Intérêt de la méthode des marges dégressives pour maîtriser les dépenses de médicaments remboursables en Albanie

Le problème des prix élevés de médicaments constitue l un des principaux obstacles à l accessibilité aux médicaments pour certaines catégories de la population albanaise. Ces prix élevés représentent un coût élevé pour l Assurance maladie représentant 65-70% des dépenses totales. L objectif du travail est de proposer un modèle de marges dégressives et d évaluer l amélioration en termes d économies pour l AM. Après avoir étudié les 5 méthodes existantes et leur fréquence d utilisation en Europe, la méthode des marges dégressives est la plus appropriée qui correspond à l intérêt de la population, compte tenu des conditions financières de l AM et des données socio-économiques du pays. Méthodologie : 1) La méthode d analyse des prix, développée par l OMS et HAI (2003). 2) L enquête auprès des professionnels de santé et des consommateurs a été réalisée. Les résultats obtenus ont indiqué l efficacité de l approche comme un moyen pour maîtriser les dépenses des médicaments en Albanie.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Contribution d'un programme éducatif de groupe à l'aide au sevrage tabagique

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evolution de la prévalence du tabagisme chez les enseignants en France entre 1999 et 2005, suite au renforcement de la politique nationale de lutte contre le tabagisme

En matière d' habitudes tabagiques, les enseignants constituent une population qui possède un rôle de modèle important auprès des élèves. Pourtant, très peu de données sont disponibles sur leur consommation tabagique. L' objectif de ce travail est d' étudier l' évolution de la consommation tabagique des enseignants suite au renforcement de la politique de la lutte contre le tabagisme, grâce à l' analyse des résultats sur la santé physique et mentale des enseignants de 20 à 59 ans provenant de deux grandes enquêtes françaises réalisées en 1999 (N=2931) et en 2005 (N=3368). Les principaux résultats montrentune diminution significative de la consommation tabagique des enseignants au cours de cette période. Entre 1999 et 2005, la prévalence du tabagisme a diminué, passant de 25,7 % à 18,2 % (p ou = 2 (OR=1,95 chez les hommes, 2,12 chez les femmes), ou ayant présenté les critères diagnostiques d' un épisode dépressif majeur dans les 12 derniers mois (OR= 1,46 chez les hommes, 1,44 chez les femmes). L' ensemble des résultats de cette étude invite à développer des prises en charges adaptées pour ces populations spécifiques de fumeurs.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Prise en charge individuelle du sevrage tabagique : les facteurs déterminants du sevrage

Le but était d évaluer l aide à l arrêt et d identifier des facteurs psychosociaux du sevrage chez les fumeurs requérant a priori une aide spécifique : précaires, femmes enceintes et petits fumeurs (moins de 10 cigarettes/jour).La base de données nationale Consultation De Tabacologie (CDT) contient les dossiers de fumeurs reçus en CDT.682 femmes enceintes consultent en 2004 2006. 80,5% fume plus de 10 cigarettes/jour. 59,8% est perdu de vue. Une faible dépendance et l usage de patchs prédisent l arrêt.Selon les motifs d arrêt de 13746 consultants en 2006 2007, des réseaux sociaux non-fumeurs se développent, motivant l arrêt via des thèmes tels "incitation ou pression des autres" (20,9% d arrêts à 1 mois de suivi), "montrer l exemple" (20,7%), "entourage non-fumeur" (20,3%).5,6% des 587 femmes enceintes sont sevrées, sans effet prédictif de la grossesse ni d autres motifs (coût, santé, image négative du tabagisme, entourage).Le coût du tabac ne prédit pas l arrêt des chômeurs ou peu éduqués qui sacrifient parfois des besoins primaires pour le tabac. 259 fumeurs heureux de fumer (69,3% peu éduqués) et réfractaires à toute aide vont en CDT sur injonction médicale. 10,4% arrêtent de fumer.36594 adultes consultent en 2007 2008. 13,3% des 6001 petits fumeurs sont sevrés versus 14,5% de gros fumeurs. Les petits fumeurs reçoivent moins de pharmacothérapie bien qu elle double leur taux d arrêt, surtout chez ceux ayant plusieurs fois tenté l arrêt.Les thérapies cognitivo-comportementales n aident l arrêt des femmes enceintes et petits fumeurs qu avec le patch.Nous proposons des pistes pour adapter la prise en charge de fumeurs pour qui les mesures actuelles sont peu efficaces.PARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Workplace smoking ban effects on unhappy smokers

Economists usually draw a distinction between smokers. They distinguish 'happy addicts' à la Becker-Murphy from 'unhappy addicts' who state that smoking is a mistake and call for some help to quit. When evaluating tobacco control policies, it might be important to distinguish their effects on those two types of population. Indeed, such policies are welfare improving only if they help unhappy addicts to quit. We investigate the effect of the French workplace smoking ban on a sample of presumably 'unhappy addicts', smokers who consult tobacco cessation services. We show that the ban caused an increase in the demand for such services, and that this increase was larger in cold and rainy areas. It also induced an increase in the percentage of successful attempts to quit. Workplace smoking bans might be welfare improving since they seem to help 'unhappy addicts' to reconcile their behavior with their preferences

Clinical factors associated with smoking cessation among smokers with Chronic Obstructive Pulmonary Disease by sex: Longitudinal analyses from French smoking cessation services

International audienceBackground: Smoking is responsible for 80 % of cases of Chronic Obstructive Pulmonary Disease (COPD), while the prognosis is improved by smoking cessation (SC). We examined clinical factors associated with SC among smokers with COPD comparing women and men.Methods: The study comprised a cohort of 1470 smokers who visited a SC service and completed at least 28-day of follow-up visits. The outcome was smoking status at follow-up (abstinence, reduction, no change). Abstinence was defined as continuous abstinence for at least 28 days, validated by the measurement of expired Carbon Monoxide. Reduction was defined as a halving of the baseline tobacco consumption.Results: The average age of the population was 53 (±11) years and 58.2 % were women. Men were 2 years younger than women and consulted more likely after a hospital contact, whereas women consulted on their own initiative. Women more often had a depression history, whereas men had medical comorbidities and co-addictions. There was no significant difference by sex regarding the abstinence rate (41.0 % in women vs 40.7 in men, p > 0.9). The factors significantly associated with higher abstinence rates in both sexes were: at least one previous quit attempt and number of follow-up visits ≥4. The factors negatively associated with quitting in women were diabetes, intake of mood stabilizers and consuming more than 10 cigarettes per day while having a chronic bronchitis, taking antidepressants and having consumed cannabis in the last 30 days hampered SC in men.Conclusions: Concerning factors associated with SC, few differences were found between female and male smokers suffering from COPD. However, due to the different medical and smoking behavior characteristics according to sex, it might be important to take these differences into account in order to provide tailored SC management

Smoking and the consumption of antidepressants, anxiolytics and hypnotic drugs: Results of a large, French epidemiological study in 2005

International audienceThe aim of this study was to describe and analyse the links between the consumption of psychotropic drugs and smoking, based on data from individuals subscribing to a health insurance organisation (a mutuelle) in France in 2005. Data on smoking status, depression, anxiety and alcohol consumption from a large transversal epidemiological study carried out in 2005 were analysed in parallel to individual data concerning the reimbursement of medical prescriptions for psychotropic drugs. We compared reimbursement data for psychotropic drugs between individuals who had smoked for at least 15 years and continued to smoke and individuals who had stopped smoking after at least 15 years of smoking. This group of ex-smokers was subdivided into three subgroups on the basis of the number of years elapsed since the time point at which the individual had been smoking for 15 years: 1 to 9 years, 10 to 19 years and 20 years or more. "Ex-smoker" status was associated with a lower risk of psychotropic drug prescription than "current smoker" status (OR=0.81 for anxiolytics, OR=0.74 for antidepressants). Analysis of the subgroups of smokers and ex-smokers also showed that mean annual consumption of antidepressants and anxiolytics was significantly lower for individuals who had stopped smoking after at least 15 years of the habit than for those who continued to smoke (respectively 1.34 versus 0.65 for anxiolytics, and 1.17 versus 0.62 for antidepressants). Our findings suggest that stopping smoking is associated with a decrease in the consumption of psychotropic drugs. They highlight the need to evaluate the medium- and long-term effects of stopping smoking on psychotropic drug consumption in more detail, taking into account the anxious and depressive disorders to which smokers are particularly prone

Smoking cessation using preference-based tools: a mixed method pilot study of a novel intervention among smokers with low socioeconomic position

International audienceBackground: Compared to smokers with favorable socio-economic position (SEP), those with low SEP are less likely to have a successful smoking cessation attempt. Tailored approaches are therefore needed, and general practitioners could help reaching and assisting usually hard-to-reach population.Method: STOP (Sevrage Tabagique à l’aide d’Outils dédiés selon la Préférence) is a pilot study, examining the feasibility, acceptability and potentiality of a smoking cessation intervention centered on smoker’s preference. Smokers with low SEP, wishing to quit, were recruited in six healthcare centers in the Greater Paris area. They were asked to choose between different types of nicotine replacement therapy (NRT) products and/or e-cigarette with liquids delivered free of charge to aid their smoking cessation attempt. We describe the characteristics of recruited participants, their perception of smoking cessation aids, and the evolution of their smoking status 4 to 6 weeks after recruitment.Results: We recruited 49 participants, of which 29% chose an e-cigarette, 29% chose NRT and 42% chose both an e-cigarette and NRT. The intervention was shown to be acceptable by participants and health professionals. Among the 24 participants followed for at least one month, 14 (28% of all participants) stopped smoking, and 9 (18%) considerably reduced their consumption.Conclusion: The STOP intervention is feasible and acceptable, even if more efforts should be made to limit lost-to-follow-up. This preference-based intervention also shows interesting prospect in helping smokers with low SEP quit smoking. We will test the efficacy of this preference-based intervention in a randomized controlled trial

Sociodemographic and Clinical Characteristics of Vapers Using E-Cigarettes Exclusively: The French Vapoquid Study

Electronic cigarettes are increasingly being used as smoking cessation aids. Most studies assess the dual use of e-cigarettes and traditional cigarettes, but there remains a paucity of literature concerning individuals who use e-cigarettes exclusively. Objective: The aim of this study is to examine the sociodemographic and clinical characteristics of exclusive e-cigarette users, and consider their willingness to quit e-cigarette use. Methods: A French online survey was conducted from March to December 2017. We assessed the following factors: sociodemographic factors; the clinical characteristics of e-cigarette use and its social acceptability; and the self-perceived effectiveness of nicotine replacement therapy (NRT). Associations between the listed factors and a willingness to quit e-cigarette use were examined. Results: A total of 386 exclusive e-cigarette users (70% men) participated in the study and were included in the analysis. Most respondents were not planning to quit e-cigarette use (75%). Compared to those who did not want to quit, a desire to quit was associated with using smoking cessation services (OR [95%CI]: 3.45 [1.82-6.56]), e-cigarette craving (OR [95%CI]: 2.63 [1.44-4.80]) and NRT past-use (1.78 [1.12-2.87]). Users who planned to quit expressed more concerns about smoking initiation among youths using e-cigarettes (OR [95%CI]: 3.62 [1.90-6.93]). In multivariate analysis, these associations remained significant for the use of smoking cessation services, e-cigarette cravings, and concerns about youth tobacco initiation. Conclusion: Most exclusive e-cigarette users were not likely to quit. Planned cessation was associated with using smoking cessation services, experiencing e-cigarette dependence symptoms, and being concerned about smoking initiation among teenager e-cigarette users

Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-‘Tabac Info Service’: ee-TIS trial

International audienceIntroduction A French national smoking cessation service, Tabac Info Service, has been developed to provide an adapted quitline and a web and mobile application involving personalised contacts (eg, questionnaires, advice, activities, messages) to support smoking cessation. This paper presents the study protocol of the evaluation of the application (e-intervention Tabac Info Service (e-TIS)). The primary objective is to assess the efficacy of e-TIS. The secondary objectives are to (1) describe efficacy variations with regard to users' characteristics, (2) analyse mechanisms and contextual conditions of e-TIS efficacy.Methods and analyses The study design is a two-arm pragmatic randomised controlled trial including a process evaluation with at least 3000 participants randomised to the intervention or to the control arm (current practices). Inclusion criteria are: aged 18 years or over, current smoker, having completed the online consent forms, possessing a mobile phone with android or apple systems and using mobile applications, wanting to stop smoking sooner or later. The primary outcome is the point prevalence abstinence of 7 days at 6 months later. Data will be analysed in intention to treat (primary) and per protocol analyses. A logistic regression will be carried out to estimate an OR (95% CI) for efficacy. A multivariate multilevel analysis will explore the influence on results of patients' characteristics (sex, age, education and socioprofessional levels, dependency, motivation, quit experiences) and contextual factors, conditions of use, behaviour change techniques.Ethics and dissemination The study protocol was reviewed by the ethical and deontological institutional review board of the French Institute for Public Health Surveillance on 18 April 2016. The findings of this study will allow us to characterise the efficacy of e-TIS and conditions of its efficacy. These findings will be disseminated through peer-reviewed articles