de préférences. Il s agit des méthodes Delphi, de classement du meilleur au pire et de révélation des préférences par les choix discrets. Ces méthodes sont appliquées sur deux échantillons : en population générale pour la première et chez des patients poly-pathologiques pour les 2 autres afin d identifier les principaux enjeux actuels et à venir de la réorganisation de l offre de soins de médecine générale du point de vue des patients. Les résultats montrent le rôle central de la relation médecin-patient et plus particulièrement de l échange d informations entre le médecin et le patient. Cependant une relation médecin-patient de qualité ne doit pas pour autant être réalisée au détriment de la qualité technique du soin et de la coordination de la prise en charge du patient. Ce travail montre également l importance de prendre en compte l expérience de soins des patients lors de l analyse de leur point de vue, et plus particulièrement de leur disposition au changement. L évaluation systématique et régulière des préférences des patients en pratique quotidienne peut permettre d améliorer la communication médecin-patient ainsi que le contenu de l offre de soins du point de vue des patients.The healthcare systems are paying a great interest to the patients perspective for the organization of health care provision. Healthcare system which is accountable and responsive of patients needs and preferences is a major issue for the quality and efficiency of care. In this thesis, we analyze the views of patients for the supply of GP care in using different complementary methods about patients experience, satisfaction, importance or preferences. These methods are applied to a sample of patients in GP and to a sample of chronically ill patients in order to identify current and future major issues for the reorganization of GP care from the patients perspective. The results show the main role of the doctor-patient relationship and especially of the information exchange between doctor and patient and between patient and doctor. However the quality of the doctor-patient relationship is not enough. The technical quality of care (i.e. thoroughness) and the coordination are of high importance for patients. This work highlights that it is necessary to take into account the patients experiences in the analysis of their perspective (e.g. preferences) to fully and appropriately understand the results, especially in terms of willingness to change. The systematic and regular screening of patient preferences in daily GP practice can improve the doctor-patient communication and the content of the provision of care from the perspective of patients.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

British residents' views about general practice care in France - a telephone survey.

International audienceBACKGROUND: Many studies have been published over the past decade on patients' views about the provision of health care. Though there is a high level of migration within the European Union, there are no studies on migrants' views about the provision of care in the country to which they moved. Given the wide spectrum of primary care in Europe, we hypothesised, without prejudging the outcome, that patients' confidence in the system they left, used as a proxy of 'the experience of care', may influence their preferences regarding specific aspects of care in the host country. The objective of the study was to analyse British migrants' views on general practice care in France. METHODS: A telephone survey was conducted with a random sample of the adult population of British people residing in France. Participants were 437 women and 423 men, aged 18 and over, who had consulted a general practitioner at least once during the past 12 months. The main outcome measures were the responses to the 23-item Europep questionnaire evaluating different aspects of general practice care, using a five-point answering scale with the extremes labelled as "poor" and "excellent". RESULTS: Participants were generally satisfied with the GP care provided. The aspects that were rated the highest were related to the doctor-patient relationship which over 80% of the respondents judged as excellent or very good. Some aspects of the organisation of services received relatively negative evaluations. For instance, "waiting time in the waiting room" was evaluated as excellent or very good by only 40% of the respondents. Twenty seven percent of the respondents were not confident in the National Health Service (NHS) when they were still living in UK. After adjusting for age, sex and number of years of residence in France, the respondents who were not confident in the NHS provided a score of "excellent" significantly more frequently (on 11 out of the 23 aspects of care) than did the patients who were confident in the NHS. Most of these aspects concerned the doctor-patient relationship and information and support during the consultation. CONCLUSIONS: British migrants' views on general practice care in France varied with the degree of confidence they had in the NHS. This finding is in line with the discussion on whether the 'experience of care' influences patient satisfaction. A better understanding of this phenomenon should provide valuable insights to make the services more responsive to the patients

Socio-Economic Status: A Barrier to Access to Mandibular Advancement Device Therapy for Patients with Obstructive Sleep Apnea Syndrome in France.

Obstructive sleep apnea syndrome (OSAS) is a major public health problem which affects between 5 to 10% of the general population. OSAS is known to be associated with high rates of morbidity and mortality mainly due to cardiovascular diseases and traffic accidents. The burden of illness is high for the individual and society. There are 2 treatment options for OSAS, Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Device therapy (MAD). CPAP is known to be an effective but very constraining treatment. Patients are usually poorly adherent. MAD is a more recent treatment easier to use and consequently better tolerated, but MAD can only be prescribed to patients with satisfactory oral hygiene. Oral health constitutes a real issue particularly among underprivileged groups in France. Through this link, the question of whether low socio-economic status constitutes a barrier to access to care for patients with OSAS is raised.In a multicenter prospective cohort of 2822 consecutive OSAS patients in whom MAD has been proposed as an alternative to CPAP between May 15, 2007 and December 1st, 2014, we identified the factors that lead to a patient diagnosed with OSAS to be treated by MAD instead of CPAP. A logistic regression was performed using a stepwise forward procedure. The main outcome of the study was that treatment by MAD was significantly associated with both educational attainment, as determined by the age at which the patient left full-time education, ≥18 years compared with <18 (adjusted odds ratio (aOR): 1.64, 95% CI 1.23 to 2.20), and the patient's occupational category. Executives and higher intellectual professions, intermediate professions, technicians, foremen and employees were significantly more likely to be treated by MAD than workers (aOR: 2.21, 95% CI 1.88 to 2.58; aOR: 1.74, 95% CI 1.15 to 2.63; aOR: 1.96, 95% CI 1.11 to 3.47, respectively).Overall, these results suggest that low socio-economic status constitutes a barrier to access to MAD for patients with OSAS in France. MAD use in patients with OSAS highlights inequalities in health care access