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Abstract: Background: In patients treated with systemic glucocorticoids (GCs), it is unknown if beliefs about the treatment are associated with level of reported adherence. Patients and methods: Cross-sectional study conducted in two departments of internal medicine during a six-month period. All patients receiving long-term GCs therapy were asked to fill in a questionnaire regarding their beliefs about (specific scale of the Beliefs about Medicines Questionnaire) and their adherence to (four-item Morisky-Green scale) GCs. Logistic regression analysis was used to assess association between beliefs about GCs and adherence to treatment. Results: One hundred and eighty one questionnaires were analysed (women: 79%, median age [IQR]: 47 [33–61] years, median duration of treatment: 18 [7–72] months, median daily dosage of prednisone equivalent: 10 [6–20] mg). Among these 181 patients, 83 (46%) reported a “concern” score equal to or higher than the “necessity” score. Nineteen percent of patients reported a low adherence level. In multivariate analysis, these patients were significantly younger (OR: 0.96 [0.93–0.98] per increasing year of age, P =0.002) and reported more frequently a “concern” score higher than a “necessity” score (OR: 3.08 [1.27–7.46], P =0.01) as compared to patients reporting a high adherence level. Conclusion: Informing patients about the “necessity” of GCs and taking into account their “concerns” about adverse events or their fear of becoming dependent on the medication may improve their adherence to treatment. [Copyright &y& Elsevier]

Abstract: Purpose: In-patients characteristics generate cost differences between hospitals. In France, there are few data on the characteristics on the patients referred to hospitals by their general practitioners (GPs) and none on the predictors of referral to the public or for-profit hospitals. The aim of this study was to analyze those characteristics and the predictors of referral to the public or for-profit hospitals. Methods: We collected, prospectively, the request for hospitalizations made by the GPs of the Sentinelles network in France, from 2007 to 2009. Patients’ characteristics and also the reasons for that request were analyzed. A logistic regression was used to compare the population between local hospitals. Results: Ten thousand seven hundred and eighteen statements were collected. The median age was 73years. Patients were women in 51% of the cases, and only 14% of the hospitalizations had been planned. Hospitalization in the public sector was preferred for young children and the elderly (P <0.001). When compared to the patients referred to the private sector, patients addressed to the public sector were more often seen for emergencies (OR: 2.3 [2.0–2.8]), by a doctor different from their referring GP (OR: 1.7 [1.4–2.1]) and out of the GP''s office. The reasons for hospital admission were different depending on the sector of hospitalization (P <0.001), patients addressed to the public sector hospitals presented with greater comorbidity or more complex diagnosis (for example: feeling ill, fainting or syncope and fever) or a greater disability (for example: stroke, neurological and psychiatric diseases). Conclusion: This study suggests that GPs send their patients to the public or for-profit hospitals according to criteria of severity, comorbidity and disability. [Copyright &y& Elsevier]

Background: In patients treated with systemic glucocorticoids (GCs), it is unknown if beliefs about the treatment are associated with level of reported adherence., Patients and Methods: Cross-sectional study conducted in two departments of internal medicine during a six-month period. All patients receiving long-term GCs therapy were asked to fill in a questionnaire regarding their beliefs about (specific scale of the Beliefs about Medicines Questionnaire) and their adherence to (four-item Morisky-Green scale) GCs. Logistic regression analysis was used to assess association between beliefs about GCs and adherence to treatment., Results: One hundred and eighty one questionnaires were analysed (women: 79%, median age [IQR]: 47 [33-61] years, median duration of treatment: 18 [7-72] months, median daily dosage of prednisone equivalent: 10 [6-20] mg). Among these 181 patients, 83 (46%) reported a "concern" score equal to or higher than the "necessity" score. Nineteen percent of patients reported a low adherence level. In multivariate analysis, these patients were significantly younger (OR: 0.96 [0.93-0.98] per increasing year of age, P=0.002) and reported more frequently a "concern" score higher than a "necessity" score (OR: 3.08 [1.27-7.46], P=0.01) as compared to patients reporting a high adherence level., Conclusion: Informing patients about the "necessity" of GCs and taking into account their "concerns" about adverse events or their fear of becoming dependent on the medication may improve their adherence to treatment., (Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)