Thomas RENAUD - Academia.edu (original) (raw)

Papers by Thomas RENAUD

Archives of Cardiovascular Diseases, 2009

Heart failure presents a major public health problem due to its high prevalence and the increasin... more Heart failure presents a major public health problem due to its high prevalence and the increasing number of hospital admissions for this condition. A coordinated healthcare network involving general practitioners and cardiologists was set up in the east of Paris in an effort to improve the management and outcomes of patients with severe heart failure.To reinforce patient education, improve compliance with medications and identify symptoms requiring treatment modification.In this ‘before and after’ study, the control group comprised patients hospitalized for severe heart failure who received conventional management in the year preceding the network set-up. The comparative group consisted of patients hospitalized for severe heart failure who underwent network-led care.No significant differences were found between rates of first rehospitalization and all-cause mortality at 1 year between control and network groups, or between rates of first hospitalization due to cardiac causes, time to the first event, duration of hospitalization, rates of cardiac death or time to death.In this non-randomized study, we found no benefit from management according to the RESICARD healthcare network in terms of mortality or hospitalization in patients with severe chronic heart failure.L’insuffisance cardiaque (IC) représente un problème de santé publique majeur, lié à sa forte prévalence, et à l’augmentation croissante des hospitalisations. Une coordination de médecins généralistes et de cardiologues de ville et hospitaliers de l’est de Paris s’est constituée dans le cadre d’un réseau ville–hôpital afin de maintenir à domicile les patients insuffisants cardiaques graves.Renforcer l’éducation du patient, s’assurer de l’observance du traitement et identifier précocement les symptômes justifiant une modification thérapeutique.La méthodologie utilisée était comparative, non randomisée. Les patients hospitalisés pour IC sévère dans les hôpitaux participants dans l’année précédant l’installation du réseau et répondant aux critères d’inclusion ont constitué le groupe témoin ayant bénéficié d’un traitement conventionnel. Les patients hospitalisés pour IC sévère dans les hôpitaux participants dans l’année suivant l’installation du réseau et répondant aux critères d’inclusion ont constitué le groupe réseau ayant bénéficié d’une prise en charge spécifique.Aucune différence significative n’a été retrouvée concernant les taux de première réhospitalisation et de mortalité à un an toutes causes confondues entre les groupes témoin et réseau. De même, aucune différence significative n’a été retrouvée concernant le taux de première réhospitalisation pour cause cardiaque, le délai moyen de survenue par rapport à l’inclusion et la durée moyenne d’hospitalisation. Aucune différence significative n’a été observée entre les deux groupes concernant les décès de cause cardiaque et leurs délais de survenue par rapport à l’inclusion.Cette étude prospective non randomisée n’a montré aucun bénéfice à la prise en charge par le réseau de soins RESICARD, en termes de réduction des hospitalisations et de la mortalité, dans l’IC chronique sévère.

This article provides a simple and preliminary study of variations in the number of days of work ... more This article provides a simple and preliminary study of variations in the number of days of work lost to illness and injury in France, over time and across jurisdictions. We test the hypothesis that workers use their physicians to cheat the system and increase their leisure time paid for by the sickness fund. Firstly, using time series analysis, we check that change in the unemployment rate correlates unequivocally and negatively with the absence rate. We then show, based on geographical aggregate level data, that physicians' density is not positively correlated to sick leaves, which runs contrary to the idea of cheating helped by doctors. We suggest and test for alternative factors, such as baseline population health. If the increase in the number of days lost to illness is seen as a matter of concern, our recommended policy would be to target demand side as well as supply side in the labour market.

Within Europe, France and the Netherlands are extremes when it comes to the prescription of antib... more Within Europe, France and the Netherlands are extremes when it comes to the prescription of antibiotics: France has the highest volume in the European Union, the Netherlands the lowest. Antibiotic prescribing for upper respiratory tract infections (URTI) is not recommended in both countries. Non-rational prescribing antibiotics is problematic in terms of public health and health care resources. Determinants for antibiotics

Health Policy, 2008

To assess international comparability of general cost of illness (COI) studies and to examine the... more To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why.Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants.In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data.A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.

Social Science & Medicine, 2010

Archives of Cardiovascular Diseases, 2009

Heart failure presents a major public health problem due to its high prevalence and the increasin... more Heart failure presents a major public health problem due to its high prevalence and the increasing number of hospital admissions for this condition. A coordinated healthcare network involving general practitioners and cardiologists was set up in the east of Paris in an effort to improve the management and outcomes of patients with severe heart failure.To reinforce patient education, improve compliance with medications and identify symptoms requiring treatment modification.In this ‘before and after’ study, the control group comprised patients hospitalized for severe heart failure who received conventional management in the year preceding the network set-up. The comparative group consisted of patients hospitalized for severe heart failure who underwent network-led care.No significant differences were found between rates of first rehospitalization and all-cause mortality at 1 year between control and network groups, or between rates of first hospitalization due to cardiac causes, time to the first event, duration of hospitalization, rates of cardiac death or time to death.In this non-randomized study, we found no benefit from management according to the RESICARD healthcare network in terms of mortality or hospitalization in patients with severe chronic heart failure.L’insuffisance cardiaque (IC) représente un problème de santé publique majeur, lié à sa forte prévalence, et à l’augmentation croissante des hospitalisations. Une coordination de médecins généralistes et de cardiologues de ville et hospitaliers de l’est de Paris s’est constituée dans le cadre d’un réseau ville–hôpital afin de maintenir à domicile les patients insuffisants cardiaques graves.Renforcer l’éducation du patient, s’assurer de l’observance du traitement et identifier précocement les symptômes justifiant une modification thérapeutique.La méthodologie utilisée était comparative, non randomisée. Les patients hospitalisés pour IC sévère dans les hôpitaux participants dans l’année précédant l’installation du réseau et répondant aux critères d’inclusion ont constitué le groupe témoin ayant bénéficié d’un traitement conventionnel. Les patients hospitalisés pour IC sévère dans les hôpitaux participants dans l’année suivant l’installation du réseau et répondant aux critères d’inclusion ont constitué le groupe réseau ayant bénéficié d’une prise en charge spécifique.Aucune différence significative n’a été retrouvée concernant les taux de première réhospitalisation et de mortalité à un an toutes causes confondues entre les groupes témoin et réseau. De même, aucune différence significative n’a été retrouvée concernant le taux de première réhospitalisation pour cause cardiaque, le délai moyen de survenue par rapport à l’inclusion et la durée moyenne d’hospitalisation. Aucune différence significative n’a été observée entre les deux groupes concernant les décès de cause cardiaque et leurs délais de survenue par rapport à l’inclusion.Cette étude prospective non randomisée n’a montré aucun bénéfice à la prise en charge par le réseau de soins RESICARD, en termes de réduction des hospitalisations et de la mortalité, dans l’IC chronique sévère.

This article provides a simple and preliminary study of variations in the number of days of work ... more This article provides a simple and preliminary study of variations in the number of days of work lost to illness and injury in France, over time and across jurisdictions. We test the hypothesis that workers use their physicians to cheat the system and increase their leisure time paid for by the sickness fund. Firstly, using time series analysis, we check that change in the unemployment rate correlates unequivocally and negatively with the absence rate. We then show, based on geographical aggregate level data, that physicians' density is not positively correlated to sick leaves, which runs contrary to the idea of cheating helped by doctors. We suggest and test for alternative factors, such as baseline population health. If the increase in the number of days lost to illness is seen as a matter of concern, our recommended policy would be to target demand side as well as supply side in the labour market.

Within Europe, France and the Netherlands are extremes when it comes to the prescription of antib... more Within Europe, France and the Netherlands are extremes when it comes to the prescription of antibiotics: France has the highest volume in the European Union, the Netherlands the lowest. Antibiotic prescribing for upper respiratory tract infections (URTI) is not recommended in both countries. Non-rational prescribing antibiotics is problematic in terms of public health and health care resources. Determinants for antibiotics

Health Policy, 2008

To assess international comparability of general cost of illness (COI) studies and to examine the... more To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why.Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants.In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data.A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.

Social Science & Medicine, 2010