17 results on '"S. Chretin"'
Search Results
2. Influence of patients' characteristics and disease management on asthma control
- Author
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S. Chretin, Eric Van Ganse, Yves Pacheco, Laurent Laforest, Geneviève Chamba, Jean Bousquet, Gilles Devouassoux, Gisele Bauguil, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, laboratoire du sommeil, CHU Grenoble, Service des maladies respiratoires, Hospices Civils de Lyon (HCL), Recherche en épidémiologie et biostatistique, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Immunovirologie et polymorphisme génétique, Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)
- Subjects
Male ,Adult ,medicine.medical_specialty ,Adolescent ,Immunology ,Pharmacy ,Lower risk ,primary care ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Drug Therapy ,Internal medicine ,Control ,medicine ,sex ,Humans ,Immunology and Allergy ,Anti-Asthmatic Agents ,030212 general & internal medicine ,Disease management (health) ,Medical prescription ,Retrospective Studies ,Asthma ,Observer Variation ,2. Zero hunger ,therapy ,business.industry ,Smoking ,Disease Management ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,3. Good health ,Logistic Models ,030228 respiratory system ,Multivariate Analysis ,Combination ,Physical therapy ,Regression Analysis ,Drug Therapy, Combination ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Body mass index - Abstract
International audience; BACKGROUND: Although asthma control is a major outcome in disease management, little is known about its determinants. OBJECTIVES: We sought to study the relationships between asthma control and patient characteristics or asthma management. METHODS: Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis. RESULTS: The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m2 were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting beta-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96). CONCLUSION: Asthma control varied according to both the patients' characteristics and therapy. CLINICAL IMPLICATIONS: Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.
- Published
- 2006
- Full Text
- View/download PDF
3. Quality of asthma care: results from a community pharmacy based survey
- Author
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G. Devouassoux, S. Chretin, L. Laforest, Yves Pacheco, Geneviève Chamba, E. Van Ganse, and Gisele Bauguil
- Subjects
Adult ,Male ,medicine.medical_specialty ,Allergy ,Adolescent ,Immunology ,Pharmacy ,Asthma care ,Pharmacy records ,Surveys and Questionnaires ,Epidemiology ,medicine ,Humans ,Immunology and Allergy ,Anti-Asthmatic Agents ,Disease management (health) ,music ,Asthma ,Pharmacies ,business.industry ,Respiratory disease ,Middle Aged ,music.record_label ,medicine.disease ,respiratory tract diseases ,Health Care Surveys ,Emergency medicine ,Physical therapy ,Female ,France ,business ,Delivery of Health Care - Abstract
Background: Optimal control is a major objective of disease management of asthma. The aim of the present study was to provide descriptive data on disease management in asthma patients, including medical resource utilization. Methods: Asthma patients (age 18–50 years) were consecutively recruited in 348 dispensing pharmacies. They completed a questionnaire which collected data on personal characteristics, asthma management, including medical resource utilization, including asthma management. Asthma control was measured with the Asthma Control Test. Data from computerized pharmacy records of medications, dispensed before inclusion, were also collected. Results: In 1791 eligible patients, 1559 accepted to participate in the study (mean age = 36.5, 56.1% of females). During the previous 4 weeks, the asthma control was satisfactory for only 28% of the patients, despite extensive provision of anti-inflammatory asthma control treatments (89%). Combinations of long acting beta agonists (LABA) and inhaled corticosteroids (ICS) were commonly used (59%), while fewer patients received LABA and ICS as two separate medications (15%). In addition, short-acting beta agonists, were frequently dispensed (71%). A substantial number of patients consulted their GPs on a monthly basis. Patients commonly reported daily shortness of breath (30%), daily use of rescue medication (29%) and weekly nocturnal symptoms (32%). Surprisingly, most patients considered their asthma as completely or well controlled (76%). Conclusions: Our results clearly identify a need to improve the management of asthma. Education programmes would be beneficial to improve asthma control.
- Published
- 2005
- Full Text
- View/download PDF
4. Use of margarine enriched in phytosterols by patients at high cardiovascular risk and treated by hypolipidemic drugs
- Author
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Philippe Moulin, Marie-Sophie Schwalm, Laurent Laforest, Eric Van Ganse, Philippe Le Jeunne, J. Massol, Brice Kitio, S. Chretin, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Régulations métaboliques, nutrition et diabètes (RMND), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), UFR de Médecine, Université de Franche-Comté (UFC), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Population ,Cardiovascular risk factors ,Medicine (miscellaneous) ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Age Distribution ,Risk Factors ,Internal medicine ,Odds Ratio ,Confidence Intervals ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Sex Distribution ,education ,Aged ,Retrospective Studies ,Hypolipidemic Agents ,Secondary prevention ,education.field_of_study ,Nutrition and Dietetics ,business.industry ,Prevention ,Phytosterol-enriched margarines ,Phytosterols ,Middle Aged ,Fortified ,medicine.disease ,Margarine ,3. Good health ,Dyslipidemia ,Cardiovascular Diseases ,Food ,Baseline characteristics ,Food, Fortified ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Cardiology and Cardiovascular Medicine ,business ,Hypolipidemic Drugs - Abstract
International audience; BACKGROUND AND AIMS: The use of phytosterol-enriched margarines (PEM) in patients at cardiovascular risk has not been thoroughly explored. We determined the proportion of users of PEM in a population at high cardiovascular risk, and their characteristics. In addition, the correlates of using at least 25 g/d of PEM were identified. METHODS AND RESULTS: Patients with at least two cardiovascular risk factors in addition to dyslipidemia (primary prevention) or with past cardiovascular disease (secondary prevention) were recruited by general practitioners (GPs). Baseline characteristics were collected from a computerized GP database linked to a survey. GPs recorded patterns of PEM use. First, users were compared with non-users. Then, analyses were conducted to identify characteristics of patients using PEM at a recommended dose (\\textgreateror=25 g/d). Among 1631 patients with documented consumption, a minority used PEM (15.2%), and only 36.4% of consumers used it at recommended level. Overall, PEM users did not differ from non-users as to general characteristics, nor as to the level of cardiovascular risk in primary prevention. However, PEM users reported significantly more cardiovascular events among their parents (OR=1.4; 95% CI=[1.0-1.9]). Consumers who used at least 25 g/d of PEM were more likely to be men (OR=3.1; 95% CI=[1.6-5.8]), to be aged 60-74 (OR=3.0; 95% CI=[1.4-6.4]), or 75 or older (OR=4.0; 95% CI=[1.5-10.6]). Again, no difference was observed regarding the level of cardiovascular risk. CONCLUSIONS: The level of use of PEM was low in this population of high cardiovascular risk patients. In addition, only a third of users consumed margarine at the recommended level. Our data suggest that pattern of use of PEM is not related to the level of cardiovascular risk.
- Published
- 2007
- Full Text
- View/download PDF
5. Primary care physicians' behaviors towards risk of iatrogenesis in elderly patients
- Author
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Bruno Fantino, Laurent Laforest, S. Chretin, Nicolas Voirin, Francoise Fantino, Eric Van Ganse, Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Male ,medicine.medical_specialty ,[SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT] ,Attitude of Health Personnel ,media_common.quotation_subject ,education ,Iatrogenic Disease ,Primary care ,030226 pharmacology & pharmacy ,Drug Prescriptions ,Iatrogenesis ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Risk Factors ,Surveys and Questionnaires ,Epidemiology ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Medical prescription ,Risk factor ,Practice Patterns, Physicians' ,media_common ,Aged ,Pharmacology ,Aged, 80 and over ,business.industry ,Physicians, Family ,General Medicine ,Middle Aged ,medicine.disease ,3. Good health ,Family medicine ,Global Positioning System ,Observational study ,Female ,Disease Susceptibility ,business ,Autonomy - Abstract
Iatrogenesis is common in elderly patients. This phenomenon could be reduced by improving awareness of general practitioners (GPs). We studied GPs’ prescribing behavior to elderly patients, to identify GP and patient characteristics related to cautious prescribing behaviors. The observational study sampled 106 GPs who had consecutively recruited, on average, 12 patients over 75 years of age. GPs completed a questionnaire on their practice and a questionnaire for each patient they recruited, describing their usual care of elderly patients, and criteria for prescribing therapy. GPs’ behaviors were studied with five scores and a global prescribing behavior (adequate/inadequate). The relationship between patients’ risk of iatrogenesis and GPs’ behaviors was studied with hierarchical logistic models. A total of 106 GPs recruited 1,318 patients (mean age 80.7 years, 36% males). A wide variety of behaviors was observed among GPs. Only 40% of GPs had specific prevention-oriented visits, while only 19.2% considered that prevention was optimally implemented in their practice. On average, GPs had behaviors considered adequate in about half of encounters. GPs’ global behaviors were more likely to be adequate for patients at higher risk (OR=1.47, 95%CI: 1.10–1.95). Likewise, before prescribing to patients at higher risk of iatrogenesis, GPs were more likely to collect data on financial autonomy, on clinical/biological data, and to adopt good prescription practices, while less attention was paid to patients’ physical and psychological autonomy. GPs tended to be more cautious when prescribing to patients at higher iatrogenesis risk. However, overall prescribing behaviors were not optimal. Efforts are needed to improve the quality of care in elderly patients.
- Published
- 2005
6. Long-term achievement of the therapeutic objectives of lipid-lowering agents in primary prevention patients and cardiovascular outcomes: an observational study
- Author
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P. Le Jeunne, Philippe Moulin, L. Laforest, E. Van Ganse, Donald Yin, M Bertrand, Evo Alemao, S. Chretin, T. Souchet, and G. de Pouvourville
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Observation ,Angina ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Myocardial infarction ,Risk factor ,Stroke ,Aged ,Dyslipidemias ,Hypolipidemic Agents ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Cholesterol, LDL ,Middle Aged ,medicine.disease ,Surgery ,Primary Prevention ,Treatment Outcome ,Cardiovascular Diseases ,Heart failure ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia ,Follow-Up Studies - Abstract
Aims Lowering elevated cholesterol levels reduces cardiovascular (CV) morbidity and mortality. Nonetheless, most patients treated with lipid-lowering agents (LLA) do not reach recommended therapeutic objectives. In a setting of primary care in France, we investigated the association between LDL-cholesterol goal attainment and the occurrence of CV events in primary prevention patients with multiple CV risk factors (≥3). According to national guidelines, the therapeutic objective (TO) for such patients is an LDL-cholesterol value below 130mg/dL. Methods 579 patients treated with LLA and with LDL-cholesterol values documented at least once a year over a period of at least 3 years (2000–2002) were allocated to three groups based on the number of years the TO was attained during the follow-up period: in all 3 years (TO+++: n =145), only part of the time (TO intermediate: n =256), and never (TO−−−: n =178). CV events (angina pectoris, myocardial infarction, heart failure, stroke, peripheral artery disease) occurring during the last year of observation (2002) were retrospectively collected. The occurrence risk (OR) of CV events was assessed based on TO status, with a logistic regression model to adjust for baseline differences in CV risk factors. Results Only a quarter of patients attained TO during all 3 study years. CV events during the third year of observation occurred in 5.5%, 10.5% and 12.9% of patients in the TO+++, TO intermediate and TO−−− groups, respectively. Compared with TO+++ patients, the risk of CV events increased significantly in TO intermediate (OR=2.34, 95% CI=[1.01–5.39]) and TO −−− patients (OR=2.99, 95% CI=[1.26–7.08]). Conclusion In real practice, a prolonged attainment of TO is rarely observed in high CV risk patients treated with LLA as primary prevention. Therapeutic failure is related to an increased incidence of cardiovascular morbidity. Our data strongly support the need to improve adherence to treatment guidelines to achieve effective cardiovascular prevention.
- Published
- 2004
7. P127 Prevalence and Incidence of Idiopathic Pulmonary Fibrosis in UK Healthcare Databases, GPRD and THIN; The Need For an IPF Registry
- Author
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R Cameron, F Bugnard, C Giot, Paula L Thompson, WC Maier, I Kausar, Christopher Hill, S Chretin, and M Fisher
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Database ,business.industry ,Public health ,Incidence (epidemiology) ,Prevalence ,Interstitial lung disease ,Disease ,respiratory system ,computer.software_genre ,medicine.disease ,respiratory tract diseases ,Idiopathic pulmonary fibrosis ,Epidemiology ,medicine ,Medical diagnosis ,business ,computer - Abstract
Background Idiopathic Pulmonary Fibrosis (IPF) is a fatal respiratory illness with limited treatment options. We previously estimated the UK prevalence of IPF using The Health Improvement Network (THIN) data. We have now further investigated this using General Practise Research Database (GPRD) data. Aims Calculate the prevalence and incidence of IPF diagnoses in the GPRD in 2010. Calculate the prevalence of IPF diagnoses in the GPRD in 2007, to compare to the THIN 2007 findings. Build a matrix of epidemiological data, to better target future public health resources. Methods Descriptive cross-sectional study, using UK GPRD data to calculate the prevalence and incidence of IPF diagnoses in 2010. Patients with a Read/OXMIS code corresponding to IPF diagnosis were identified; H563.00 Idiopathic Fibrosing Alveolitis (IFA), H563z00 Idiopathic Fibrosing Alveolitis NOS (IFA NOS), H563.12 Cryptogenic Fibrosing Alveolitis (CFA), H563100 Diffuse Pulmonary Fibrosis (DPF). To investigate coding variability, IPF diagnoses were classified as broad (all codes), narrow (IFA/IFA NOS) and IFA+CFA Patients with a first record of IPF during 2010 were classed as incident. Patients with a first record of IPF prior to or during 2010 were classed as prevalent. Results In 2010 in the GPRD, IPF was most commonly diagnosed in males (56.5%) and ≥65 year olds (80.8%). Most IPF was coded as DPF (prevalence: 39.4 [37.6–41.3] per 100,000 persons; incidence: 9.6 [8.8–10.6] per 100,000 person-years). For the broad definition, IPF prevalence was 50.7 (48.6–52.8) per 100,000 persons, with an incidence of 11.0 (10.1–12.0) per 100,000 person-years. For the narrow definition, IPF prevalence was 10.1 (9.2–11.1) per 100,000 persons, with an incidence of 1.5 (1.1–1.9) per 100,000 person-years. For the IFA+CFA definition, IPF prevalence was 13.3 (12.3–14.4) per 100,000 persons, with an incidence of 1.6 (1.3–2.0) per 100,000 person-years. In 2007, compared to THIN, the GPRD IPF point prevalence was lower in both males and females, for all diagnosis definitions (Figure 1). Conclusions IPF rates differ amongst UK healthcare databases; this may be due to GP coding variability, which is an inherent limitation of database studies. A prospective IPF registry is essential to characterise this orphan disease, to better target future public health resources.
- Published
- 2012
- Full Text
- View/download PDF
8. PCV106 THE MISSING PIECE BETWEEN TREATMENT EXPERIENCE AND INTENTION TO PERSIST:TESTING THE INTERNAL CONSISTENCY RELIABILITY AND PREDICTIVE VALIDITY OF ACCEPTABILITY
- Author
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M Viala-Danten, Donald L. Patrick, J Longin, S. Chretin, E. Van Ganse, and Benoit Arnould
- Subjects
Predictive validity ,Computer science ,Health Policy ,Internal consistency ,Concurrent validity ,Public Health, Environmental and Occupational Health ,Criterion validity ,Validity ,Test validity ,Incremental validity ,Reliability (statistics) ,Reliability engineering - Published
- 2010
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9. Analyse de l’impact de l’utilisation prolongée d’un programme d’autogestion sur le suivi d’une cohorte de patients asthmatiques
- Author
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Nathalie Freymond, S. Chretin, Yves Pacheco, E. Van Ganse, A. Cazaux, L. Kiakouama, L. Laforest, G. Devouassoux, and T. Vitry
- Subjects
Pulmonary and Respiratory Medicine - Published
- 2006
- Full Text
- View/download PDF
10. CV2 CHOLESTEROL ATTAINMENT IN DYSLIPIDAEMIC TREATED PATIENTS AND INCIDENCE OF CARDIOVASCULAR EVENTS IN CLINICAL PRACTICE
- Author
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Donald Yin, M Bertrand, L. Laforest, Philippe Moulin, P. Le Jeunne, E. Van Ganse, Evo Alemao, S. Chretin, T. Souchet, and G. de Pouvourville
- Subjects
Clinical Practice ,chemistry.chemical_compound ,Pediatrics ,medicine.medical_specialty ,chemistry ,Cholesterol ,business.industry ,Health Policy ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,Medicine ,business - Published
- 2004
- Full Text
- View/download PDF
11. Accept® Questionnaire: Relation Between Acceptance And Compliance In Liver- And Kidney-Transplanted Patients Converted To Once-Daily Tacrolimus.
- Author
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Bourhis Y, Chretin S, Cantarovich D, Gilet H, Bugnard F, and Arnould B
- Published
- 2014
- Full Text
- View/download PDF
12. Use of margarine enriched in phytosterols by patients at high cardiovascular risk and treated by hypolipidemic drugs.
- Author
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Laforest L, Moulin P, Schwalm MS, Le Jeunne P, Chretin S, Kitio B, Massol J, and Van Ganse E
- Subjects
- Age Distribution, Aged, Confidence Intervals, Female, Humans, Hypolipidemic Agents therapeutic use, Male, Middle Aged, Odds Ratio, Phytosterols therapeutic use, Retrospective Studies, Risk Factors, Sex Distribution, Cardiovascular Diseases prevention & control, Food, Fortified, Hypolipidemic Agents administration & dosage, Margarine, Phytosterols administration & dosage
- Abstract
Background and Aims: The use of phytosterol-enriched margarines (PEM) in patients at cardiovascular risk has not been thoroughly explored. We determined the proportion of users of PEM in a population at high cardiovascular risk, and their characteristics. In addition, the correlates of using at least 25 g/d of PEM were identified., Methods and Results: Patients with at least two cardiovascular risk factors in addition to dyslipidemia (primary prevention) or with past cardiovascular disease (secondary prevention) were recruited by general practitioners (GPs). Baseline characteristics were collected from a computerized GP database linked to a survey. GPs recorded patterns of PEM use. First, users were compared with non-users. Then, analyses were conducted to identify characteristics of patients using PEM at a recommended dose (>or=25 g/d). Among 1631 patients with documented consumption, a minority used PEM (15.2%), and only 36.4% of consumers used it at recommended level. Overall, PEM users did not differ from non-users as to general characteristics, nor as to the level of cardiovascular risk in primary prevention. However, PEM users reported significantly more cardiovascular events among their parents (OR=1.4; 95% CI=[1.0-1.9]). Consumers who used at least 25 g/d of PEM were more likely to be men (OR=3.1; 95% CI=[1.6-5.8]), to be aged 60-74 (OR=3.0; 95% CI=[1.4-6.4]), or 75 or older (OR=4.0; 95% CI=[1.5-10.6]). Again, no difference was observed regarding the level of cardiovascular risk., Conclusions: The level of use of PEM was low in this population of high cardiovascular risk patients. In addition, only a third of users consumed margarine at the recommended level. Our data suggest that pattern of use of PEM is not related to the level of cardiovascular risk.
- Published
- 2007
- Full Text
- View/download PDF
13. Primary care physicians' behaviors towards risk of iatrogenesis in elderly patients.
- Author
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Fantino B, Voirin N, Laforest L, Fantino F, Chretin S, and Van Ganse E
- Subjects
- Aged, Aged, 80 and over, Drug Prescriptions, Female, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires, Attitude of Health Personnel, Disease Susceptibility, Iatrogenic Disease, Physicians, Family psychology, Practice Patterns, Physicians'
- Abstract
Objectives: Iatrogenesis is common in elderly patients. This phenomenon could be reduced by improving awareness of general practitioners (GPs). We studied GPs' prescribing behavior to elderly patients, to identify GP and patient characteristics related to cautious prescribing behaviors., Methods: The observational study sampled 106 GPs who had consecutively recruited, on average, 12 patients over 75 years of age. GPs completed a questionnaire on their practice and a questionnaire for each patient they recruited, describing their usual care of elderly patients, and criteria for prescribing therapy. GPs' behaviors were studied with five scores and a global prescribing behavior (adequate/inadequate). The relationship between patients' risk of iatrogenesis and GPs' behaviors was studied with hierarchical logistic models., Results: A total of 106 GPs recruited 1,318 patients (mean age 80.7 years, 36% males). A wide variety of behaviors was observed among GPs. Only 40% of GPs had specific prevention-oriented visits, while only 19.2% considered that prevention was optimally implemented in their practice. On average, GPs had behaviors considered adequate in about half of encounters. GPs' global behaviors were more likely to be adequate for patients at higher risk (OR=1.47, 95%CI: 1.10-1.95). Likewise, before prescribing to patients at higher risk of iatrogenesis, GPs were more likely to collect data on financial autonomy, on clinical/biological data, and to adopt good prescription practices, while less attention was paid to patients' physical and psychological autonomy., Conclusions: GPs tended to be more cautious when prescribing to patients at higher iatrogenesis risk. However, overall prescribing behaviors were not optimal. Efforts are needed to improve the quality of care in elderly patients.
- Published
- 2006
- Full Text
- View/download PDF
14. Influence of patients' characteristics and disease management on asthma control.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Bousquet J, Chretin S, Bauguil G, Pacheco Y, and Chamba G
- Subjects
- Adolescent, Adult, Anti-Asthmatic Agents therapeutic use, Asthma physiopathology, Drug Therapy, Combination, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Observer Variation, Regression Analysis, Retrospective Studies, Sex Factors, Smoking adverse effects, Asthma drug therapy, Asthma prevention & control, Disease Management
- Abstract
Background: Although asthma control is a major outcome in disease management, little is known about its determinants., Objectives: We sought to study the relationships between asthma control and patient characteristics or asthma management., Methods: Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis., Results: The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m2 were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting beta-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96)., Conclusion: Asthma control varied according to both the patients' characteristics and therapy., Clinical Implications: Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.
- Published
- 2006
- Full Text
- View/download PDF
15. Long-term achievement of the therapeutic objectives of lipid-lowering agents in primary prevention patients and cardiovascular outcomes: an observational study.
- Author
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Van Ganse E, Souchet T, Laforest L, Moulin P, Bertrand M, Le Jeunne P, Chretin S, Yin D, Alemao E, and de Pouvourville G
- Subjects
- Aged, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology, Cholesterol, LDL blood, Dyslipidemias blood, Dyslipidemias complications, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Observation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Cardiovascular Diseases prevention & control, Dyslipidemias drug therapy, Hypolipidemic Agents therapeutic use, Primary Prevention
- Abstract
Aims: Lowering elevated cholesterol levels reduces cardiovascular (CV) morbidity and mortality. Nonetheless, most patients treated with lipid-lowering agents (LLA) do not reach recommended therapeutic objectives. In a setting of primary care in France, we investigated the association between LDL-cholesterol goal attainment and the occurrence of CV events in primary prevention patients with multiple CV risk factors (> or = 3). According to national guidelines, the therapeutic objective (TO) for such patients is an LDL-cholesterol value below 130 mg/dL., Methods: 579 patients treated with LLA and with LDL-cholesterol values documented at least once a year over a period of at least 3 years (2000-2002) were allocated to three groups based on the number of years the TO was attained during the follow-up period: in all 3 years (TO+++: n=145), only part of the time (TO intermediate: n=256), and never (TO---: n=178). CV events (angina pectoris, myocardial infarction, heart failure, stroke, peripheral artery disease) occurring during the last year of observation (2002) were retrospectively collected. The occurrence risk (OR) of CV events was assessed based on TO status, with a logistic regression model to adjust for baseline differences in CV risk factors., Results: Only a quarter of patients attained TO during all 3 study years. CV events during the third year of observation occurred in 5.5%, 10.5% and 12.9% of patients in the TO+++, TO intermediate and TO--- groups, respectively. Compared with TO+++ patients, the risk of CV events increased significantly in TO intermediate (OR=2.34, 95% CI=[1.01-5.39]) and TO--- patients (OR=2.99, 95% CI=[1.26-7.08])., Conclusion: In real practice, a prolonged attainment of TO is rarely observed in high CV risk patients treated with LLA as primary prevention. Therapeutic failure is related to an increased incidence of cardiovascular morbidity. Our data strongly support the need to improve adherence to treatment guidelines to achieve effective cardiovascular prevention.
- Published
- 2006
- Full Text
- View/download PDF
16. Management of asthma in patients supervised by primary care physicians or by specialists.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Chretin S, Osman L, Bauguil G, Pacheco Y, and Chamba G
- Subjects
- Adult, Asthma physiopathology, Female, France, Humans, Male, Primary Health Care, Respiratory Function Tests, Retrospective Studies, Surveys and Questionnaires, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Medicine, Physicians, Family, Practice Patterns, Physicians' statistics & numerical data, Specialization
- Abstract
French asthma patients may be supervised by general practitioners (GPs) and/or specialists. Therefore, this study examined asthma management in patients exclusively supervised by specialists (SPE), GPs, (GP) and both (GP+SPE group), and compared the findings. Asthma patients were consecutively recruited in 348 pharmacies. Each patient completed a questionnaire providing data on personal characteristics, asthma management, perception of disease and asthma supervision. Asthma control was measured using the Asthma Control Test. Questionnaires were linked to computerised records of medications which had been dispensed before inclusion in the study. From the 1,256 patients (mean age = 36.1 yrs, 54.3% females), 11.4, 36.6, and 52.0% were placed in the SPE, GP, and GP+SPE groups, respectively. During the previous 4 weeks, most patients in the SPE group were properly controlled (52.2 versus 26.4 and 21.5% in GP and GP+SPE groups, respectively). The SPE group made more use of fixed combinations of long-acting beta agonist and inhaled corticosteroid, while receiving less short-acting beta agonists, antitussives and antibiotics. Striking differences in symptoms and asthma management were observed according to the type of asthma supervision. The current results strongly support the need to improve the management of asthma in primary care, and the coordination of care between general practitioners and specialists.
- Published
- 2006
- Full Text
- View/download PDF
17. Quality of asthma care: results from a community pharmacy based survey.
- Author
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Laforest L, Van Ganse E, Devouassoux G, Chretin S, Bauguil G, Pacheco Y, and Chamba G
- Subjects
- Adolescent, Adult, Anti-Asthmatic Agents administration & dosage, Anti-Asthmatic Agents therapeutic use, Asthma prevention & control, Delivery of Health Care statistics & numerical data, Female, France epidemiology, Humans, Male, Middle Aged, Surveys and Questionnaires, Asthma drug therapy, Asthma epidemiology, Health Care Surveys, Pharmacies
- Abstract
Background: Optimal control is a major objective of disease management of asthma. The aim of the present study was to provide descriptive data on disease management in asthma patients, including medical resource utilization., Methods: Asthma patients (age 18-50 years) were consecutively recruited in 348 dispensing pharmacies. They completed a questionnaire which collected data on personal characteristics, asthma management, including medical resource utilization, including asthma management. Asthma control was measured with the Asthma Control Test. Data from computerized pharmacy records of medications, dispensed before inclusion, were also collected., Results: In 1791 eligible patients, 1559 accepted to participate in the study (mean age = 36.5, 56.1% of females). During the previous 4 weeks, the asthma control was satisfactory for only 28% of the patients, despite extensive provision of anti-inflammatory asthma control treatments (89%). Combinations of long acting beta agonists (LABA) and inhaled corticosteroids (ICS) were commonly used (59%), while fewer patients received LABA and ICS as two separate medications (15%). In addition, short-acting beta agonists, were frequently dispensed (71%). A substantial number of patients consulted their GPs on a monthly basis. Patients commonly reported daily shortness of breath (30%), daily use of rescue medication (29%) and weekly nocturnal symptoms (32%). Surprisingly, most patients considered their asthma as completely or well controlled (76%)., Conclusions: Our results clearly identify a need to improve the management of asthma. Education programmes would be beneficial to improve asthma control.
- Published
- 2005
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