Didier Duhot | Société Française de Médecine Générale (original) (raw)
Papers by Didier Duhot
Médecine et maladies infectieuses formation, May 1, 2023
Value in Health, Nov 1, 2015
mine the impact of parameter uncertainty. Results: With universal vaccination at a cost per dose ... more mine the impact of parameter uncertainty. Results: With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are costeffective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program. ConClusions: The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.
La Revue du praticien, 2011
notamment la prescription médicamenteuse, pour laquelle les « explications sur les risques fréque... more notamment la prescription médicamenteuse, pour laquelle les « explications sur les risques fréquents ou graves normalement prévisibles » sont explicitement citées (art. R.4127 du CSP). À cette obligation d’information répond celle de la recherche du « consentement libre et éclairé de la personne sans lequel aucun traitement ne peut être pratiqué » (art. R.4127-36 du CSP). Contexte Tout médecin est tenu, par le code de déontologie médicale 1 et la partie réglementaire du Code de la santé publique (CSP),2 d’apporter au patient « une information médicale claire, loyale et appropriée sur son état, les investigations et les soins qu’il lui propose » (art. R.4127-35 du CSP). Cette obligation concerne Summary Feasibility, in general practice, to give to the patients clear, loyal and appropriate information about the undesirable side effects of the medicines prescribed. EICLAT study
PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Structure of the questionnaire. Includes a table of all sections of the questionnaire (DOCX 17 kb)
BMC Primary Care, 2022
Background Smoking cessation is a major public health issue. In France, primary care physicians (... more Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resource...
Роль таможенных органов в контроле за незаконным перемещением товаров, наносящих ущерб окружающей... more Роль таможенных органов в контроле за незаконным перемещением товаров, наносящих ущерб окружающей среде В статье определено значение таможенных органов в обеспечении выполнения Российской Федерацией международных обязательств в экологической сфере и сфере общественной безопасности. Обозначены основные проблемы предупреждения, выявления и пресечения фактов незаконного перемещения через таможенную границу товаров, наносящих ущерб окружающей среде. Предлагаются пути совершенствования законодательства в области усиления контроля за оборотом товаров, наносящих ущерб окружающей среде. Ключевые слова: таможня, борьба с контрабандой, озоноразрушающие вещества, химические средства защиты растений, опасные отходы.
• Type 2 diabetes (T2DM) is a growing global problem. • T2DM is usually a progressive disease tha... more • Type 2 diabetes (T2DM) is a growing global problem. • T2DM is usually a progressive disease that starts with impaired glucose tolerance (IGT, or pre-diabetes), which may lead insulin resistance (IR), and the accumulation of complications over time. T2DM is associated with an increased risk of a range of cardiovascular diseases (CVD) and is recognized as a cardiovascular (CV) mortality risk factor. • Traditionally, the focus of T2DM treatment was on lowering glycated haemoglobin (HbA1c). • Whilst lowering glucose has been shown to decrease microvascular complications, lowering HbA1c with older therapies, with the exception of metformin, does not improve mortality or vascular risk. However, some newer anti-diabetes medications have demonstrated significant CV benefits, namely the sodium-glucose cotransporter-2 (SGLT2) inhibitors, and some GLP-1 receptor agonists (GLP-1RAs). These new findings offer the potential a more comprehensive treatment approach in T2DM management, which addresses both hyperglycaemia and the associated risk of CV morbidity and mortality. • All of these aspects will be discussed in more detail in this practical guidance document, which aims to guide general practitioners (GPs) and other primary care physicians on how to manage vascular disease in T2DM patients in primary care.
Santé publique (Vandoeuvre-lès-Nancy, France)
One of the factors responsible for the creation of multidisciplinary health centres is the growth... more One of the factors responsible for the creation of multidisciplinary health centres is the growth of outpatient management of multiple chronic conditions. Based on a classification of hypertensive patients into eight groups, the authors discuss the interrelations between health care organization and modification of management. They discuss the effects of modification of health care structures and the need to create new job positions for the purposes of coordination, support of patients in the form of therapeutic education and support ofyoung professionals in multidisciplinary practice. External effects are improvement of office-hospital flows, especially with the development of second-line consultant roles and improved management of patient admissions and discharges. However, to ensure sustainable changes, there must be a change of mentalities with new modalities of remuneration of private practitioners and development of the health information system.
Primary Health Care: Open Access, 2014
Background: Obesity is a global health problem. Physicians are frequently engaged with overweight... more Background: Obesity is a global health problem. Physicians are frequently engaged with overweight and obese patients. Obesity guidelines have been successfully implemented on a small scale, but generally physicians struggle to manage obesity effectively. Methods: In a web-based survey, primary care physicians in the United States (US), France, Israel and Japan, were asked how they manage cardiovascular risk factors. They were specifically asked how frequently they saw patients in follow-up for hypertension, hyperlipidemia and obesity. Results: Respondents (956) included 656 French, 198 Israeli, 45 Japanese, and 53 US physicians. Follow-up for obesity no sooner than 3 months was recommended, by 73% (US) and 79% (Israeli) physicians, whereas 67% of French and 66% of Japanese physicians recommended more frequent follow-up (3 months or less). Hypertension and hyperlipidemia was managed more aggressively, especially the US, Israel and Japan. Discussion: Obesity is an international concern, with rates increasing everywhere. The prevalence of obesity is high in the US and Israel and much lower in France and Japan. Chronic disease management is most effective with frequent follow-up. US obesity guidelines recommend frequent (often monthly) follow-up visits. US and Israeli physicians do not appear to be aggressive in managing obesity, whereas French and Japanese physicians report more effort to manage obesity. In the US, obesity management is not considered effective and physicians are uncomfortable attempting to manage obesity with their patients. In France especially, physicians have a more social relationship with their patients and seem oriented toward chronic disease management, including greater attention to lifestyle change. Conclusion: Obesity has been medicalized and is a profound problem internationally. The medical care system must address obesity management more effectively. Further studies are needed to understand how physicians manage obesity and new approaches should be promoted to improve the outcomes of obesity management.
La Revue du praticien, Jan 20, 2010
Based on patient's declarations, evaluate if the media coverage of the pandemic flu (H1N1) ha... more Based on patient's declarations, evaluate if the media coverage of the pandemic flu (H1N1) has lead to an overconsumption of primary care. Identify the opinions of the general practionners (GP) concerning this media coverage and the health crisis. A prospective study, based on an electronic questionnaire, was conducted during the main period of the pandemic flu. Each GP was invited to include one patient who presented fever since less than 2 days, associated to two of four following clinical signs: cough, headache, coat throat and ache. 730 questionnaires were fully completed and analyzed. 96 patients (12,9%) have declared to the GP an overconsumption, and two thirds of them because of their concern about the swine flu and a quarter because the social control. This concern was noted by 80% of the GP from the beginning of the flu 77% of the GP have considered the media coverage of the flu alarming, while 69% of them have declared to feel serene concerning the pandemic. No statist...
PLoS ONE, 2012
Context: From one country to another, the pay-for-performance mechanisms differ on one significan... more 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.
Family Practice, 2012
Background. For preventive interventions in general practice to succeed, patients' points of view... more Background. For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective. To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods. Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results. Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years.
La mise à la disposition des professionnels de santé des données issues de la recherche n'est pas... more La mise à la disposition des professionnels de santé des données issues de la recherche n'est pas suffisante pour qu'ils y accèdent, les analysent et les intègrent dans leur pratique. 1 Les recommandations pour la pratique clinique (RPC) qui s'appuient sur « la médecine fondée sur les preuves » ont aussi leurs propres limites. Les preuves sont souvent limitées à une partie des recommandations. Les opinions d'experts, les préférences des patients ou des médecins, les priorités sociales priment souvent sur les données de la recherche. 2 L'intégration des recommandations dans la pratique est rendue difficile, car les populations soignées par les médecins sont souvent plus hétérogènes que celles incluses dans les programmes de recherche. De même, la plus grande complexité des soins délivrés en pratique quotidienne, et la non-prise en compte de tous les détails pertinents pour la prise en charge du patient freinent l'appropriation des recommandations. L'Anaes a régulièrement été informée par les sociétés savantes de médecine générale des difficultés à intégrer les objectifs de > Quelle est la cible des recommandations ? p. 1405 > Quel niveau de preuve des objectifs ? p. 1405 > Comment définit-on l'incontinence urinaire ? p. 1405 > Pourquoi rechercher activement une incontinence urinaire ? p. 1406 > Quand rechercher une incontinence urinaire chez une femme consultant en médecine générale ? p. 1406 > Comment faire le diagnostic ? p. 1407 > Quel bilan initial doit être pratiqué ? p. 1408 > En fonction du type d'incontinence, quel traitement peut être donné ? p. 1410 > Conclusion p. 1412
Objectifs : Determiner la prevalence de la prise en charge de l'hypertension arterielle en me... more Objectifs : Determiner la prevalence de la prise en charge de l'hypertension arterielle en medecine generale. Methode : Exploitation des donnees de l'Observatoire de la medecine generale (OMG), qui est le reseau de medecins informatises de la Societe francaise de medecine generale. L'etude s'est interessee au resultat de consultation « HTA » tel qu'il est defini dans le Dictionnaire des resultats de consultation en medecine generale. Resultats : Entre juillet 1994 et juin 1995, les 7 1 medecins generalistes de l'OMG avaient vu 55 495 patients (29 600 femmes et 25 895 hommes) ; 5 945 d'entre eux ont eu un probleme d'hypertension, soit une prevalence globale de l'hypertension de 10,73 % : 11,8 % pour les femmes et 9,4 % pour les hommes. Sur les 176123 consultations (au cabinet ou au domicile du patient), 24 092 incluaient le resultat de consultation « HTA » (18 716 consultations et 5 376 visites). L'hypertension apparaissait apres 40 ans. Parmi ...
Médecine et maladies infectieuses formation, May 1, 2023
Value in Health, Nov 1, 2015
mine the impact of parameter uncertainty. Results: With universal vaccination at a cost per dose ... more mine the impact of parameter uncertainty. Results: With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are costeffective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program. ConClusions: The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.
La Revue du praticien, 2011
notamment la prescription médicamenteuse, pour laquelle les « explications sur les risques fréque... more notamment la prescription médicamenteuse, pour laquelle les « explications sur les risques fréquents ou graves normalement prévisibles » sont explicitement citées (art. R.4127 du CSP). À cette obligation d’information répond celle de la recherche du « consentement libre et éclairé de la personne sans lequel aucun traitement ne peut être pratiqué » (art. R.4127-36 du CSP). Contexte Tout médecin est tenu, par le code de déontologie médicale 1 et la partie réglementaire du Code de la santé publique (CSP),2 d’apporter au patient « une information médicale claire, loyale et appropriée sur son état, les investigations et les soins qu’il lui propose » (art. R.4127-35 du CSP). Cette obligation concerne Summary Feasibility, in general practice, to give to the patients clear, loyal and appropriate information about the undesirable side effects of the medicines prescribed. EICLAT study
PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Structure of the questionnaire. Includes a table of all sections of the questionnaire (DOCX 17 kb)
BMC Primary Care, 2022
Background Smoking cessation is a major public health issue. In France, primary care physicians (... more Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resource...
Роль таможенных органов в контроле за незаконным перемещением товаров, наносящих ущерб окружающей... more Роль таможенных органов в контроле за незаконным перемещением товаров, наносящих ущерб окружающей среде В статье определено значение таможенных органов в обеспечении выполнения Российской Федерацией международных обязательств в экологической сфере и сфере общественной безопасности. Обозначены основные проблемы предупреждения, выявления и пресечения фактов незаконного перемещения через таможенную границу товаров, наносящих ущерб окружающей среде. Предлагаются пути совершенствования законодательства в области усиления контроля за оборотом товаров, наносящих ущерб окружающей среде. Ключевые слова: таможня, борьба с контрабандой, озоноразрушающие вещества, химические средства защиты растений, опасные отходы.
• Type 2 diabetes (T2DM) is a growing global problem. • T2DM is usually a progressive disease tha... more • Type 2 diabetes (T2DM) is a growing global problem. • T2DM is usually a progressive disease that starts with impaired glucose tolerance (IGT, or pre-diabetes), which may lead insulin resistance (IR), and the accumulation of complications over time. T2DM is associated with an increased risk of a range of cardiovascular diseases (CVD) and is recognized as a cardiovascular (CV) mortality risk factor. • Traditionally, the focus of T2DM treatment was on lowering glycated haemoglobin (HbA1c). • Whilst lowering glucose has been shown to decrease microvascular complications, lowering HbA1c with older therapies, with the exception of metformin, does not improve mortality or vascular risk. However, some newer anti-diabetes medications have demonstrated significant CV benefits, namely the sodium-glucose cotransporter-2 (SGLT2) inhibitors, and some GLP-1 receptor agonists (GLP-1RAs). These new findings offer the potential a more comprehensive treatment approach in T2DM management, which addresses both hyperglycaemia and the associated risk of CV morbidity and mortality. • All of these aspects will be discussed in more detail in this practical guidance document, which aims to guide general practitioners (GPs) and other primary care physicians on how to manage vascular disease in T2DM patients in primary care.
Santé publique (Vandoeuvre-lès-Nancy, France)
One of the factors responsible for the creation of multidisciplinary health centres is the growth... more One of the factors responsible for the creation of multidisciplinary health centres is the growth of outpatient management of multiple chronic conditions. Based on a classification of hypertensive patients into eight groups, the authors discuss the interrelations between health care organization and modification of management. They discuss the effects of modification of health care structures and the need to create new job positions for the purposes of coordination, support of patients in the form of therapeutic education and support ofyoung professionals in multidisciplinary practice. External effects are improvement of office-hospital flows, especially with the development of second-line consultant roles and improved management of patient admissions and discharges. However, to ensure sustainable changes, there must be a change of mentalities with new modalities of remuneration of private practitioners and development of the health information system.
Primary Health Care: Open Access, 2014
Background: Obesity is a global health problem. Physicians are frequently engaged with overweight... more Background: Obesity is a global health problem. Physicians are frequently engaged with overweight and obese patients. Obesity guidelines have been successfully implemented on a small scale, but generally physicians struggle to manage obesity effectively. Methods: In a web-based survey, primary care physicians in the United States (US), France, Israel and Japan, were asked how they manage cardiovascular risk factors. They were specifically asked how frequently they saw patients in follow-up for hypertension, hyperlipidemia and obesity. Results: Respondents (956) included 656 French, 198 Israeli, 45 Japanese, and 53 US physicians. Follow-up for obesity no sooner than 3 months was recommended, by 73% (US) and 79% (Israeli) physicians, whereas 67% of French and 66% of Japanese physicians recommended more frequent follow-up (3 months or less). Hypertension and hyperlipidemia was managed more aggressively, especially the US, Israel and Japan. Discussion: Obesity is an international concern, with rates increasing everywhere. The prevalence of obesity is high in the US and Israel and much lower in France and Japan. Chronic disease management is most effective with frequent follow-up. US obesity guidelines recommend frequent (often monthly) follow-up visits. US and Israeli physicians do not appear to be aggressive in managing obesity, whereas French and Japanese physicians report more effort to manage obesity. In the US, obesity management is not considered effective and physicians are uncomfortable attempting to manage obesity with their patients. In France especially, physicians have a more social relationship with their patients and seem oriented toward chronic disease management, including greater attention to lifestyle change. Conclusion: Obesity has been medicalized and is a profound problem internationally. The medical care system must address obesity management more effectively. Further studies are needed to understand how physicians manage obesity and new approaches should be promoted to improve the outcomes of obesity management.
La Revue du praticien, Jan 20, 2010
Based on patient's declarations, evaluate if the media coverage of the pandemic flu (H1N1) ha... more Based on patient's declarations, evaluate if the media coverage of the pandemic flu (H1N1) has lead to an overconsumption of primary care. Identify the opinions of the general practionners (GP) concerning this media coverage and the health crisis. A prospective study, based on an electronic questionnaire, was conducted during the main period of the pandemic flu. Each GP was invited to include one patient who presented fever since less than 2 days, associated to two of four following clinical signs: cough, headache, coat throat and ache. 730 questionnaires were fully completed and analyzed. 96 patients (12,9%) have declared to the GP an overconsumption, and two thirds of them because of their concern about the swine flu and a quarter because the social control. This concern was noted by 80% of the GP from the beginning of the flu 77% of the GP have considered the media coverage of the flu alarming, while 69% of them have declared to feel serene concerning the pandemic. No statist...
PLoS ONE, 2012
Context: From one country to another, the pay-for-performance mechanisms differ on one significan... more 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.
Family Practice, 2012
Background. For preventive interventions in general practice to succeed, patients' points of view... more Background. For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective. To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods. Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results. Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years.
La mise à la disposition des professionnels de santé des données issues de la recherche n'est pas... more La mise à la disposition des professionnels de santé des données issues de la recherche n'est pas suffisante pour qu'ils y accèdent, les analysent et les intègrent dans leur pratique. 1 Les recommandations pour la pratique clinique (RPC) qui s'appuient sur « la médecine fondée sur les preuves » ont aussi leurs propres limites. Les preuves sont souvent limitées à une partie des recommandations. Les opinions d'experts, les préférences des patients ou des médecins, les priorités sociales priment souvent sur les données de la recherche. 2 L'intégration des recommandations dans la pratique est rendue difficile, car les populations soignées par les médecins sont souvent plus hétérogènes que celles incluses dans les programmes de recherche. De même, la plus grande complexité des soins délivrés en pratique quotidienne, et la non-prise en compte de tous les détails pertinents pour la prise en charge du patient freinent l'appropriation des recommandations. L'Anaes a régulièrement été informée par les sociétés savantes de médecine générale des difficultés à intégrer les objectifs de > Quelle est la cible des recommandations ? p. 1405 > Quel niveau de preuve des objectifs ? p. 1405 > Comment définit-on l'incontinence urinaire ? p. 1405 > Pourquoi rechercher activement une incontinence urinaire ? p. 1406 > Quand rechercher une incontinence urinaire chez une femme consultant en médecine générale ? p. 1406 > Comment faire le diagnostic ? p. 1407 > Quel bilan initial doit être pratiqué ? p. 1408 > En fonction du type d'incontinence, quel traitement peut être donné ? p. 1410 > Conclusion p. 1412
Objectifs : Determiner la prevalence de la prise en charge de l'hypertension arterielle en me... more Objectifs : Determiner la prevalence de la prise en charge de l'hypertension arterielle en medecine generale. Methode : Exploitation des donnees de l'Observatoire de la medecine generale (OMG), qui est le reseau de medecins informatises de la Societe francaise de medecine generale. L'etude s'est interessee au resultat de consultation « HTA » tel qu'il est defini dans le Dictionnaire des resultats de consultation en medecine generale. Resultats : Entre juillet 1994 et juin 1995, les 7 1 medecins generalistes de l'OMG avaient vu 55 495 patients (29 600 femmes et 25 895 hommes) ; 5 945 d'entre eux ont eu un probleme d'hypertension, soit une prevalence globale de l'hypertension de 10,73 % : 11,8 % pour les femmes et 9,4 % pour les hommes. Sur les 176123 consultations (au cabinet ou au domicile du patient), 24 092 incluaient le resultat de consultation « HTA » (18 716 consultations et 5 376 visites). L'hypertension apparaissait apres 40 ans. Parmi ...