Date : 2012
Type : Livre / Book
Type : Thèse / ThesisLangue / Language : français / French
Syndrome métabolique -- Chimiothérapie
Médecins généralistes -- France -- Grenoble (Isère) -- Enquêtes
Psychiatres -- France -- Grenoble (Isère) -- Enquêtes
Classification Dewey : 610
Accès en ligne / online access
Résumé / Abstract : La prescription d’antipsychotiques atypiques (APA) est de plus en plus fréquente (plus d’indications, tolérance correcte). Les effets indésirables de type syndrome métabolique sont connus, avec la publication de recommandations pour le suivi cardio-vasculaires des patients sous APA par l’AFSSAPS en 2010. Nous avons voulu caractériser la collaboration entre médecins généralistes et psychiatres dans cette situation, évaluer le suivi de ces patients, la connaissance des recommandations, et enfin, élaborer des propositions. Nous avons envoyé un questionnaire aux médecins généralistes (MG) et aux psychiatres d’exercice ambulatoire à Grenoble (Pages Jaunes électroniques). Nous avons reçu 76 réponses : 28 psychiatres et 46 MG (244 médecins contactés). Nous avons contacté la caisse régionale d’assurance maladie (CRAM) de Lyon, qui nous a communiqué le nombre de prescriptions pour 4 APA le premier semestre 2011. Nos résultats confirment une collaboration non satisfaisante et en conséquence un suivi non optimal des patients. Les raisons invoquées sont : manque de temps, divergences d’opinion… Les solutions proposées sont souvent simples (téléphone, présentation à l’installation, réunions pluridisciplinaires…) et consistent en la mise en application de méthodes sous-exploitées. Il existe une différence majeure entre les résultats de nos questionnaires (prescriptions dites peu fréquentes d’APA) et ceux de la CRAM (volume de prescriptions important), et une différence significative sur la connaissance des recommandations entre MG (41%) et psychiatres (93%). Dans chaque spécialité apparait le besoin de travailler ensemble et la reconnaissance d’un apport mutuel.
Résumé / Abstract : The prescription of atypical antipsychotics (AAP) is becoming a more and more common habit, given the extension of the indication and the tolerance of the molecules. The arisen of side effects under atypical antipsychotics, and specifically the appearance of a metabolic syndrome is widely admitted today, leading the AFSSAPS to publish recommendations for the follow up of patients treated by AAP. Our objective was to do an inventory on the team work between general practitioners (GP) and psychiatrists in this specific situation, as well as an evaluation of the supervision of the patients treated by AAP; the knowledge of the recommendation by the doctors of these two specialties and to elaborate propositions to improve the collaboration. In order to accomplish this task, we have done a questionnaire intended to general practitioners and psychiatrists who practice in ambulatory in Grenoble (Data collected via the Yellow Pages). We have received 76 answers among the 244 contacted doctors (28 from the psychiatrist and 46 from the general practitioners) based on which we have done statistical analyses. Besides, we have contacted the CRAM of Lyon, who have provided us with the requested information in term of numbers of prescriptions for 4 AAP for the first half-year / semester of 2011. The most relevant results of our study confirm that, most of the time, the collaboration isn’t fully satisfactory between GPs and psychiatrists, which leads to a under-achievement medical supervision of the patients (even though it is well known by doctors that the metabolic side effect are very common). There is an important difference between the statements done by the GP in the questionnaire, who declare issuing fewer prescriptions than shown in the CRAM results. The solutions proposed are often simple and realistic, such as communication over the phone between GPs and psychiatrists, introducing ourselves at the time of settlement, multidisciplinary meetings… all of these mentioned solutions are methods that already exist but which are currently not used to their full potential. There is a significant difference between GPs (41%) and psychiatrists (93%) about the knowledge of the recommendations of AFSSAPS. In this two specialties, a real need of working together appears, as well as an acknowledge of the contribution of each one, who just request to set up. The called reasons were: the lack of time, the difference of opinion.