Analyse de la satisfaction des usagers du Samu 47 (Lot-et-Garonne) sur leur prise en charge dans le cadre de l’aide médicale urgente (AMU)

Objectif : Évaluer la satisfaction des usagers du Samu 47 à la suite de leur appel dans le cadre de l’aide médicale urgente.

Matériel et méthodes : Étude de cohorte observationnelle, monocentrique, prospective, menée entre le 25 août et le 13 septembre 2020 par un même opérateur, à partir d’un questionnaire téléphonique. Le critère de jugement principal était le niveau de satisfaction générale des requérants après leur appel. Les critères secondaires étaient le ressenti du délai de décroché ARM (assistant de régulation médicale) et médical, le niveau de satisfaction de la prise en charge ARM et médicale, le ressenti du délai d’arrivée des effecteurs envoyés, le niveau de satisfaction de leur prise en charge, la mise en application du conseil formulé par le médecin régulateur et la suggestion d’axes d’amélioration.

Résultats : Parmi les 596 requérants inclus, 419 (70 %) étaient « très satisfaits », 132 (22 %) « assez satisfaits », 25 (4 %) « peu satisfaits » et 20 (3 %) « pas du tout satisfaits ». Les analyses univariées montraient que cela était lié à l’entretien avec l’ARM et le médecin régulateur, à la prise en charge des secours, à certaines attentes, à la suite donnée à l’appel, au délai ressenti d’arrivée des secours et au délai ressenti de décroché. L’analyse multivariée révélait que les éléments liés à l’insatisfaction étaient l’attente « faire venir les secours » (RC : 5,71, IC 95 % : 2,56–13,01), le fait de recevoir un conseil à l’issue de l’appel (RC : 9,28, IC 95 % : 4,15–21,96) et le délai ressenti de décroché de l’appel jugé « long » (RC : 3,64, IC 95 % : 1,06–10,75).

Conclusion : Les usagers sont globalement satisfaits à la suite de leur appel au Samu 47.

[Assessing post-hospitalization therapeutic ranges in elderly patients treated for atrial fibrillation with vitamin k antagonists]

BACKGROUND

In France, anticoagulants are among the most recommended treatments for serious accidents, particularly among the elderly.

OBJECTIVES

The purpose of this study was to evaluate the impact of practical and validated tools designed to reduce the negative effects of vitamin K antagonist (VKA) treatments by assessing patients before and after the tools were implemented.

METHODS

An exhaustive before and after multi-centric cohort study was performed in the Agen territory. The follow-up period corresponded to the six-month period post-hospitalization. The principal criterion was the time in the therapeutic range (TTR) at values of 2 to 3 according to the Rosendaal method.

RESULTS

The overall time spent in the follow-up period before and after the implementation of the tools in 65- and 74-year-old patients was 58% and 64%, respectively (P=0.584). After the treatments, the TTR in the 85- to 90-year-old patients was 71.1%. An increase was observed in the number of subjects with a TTR≥70% after the implementation of the tools according to age, particularly in the 85- to 90-year-old patients (8 vs. 41; [P=0.01]). Prescription help software revealed a tendency of improvement in TTR values from 61% to 68% (P=0.472). In addition, longer therapeutic periods corresponded to longer patient lifespans (r=0.86).

CONCLUSION

This study demonstrates the feasibility and advantages of implementing tools to improve the efficacy of VKA treatment in primary care, particularly for patients from 85 to 90 years old. The results should promote the implementation of this type of treatment method at the national level.

[Adverse drug effects: a prospective study by Apnet performed in seven emergency care units in France: propositions for preventive measures]

Various studies have shown that adverse drug effects (ADEs) are a substantial cause of hospital admissions. However, little is known about the incidence and severity of ADEs resulting in hospital visits. To address this issue, we conducted a prospective survey in primary care and emergency departments of French public hospitals. This study was performed over two periods of one week, one in January, February and one in June 2003, in primary care and emergengy departments of four university hospitals and three general hospitals throughout France. Out of a total of 1826 patients consulting, 1663 were taking at least one drug during the previous week and were included for analysis according to the protocol. Altogether, 370 (22.2%; IC 95: 20.2-24.3%) of these patients receiving at least one drug consulted because of an ADE. From these 370 patients, 263 (15.8%) where considered as touched by a probably (12), likely (13) or very likely (14) ADE. The sex ratio was the same in both groups with or without ADE (0.88%; P=0.95). Patients with ADE were older than those without (62.4 vs 53.8 years, P=0.0016). Furthermore, ADE patients were more likely to have a higher severity score than no-ADE group (P=0.0003). The outcome seemed to be worse in patients with an ADE. The percentage of patients treated with 2 or more drugs and the number of drug exposures were significantly higher in patients with ADE than in those without (93.2% vs 84.2%, P<0.0001, and 5.8 vs 4.5 P<0.0001, respectively). The most frequent causes of visits for ADE-patients were digestive (n=38: 14.4%), neurological (n=23: 10.6%), malaise (n=48: 18,2%) events. The most frequently incriminated drug classes were (1) psychotropic agents, (including anxiolytics, hypnotics, antidepressants and antipsychotics), (2) diuretics (3) anticoagulants, (4) other cardiovascular drugs and (5) analgesics, including non steroidal anti-inflammatory agents. In 150 cases (40.8%; IC 95: 33.7% - 45%), the ADE was considered to be preventable because a contra-indication or a warning about drug use had not been respected.