Analyse des trajectoires de consommation d’alcool chez les patients inclus dans l’essai Bacloville

Contexte. En France, 45000 décès seraient attribuables à l’alcool chaque année. Un autre phénomène vient alourdir ce constat : l’alcoolisation des jeunes chez qui l’on observe de nouveaux modes de consommation (« binge drinking »), dont les conséquences à long terme sont encore mal connues. À ce jour, aucun traitement n’a pu enrayer ces chiffres. C’est dans ce contexte que l’essai pragmatique Bacloville a été lancé pour évaluer l’efficacité du baclofène dans le traitement de l’alcoolisme. Objectif. L’objectif de ce travail est de décrire et d’analyser les trajectoires de consommation des patients inclus dans l’essai Bacloville, en étudiant plus particulièrement l’âge de premier contact avec l’alcool, les facteurs qui lui sont associés et les conséquences sur les trajectoires des patients. Un objectif secondaire est d’étudier les délais de perte de contrôle et de prise de conscience d’avoir un problème avec l’alcool chez ces patients. Méthodes. Analyse de données rétrospectives, obtenues par un questionnaire remis au patient à la visite d’inclusion de l’essai Bacloville. Réalisation d’analyses bivariées puis multivariées pour les variables étudiées. Résultats. 298 questionnaires (93,1%) ont été récupérés et analysés. L’âge médian des patients était de 47,2 ans (IQR 41-55) et 203 (68,8%) étaient des hommes. L’âge médian du premier contact avec l’alcool était de 16 ans (IQR 14-18) ; une initiation précoce (avant 15 ans) était associée de façon statistiquement significative à l’exposition à des problèmes d’alcool dans la famille (OR 1,85, IC95[1,02-1,43]), à des traumatismes dans l’enfance ou l’adolescence (OR =1,82, IC95[1,01-3,31]), ainsi qu’à l’année de naissance ([1968-1973] : OR 2,4 IC95[1,07-5,62]), ≥1974 : OR=4,6 IC95[2,01- 10.8]). Les patients expérimentant l’alcool plus tôt (avant 15 ans) expérimentaient également plus tôt une première ivresse (p0,05). Le délai de prise de conscience était associé de façon significative à l’exposition à des antécédents familiaux (OR 0, 38, IC95[0,19-0,76]), à un âge de consommation régulière avant 25 ans (OR 3,07, IC95[1,58-6,19]), ainsi qu’à une consommation sur le lieu de travail (OR 0,45, IC95[0,9-1,18]). Conclusion. Ce travail a permis de décrire les trajectoires de consommation des patients inclus dans l’essai Bacloville. Des études prospectives sont nécessaires pour affirmer le caractère causal des associations retrouvées mais ce travail exploratoire ouvre des perspectives notamment pour la recherche future de typologies de répondeurs au baclofène

Impact of an interactive web tool on patients’ intention to receive COVID-19 vaccination: a before-and-after impact study among patients with chronic conditions in France

Objectives In France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination. Methods The most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline. Results Between January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination. Conclusions Our interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information

Tailored-Dose Baclofen in the Management of Alcoholism: A Retrospective Study of 144 Outpatients Followed for 3 Years in a French General Practice

Background: More information is needed about the efficacy and safety of long-term baclofen in the treatment of alcohol use disorders. The objective of this study was to assess the effect of treatment with tailored-dose baclofen on alcohol consumption in patients with alcohol use disorders followed for 3 years after first initiating baclofen treatment.Methods: This retrospective descriptive cohort included outpatients followed in a French general practice clinic for 3 years and treated with tailored-dose baclofen to reduce or eliminate alcohol consumption. At 3 years, treatment was considered successful if alcohol consumption was at or below levels defined as low-risk by the WHO (≤ 40 g/d in men and ≤ 20 g/d in women).Results: The study population included 144 patients (88 men and 56 women). The participants' mean age was 46 ± 11 years and mean daily alcohol intake before treatment was 167 ± 77 grams. At the end of the study, treatment was successful for 91 (63.2%) patients. Participants' mean dose of baclofen at the end of study period was 100 ± 101 mg/d. We identified 75 (52.1%) patients for whom treatment was successful at each annual follow-up appointment: at 1, 2, and 3 years. The mean maximum dose of baclofen over follow-up of the 144 patients was 211 ± 99 mg/d (dose range: 40 mg/d to 520 mg/d).Conclusion: In this study, tailored-dose baclofen appears to be an effective treatment in patients with alcohol use disorders, with sustainable effect over time (3 years). There are many adverse effects but they are consistent with those already described in the literature

Acceptable medication non-adherence: A crowdsourcing study among French physicians for commonly prescribed medications.

BACKGROUND:Achieving good medication adherence is a major challenge for patients with chronic conditions. Our study aimed to assess the Threshold for Unacceptable Risk of Non-adherence (TURN), defined as the threshold at which physicians consider the health risks incurred by patients due to medication non-adherence unacceptable, for the most commonly prescribed drugs in France. METHODS:We conducted an online study using a crowdsourcing approach among French general practitioners and specialists from September 2016 to August 2017. Physicians assessed the TURN for various levels of missed doses by evaluating a series of randomly presented clinical vignettes, each presenting a given medication with a given therapeutic indication. For each "drug-indication group" (i.e., all drugs from the same pharmacological class with a similar therapeutic indication): 1) we described the distribution of physicians' assessments, 2) we provided a summary estimate of the TURN, defined as the frequency of missed doses above which 75% of the physicians' assessments were located; 3) we computed the number of pill boxes reimbursed in France in 2016 to put our results into context. RESULTS:We collected a total of 5365 assessments from 544 physicians, each of whom evaluated a random sample among 528 distinct clinical vignettes. Estimates of the TURN varied widely across drug-indication groups, ranging from risk considered unacceptable with 1 daily dose missed per month (e.g., insulin for diabetes) to risk always considered acceptable (e.g., anti-dementia drugs). Drugs with an estimated TURN of over one missing daily dose per week represented 44.9% of the prescription volume of the medications assessed in our study. CONCLUSIONS:According to physicians, the impact of non-adherence may vary greatly. Patient-physician discussions on the variable consequences of non-adherence could lead to a paradigm shift by seeking to reach "optimal adherence" depending on drugs rather than unrealistic "perfect adherence" to all drugs

Impact of an interactive web tool on patients’ intention to receive COVID-19 vaccination: a before-and-after impact study among patients with chronic conditions in France

International audienceObjectives: In France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination. Methods: The most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline. Results: Between January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination. Conclusions: Our interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information

Reply to comments on the Rigal et al . (2019) Bacloville trial

International audienc

Patients’ Perceived Importance of Medication and Adherence in Polypharmacy, a Quantitative, Cross-Sectional Study Using a Questionnaire Administered in Three Doctors’ Private Practices in France

International audienceBackground : Among the determinants of nonadherence, polypharmacy (common in people with multiple pathologies and especially in elderly patients), plays a major role. Objective: In patients who are subject to polypharmacy involving different classes of medications, the first aim is to assess the impact of medication importance given by patients on (i) medication adherence and (ii) the respective effect of intentionality and habit in medication importance and medication adherence. The second objective is to compare the importance given to medication and adherence in the different therapeutic classes. Patients and Methods : Patients taking 5–10 different medications for at least 1 month were included in a cross-sectional survey in three private practices in one region in France. Results : This study included 130 patients (59.2 % female) with 851 medications in total. The mean ± standard deviation (SD) age was 70.5 ± 12.2 years. The mean ± SD of medications taken was 6.9 ± 1.7. Treatment adherence had a strong positive correlation with the patient-perceived medication importance (p < 0.001). Counter-intuitively, taking a large num-ber of medications (≥7) was associated with being fully adherent (p = 0.02). A high intentional nonadherence score was negatively associated with high medication importance (p = 0.003). Furthermore, patient-perceived medication importance was positively associated with taking treatment by habit (p = 0.03). Overall nonadherence more strongly correlated with unintentional nonadherence (p < 0.001) than with intentional nonadherence (p = 0.02). Compared to the antihypertensive class, a decrease in adherence by medication was observed in psychoanaleptics (p < 0.0001) and drugs used in diabetes class (p = 0.002), and a decrease in importance in lipid-modifying agents class (p = 0.001) and psychoanaleptics (p < 0.0001). Conclusion : The perception of the importance of a medicine is associated with the place of intentionality and habit in patient adherence. Therefore, explaining the importance of a medicine should become an important part of patient education

Titrated baclofen for high-risk alcohol consumption: a randomized placebo-controlled trial in out-patients with 1-year follow-up

International audienc

Development and evaluation of a decision aid for women eligible for organized breast cancer screening according to international standards: A multi-method study

Backgroundand purpose:In France, women lack information to make a shared decision to start breast cancer screening. Decision aids are useful to facilitate this discussion, yet few meet international standards. The objective of this project was to build, validate and measure the quality of a decision aid for organized breast screening in France, in line with international standards, intended for both women and healthcare professionals.Materials and methodsThis mixed-methods study was conducted between January 2017 and June 2022. The prototype was developed from a qualitative study, systematic review and targeted literature review and alpha tested during two Delphi rounds. Readability was evaluated with the Flesch score and content with International Patient Decision Aid Standards Instrument (IPSASi).ResultsAn online decision aid, accessible at www.Discutons-mammo.fr, written in French was developed. The content included eligibility, information about breast screening the advantages and disadvantages of screening, patient preferences and a patient-based discussion guide using text, infographics, and videos. The Flesch readability test score was 65.4 and the IPDASi construct quality score was 176 out of 188.ConclusionsThis decision aid complies with IPDASi standards and could help women eligible for breast screening in France make a shared decision with a specialized healthcare professional about whether or not to participate in organized breast screening