La prescription de Buprénorphine Haut Dosage (revue de pertinence des pratiques et effets des opinions des médecins)

Le principe du traitement de l'héroïnomanie par des substances opioïdes agonistes est connu depuis la fin des années 1960. Pourtant en France, le dispositif de traitement des pharmacodépendances aux opiacés, reposant en grande partie sur une dispensation large de la BHD n'a été mis en place qu'en 1996, face à l'urgence sanitaire de l'épidémie de SIDA chez les toxicomanes. La BHD s'intégrait alors tout autant à un projet de réduction des risques pour les toxicomanes aux prises avec le manque , qu'à une démarche addictologique d'éloignement progressif des substances. Ce positionnement ambigu de la BHD a conduit à un certain trouble des prescripteurs quant aux objectifs thérapeutiques. Après 15 ans de substitution par BHD, il nous a semblé intéressant de confirmer ou d'infirmer cette impression de non-conformité des pratiques par rapport aux recommandations HAS (23 et 24 juin 2004) et de s'interroger sur l'effet des opinions des médecins sur leurs prescriptions de BHD. 193 médecins appartenant à 3 échantillons distincts (médecins généralistes libéraux, médecins salariés et médecins participant à un réseau toxicomanie) ont été interrogés afin d'évaluer leurs pratiques de prescription de BHD (revue de pertinence) et leurs opinions principales sur le produit (étude exploratoire des opinions).NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

4,000 Years of Human Occupation on Santa Barbara Island, California

Over the years, the authors have been doing background research, survey, data recovery, and collections analysis related to the prehistory of Santa Barbara Island. In this paper, we present radiocarbon dates for six of the prehistoric sites on Santa Barbara Island and discuss the potential antiquity of its initial settlement. First, however, we provide a context for our discussion by summarizing the environmental setting and history of archaeological research on the island. In the following sections, all site designations follow Greenwood's (1978:7-42) trinomial system

4,000 Years of Human Occupation on Santa Barbara Island, California

Over the years, the authors have been doing background research, survey, data recovery, and collections analysis related to the prehistory of Santa Barbara Island. In this paper, we present radiocarbon dates for six of the prehistoric sites on Santa Barbara Island and discuss the potential antiquity of its initial settlement. First, however, we provide a context for our discussion by summarizing the environmental setting and history of archaeological research on the island. In the following sections, all site designations follow Greenwood's (1978:7-42) trinomial system

4,000 Years of Human Occupation on Santa Barbara Island, California

Over the years, the authors have been doing background research, survey, data recovery, and collections analysis related to the prehistory of Santa Barbara Island. In this paper, we present radiocarbon dates for six of the prehistoric sites on Santa Barbara Island and discuss the potential antiquity of its initial settlement. First, however, we provide a context for our discussion by summarizing the environmental setting and history of archaeological research on the island. In the following sections, all site designations follow Greenwood's (1978:7-42) trinomial system

French Experience with Buprenorphine : Do Physicians Follow the Guidelines?

Opiate dependence affects about 15,479,000 people worldwide. The effectiveness of opiate substitution treatments (OST) has been widely demonstrated. Buprenorphine plays a particular role in opiate dependence care provision in France. It is widely prescribed by physicians and national opiate substitution treatment guidelines have been available since 2004. In order to study the prescribing of buprenorphine, we used a questionnaire sent by email, to a large sample of physicians. These physicians were either in practice, or belonged to an addiction treatment network or a hospital. The main objective of this work was to measure the extent to which the theoretical, clinical attitude of physicians towards prescribing buprenorphine (BHD) complied with the statutory guidelines. We showed that the physicians we interviewed rarely took into account the guidelines regarding buprenorphine prescription. The actual prescribing of Buprenorphine differed from the guidelines. Only 42% of independent Family Physicians (FPs), working outside the national health care system, had prescribed buprenorphine as a first-time prescription and 40% of FPs do not follow up patients on buprenorphine. In terms of compliance with the guidelines, 55% of FPs gave theoretical answers that only partially complied with the guidelines. The variations in compliance with the guidelines was noted according to different variables and took into particular account whether the physician were affiliated to a network or in training

Distribution of the FPs, Network and Hospital groups within weighted scores compliance categories.

<p>The information received was perceived as « moderately » or « completely » sufficient by respectively 85% and 98% of the « Hospital » and « Network » groups, vs 36% for the « FPs » group.</p><p>The information received was perceived as « moderately » or « completely » appropriate by respectively 83% and 92% for the « Hospital » and « Network » groups, vs 40% for the « FP » group.</p><p>Distribution of the FPs, Network and Hospital groups within weighted scores compliance categories.</p

Compliance in three groups of prescribers, according to number of patients followed up with BHD treatment.

<p>Compliance in three groups of prescribers, according to number of patients followed up with BHD treatment.</p

Ease in opioid dependent patients follow-up.

<p>65% of FPs considered medical information received regarding OSTs as inadequate for their practice needs. 85% of hospital physicians considered it adequate, as did 98% of network physicians.</p><p>Ease in opioid dependent patients follow-up.</p