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Thevenet V, Lesaine E, Domecq S, Miganeh-Hadi S, Maugeais M, Rouanet F, Sibon I, Saillour-Glenisson F. Alert on elongated in-hospital acute stroke management delays. An Aquitain cohort study. Rev Neurol (Paris) 2022; 179:368-372. [PMID: 36336489 DOI: 10.1016/j.neurol.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/28/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
The objectives were to analyze changes from 2012 to 2017 in different management times of stroke patients included in the Aquitaine stroke Observatory (ObA2). The studied times (onset-to-needle time-ONT, onset-to-door time-ODT, door-to-imaging time-DIT, door-to-needle time-DNT and imaging-to-needle time-INT) were described as median, interquartile ranges and proportion of patients within the recommended median time goals (ODT under 4hours, DIT within 20min; for thrombolyzed patients, DIT under 20min and a ONT under 4:30) to be compared with an objective of 50% of patients within said time goal. Globally, ODT was 160min, with 43.6% to 59.6% of patients within the ODT goal along the study period. With no improvement over time, the proportion of patients within the DIT goal stayed stable and at a low level (range: 5.5-7.0%) for all patients, decreasing from 25.2% to 11.4% for thrombolyzed patients. The proportion of thrombolyzed patients within the DNT goal varied from 15.1% to 30.3% during study period. These results highlight the urgent need for action to improve in-hospital management of stroke patients, focusing on delays between admission and imaging.
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Affiliation(s)
- V Thevenet
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France.
| | - E Lesaine
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France
| | - S Domecq
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France
| | - S Miganeh-Hadi
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France
| | - M Maugeais
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France
| | - F Rouanet
- Stroke Unit, Bordeaux University Hospital Neurology, Bordeaux, France
| | - I Sibon
- Stroke Unit, Bordeaux University Hospital Neurology, Bordeaux, France; INCIA CNRS UMR 5287, University of Bordeaux, Bordeaux, France
| | - F Saillour-Glenisson
- Centre Inserm U1219-Bordeaux Population Health, ISPED, University of Bordeaux, 33000 Bordeaux, France; Pôle de santé publique, CIC-EC 14-01, Bordeaux University Hospital, 33000 Bordeaux, France
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Salmi R, Roberts T, Cueille S, Thiessard F, Saillour-Glenisson F, EVA-TSN G. Évaluation des cinq programmes " Territoire de soins numériques " pour améliorer la coordination des soins de santé et des services sociaux, France. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lesaine E, Belhamri NM, Legrand JP, Domecq S, Coste P, Lacroix A, Saillour-Glenisson F. [Linking Interventional Cardiology clinical registry data with French hospital administrative data: Development and validation of deterministic record linkage]. Rev Epidemiol Sante Publique 2021; 69:78-87. [PMID: 33707007 DOI: 10.1016/j.respe.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To recreate the in-hospital healthcare pathway for patients treated with coronary angiography or percutaneous coronary intervention, we linked the interventional cardiology registry (ACIRA) and the pseudonymized French hospital medical information system database (PMSI) in the Aquitaine region. The objective of this study was to develop and validate a deterministic merging algorithm between these exhaustive and complementary databases. METHODS After a pre-treatment phase of the databases to standardize the 11 identified linking variables, a deterministic linking algorithm was developed on ACIRA hospital stays between December 2011 and December 2014 in nine interventional cardiology centers as well as the data from the consolidated PMSI databases of the Aquitaine region from 2011 to 2014. Merging was carried out through 12 successive steps, the first consisting in strict linking of the 11 variables. The performance of the algorithm was analyzed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Strategies complementary to the initial algorithm (change in the order of variables and base preprocessing) were tested. Comparative analysis of merged/unmerged patients explored potential causes of mismatch. RESULTS The algorithm found 97.2% of the 31,621 ACIRA stays to have sensitivity of 99.9% (95% CI [99.9; 99.9]), specificity of 97.9% (95% CI [97.7; 98.1]), PPV of 99.9% (95% CI [99.9; 99.9]) and NPV of 96.9% (95% CI [96.7; 97.1]). Complementary strategies did not yield better results. The unmerged patients were older, and hospitalized mostly in 2012 in two interventional cardiology centers. CONCLUSION This study underscored the feasibility and validity of an indirect deterministic pairing to routinely link a registry of practices using hospital data to pseudonymized medico-administrative databases. This method, which can be extrapolated to other health events leading to hospitalization, renders it possible to effectively reconstruct patients' hospital healthcare pathway.
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Affiliation(s)
- E Lesaine
- University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France.
| | - N-M Belhamri
- University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France
| | - J-P Legrand
- University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France
| | - S Domecq
- University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France
| | - P Coste
- CHU de Bordeaux Hôpital Cardiologique, Coronary Care Unit, 33600 Pessac, France; University Bordeaux, Collège sciences de la santé, Cardiology Bordeaux, Aquitaine, 33000 Bordeaux, France
| | - A Lacroix
- Agence régionale de santé Nouvelle-Aquitaine, Direction du pilotage de la stratégie et des parcours, 33000 Bordeaux, France
| | - F Saillour-Glenisson
- University Bordeaux, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France; Service d'information médicale, CHU de Bordeaux, pôle de santé publique, 33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, 33000 Bordeaux, France
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Cetran L, Lesaine E, Miganeh-Hadi S, Sevin F, Saillour-Glenisson F, Pradeau C, Coste P. Socioeconomic status influences delays in the management of acute ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A prompt diagnosis to initiate the appropriate reperfusion therapy is crucial to improve clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients. Socio-economic status (SES) refers to parameters like income, educational status and occupation. A low SES negatively interferes with the prognosis of STEMI patients. However, the impact of SES on delay time in acute STEMI remains matter of debate.
Methods
We used databases from two French multicentric and prospective registries: ACIRA (patients undergoing coronary angiography in any catheterization laboratories of Aquitaine) and REANIM (acute STEMI patients supported by emergency medical system (EMS) in Aquitaine). An ecological indicator of social deprivation Fdep09 was calculated to describe geographical inequalities in health based on municipality of residence. The higher the value, the more disadvantaged the population. Low SES was defined as Fdep09 > median value.
Results
Two-thousand-eight-hundred-and-forty consecutive patients with acute STEMI undergoing coronary angiography from January 2017 to December 2018 in Aquitaine were included. Patients with lower SES were more often initially referred to emergency departments of non-percutaneous coronary intervention capable centers whereas patients with higher SES were more often directly transferred to PCI centers by the mobile emergency care units as recommended by the most recent European guidelines (p<10–4). Patients with low SES had longer delays from symptom onset to first medical contact (FMC) (116 [60–119] vs 98 [55–233] min, p=0.0078) and were more likely to receive fibrinolysis (9.9 vs 5.2%, p<10–4). Linear regression modeling showed that each point of the Fdep09 index was associated with increase in the delay from symptom onset to FMC by a factor 1.1 (95% CI: 1.04–1.17, p<10–3) after adjusting for potential confounders.
Conclusion
SES inequality has negative influence on the delays in the management of acute STEMI patients. Efforts to raise awareness of suspicious signs of acute MI among individuals in lower SES could be valuable.
FDep09 distribution
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ARS Nouvelle-Aquitaine
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Affiliation(s)
- L Cetran
- Hospital Haut Leveque, Cardiac Intensive Care Unit, Bordeaux, France
| | - E Lesaine
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | - S Miganeh-Hadi
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | - F Sevin
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | | | - C Pradeau
- Pellegrin Hospital Group - University Hospital Centre, Bordeaux, France
| | - P Coste
- Hospital Haut Leveque, Cardiac Intensive Care Unit, Bordeaux, France
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Sevin F, Gilbert F, Domecq S, Jouson D, Lesaine E, Saillour-Glenisson F. Mise en place du système d’information régional de l’Observatoire des accidents vasculaires cérébraux en Nouvelle-Aquitaine (ObA2-NA). Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lahrach M, Sevin F, Domecq S, Lesaine E, Saillour-Glenisson F. Reconstruction des parcours de soins des patients victimes d’un accident vasculaire cérébral–Observatoire Aquitain des accidents vasculaires cérébraux (ObA2). Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sevin F, Legrand J, Perez C, Soudain G, Joulia S, Lesaine E, Saillour-Glenisson F. Méthodes de reconstruction des parcours de soins : exemple de l’infarctus du myocarde – Registres REANIM et ACIRA. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Domecq S, Saillour-Glenisson F, Lesaine E, Gilbert F, Maugeais M, Rouanet F. Description des délais de prise en charge des patients victimes d’un accident vasculaire cérébral entre l’apparition des symptômes et le traitement dans six établissements de santé aquitains entre 2012 et 2017. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lesaine E, Coste P, Kret M, Legrand JP, Perez C, Saillour-Glenisson F. Réhospitalisations à un an suivant un acte de coronarographie ou d’angioplastie coronaire en ex-Aquitaine. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lesaine E, Coste P, Kret M, Legrand JP, Perez C, Saillour-Glenisson F. Facteurs associés aux réhospitalisations précoces programmées pour un acte de coronarographie ou d’angioplastie coronaire en ex-Aquitaine. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lesaine E, Pradeau C, Daniel M, Sevin F, Perez C, Saillour-Glenisson F. Description des délais de prise en charge des patients victimes d’un syndrome coronarien aigu ST+, entre les symptômes et la reperfusion coronaire en 2017 - région ex-Aquitaine. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lahrach M, Sevin F, Domecq S, Lesaine E, Saillour-Glenisson F. Reconstruction des parcours de soins des patients victimes d’un accident vasculaire cérébral–Observatoire Aquitain des Accidents vasculaires cérébraux - ObA2. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Broussy S, Rouanet F, Lesaine E, Domecq S, Kret M, Maugeais M, Aly F, Dehail P, Bénard A, Wittwer J, Salamon R, Sibon I, Saillour-Glenisson F. Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: the PAPASePA protocol study. BMC Health Serv Res 2019; 19:770. [PMID: 31665006 PMCID: PMC6820977 DOI: 10.1186/s12913-019-4522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a health problem with serious consequences, both in terms of mortality, and after-effects affecting patient quality of life. Stroke requires both urgent and chronic management involving the entire health care system. Although large variability in the management of stroke patients have been noticed, knowledge of the diversity and the scalability of post-stroke pathways, whether it is the care pathway or the life pathway, is currently not sufficient. Moreover the link between post-stroke pathways and patients sequelae have not been yet clearly defined. All this information would be useful to better target the needs to improve stroke patient management. The purposes are to identify the post-stroke life pathways components associated with sequelae (activity limitations – main purpose, cognitive disorders, anxio-depressive disorders, fatigue, participation restrictions) at 3 months and 1 year post-stroke, to define a typology of life pathways of patients during the post-stroke year and to analyze the social and geographical inequalities in the management of stroke. Methods Design: a prospective multicenter comparative cohort study with a follow up to 1 year after the acute episode. Participant centers: 13 hospitals in the Aquitaine region (France). Study population: patients diagnosed with a confirmed ischemic or hemorrhagic stroke included in the Aquitaine Observatory of Stroke (ObA2) cohort and voluntary to participate. Data sources are existing databases (ObA2 database and the French National Health Data System - SNDS) to collect information about care pathways, patient characteristics and stroke characteristics and Ad hoc surveys to collect information about life pathways and post-stroke sequelae. The endpoints of the study are post-stroke activity limitations evaluated by the modified Rankin score, other post-stroke sequelae (Cognitive disorders, anxio-depressive disorders, fatigue, restriction of participation) assessed by standardized and validated scales and Clusters of patients responding to pathways with common or similar characteristics.; Discussion By integrating a longitudinal dimension and relying on a large cohort, the project will make it possible to identify the sources of disturbances and the factors favorable to the outcome of the life pathways, important for the planning of the offer and the management of the public policies concerning stroke pathways. Trial registration ClinicalTrials.gov ID: NCT03865173, March 6th, 2019.
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Affiliation(s)
- S Broussy
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France. .,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - F Rouanet
- Pôle des Neurosciences Cliniques (I.S., F.R.) CHU Bordeaux, Bordeaux, France
| | - E Lesaine
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - S Domecq
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - M Kret
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - M Maugeais
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - F Aly
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - P Dehail
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - A Bénard
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - J Wittwer
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - R Salamon
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - I Sibon
- Pôle des Neurosciences Cliniques (I.S., F.R.) CHU Bordeaux, Bordeaux, France.,Neurology, Stroke Unit, INCIA CNRS UMR 5287, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - F Saillour-Glenisson
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
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Lesaine E, Saillour-Glenisson F, Leymarie J, Jamet I, Fernandez L, Perez C, Legrand J, Salmi L, Coste P. The ACIRA registry: A tool to analyze the coronary intervention post-hospital pathway in the French Aquitaine region. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Broussy S, Lesaine E, Rouanet F, Maugeais M, Salamon R, Saillour-Glenisson F. Quantification des séquelles fonctionnelles chez les patients ayant présenté un accident vasculaire cérébral. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Legrand JP, Sevin F, Lesaine E, Pradeau C, Saillour-Glenisson F. Rapprochement des bases de données du Registre aquitain de prise en charge initiale des infarctus du myocarde (REANIM) et de celle de la régulation Samu. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lesaine E, Perez C, Legrand JP, Coste P, Benetier MP, Saillour-Glenisson F. Utilisation d’un registre de pratiques pour le développement professionnel continu, le registre ACIRA et les angioplasties. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Levache B, Sousselier B, Cany L, Maguire C, Saillour-Glenisson F, Fagnani F. 3053 Management of anaemia in oncology: use and efficacy of Darbepoetin alfa in CIA patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Trouve P, Puig PL, Savalli L, Laboute E, Saillour-Glenisson F. Bilan à un an d’un chemin clinique informatisé sur la rééducation des ligamentoplasties du croisé antérieur du genou. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Touzé E, Saillour-Glenisson F, Durieux P, Verdier A, Leyshon S, Bendavid S, Attard T, Scheimann A, Mas JL, Coste J. Lack of validity of a French adaptation of a scale measuring attitudes towards clinical practice guidelines. Int J Qual Health Care 2006; 18:195-202. [PMID: 16484314 DOI: 10.1093/intqhc/mzi104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Valid instruments to measure practitioners' attitudes towards clinical practice guidelines need to be developed. However, few of the available instruments have been thoroughly validated. OBJECTIVE To adapt into French and to test the reliability and validity of a scale for measurement of attitudes towards guidelines developed by Elovainio et al. METHODS A 27-item scale (divided into six dimensions) measuring attitudes towards guidelines was translated into French by two English native translators, reviewed and finalized by expert committee and administered to 314 practitioners who agreed to participate. Main practitioners' characteristics were collected. Item and dimension reproducibility were assessed for 62 practitioners by calculation of intraclass correlation coefficients. Internal construct validity was assessed by principal components analyses. Convergent and discriminant validity were analysed. RESULTS Item response rates ranged from 82 to 100%. In the test-retest procedure, intraclass correlation coefficients for separate items ranged from 0.1 to 0.7 and those for dimensions were 0.7 [95% confidence interval (CI): 0.5-0.8] for usefulness, 0.5 (0.3-0.6) for reliability, 0.4 (0.2-0.5) for individual competence, 0.5 (0.3-0.6) for organizational competence, 0.7 (0.5-0.8) for impracticality and 0.4 (0.3-0.6) for availability. The factorial structure after Varimax rotation showed that none of the different solutions obtained had a strictly comparable structure to that of the original scale. External construct validity was satisfactory. CONCLUSION This scale does not have satisfactory psychometric properties and therefore cannot confidently be used in future research assessing whether attitudes towards guidelines are a determining factor in physicians' compliance with guidelines. More research is needed to develop valid scales in a more rigorous procedure, involving qualitative and quantitative steps.
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Affiliation(s)
- E Touzé
- Medexact Company, Boulogne-Billancourt, France.
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Saillour-Glenisson F, Michel P. [Individual and collective facilitators of and barriers to the use of clinical practice guidelines by physicians: a literature review]. Rev Epidemiol Sante Publique 2003; 51:65-80. [PMID: 12684582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The effectiveness of Clinical Practice Guidelines (CPG) diffusion to physicians depends on local barriers or facilitators related to the CPG, to the individual clinician and the professional context. Our project aimed to retrieve, by a literature review, all the facilitators of and barriers to physician's adherence to CPG and propose a classification of these barriers and facilitators. METHOD A comprehensive review of the literature. We searched in Medline, Healthstar, Current contents, Cochrane library databases, consulted experts in the domain of CPG implementation and reviewed study bibliography to retrieve all original reports studying facilitators of and barriers to physician's adherence to CPG (inclusion criteria). The article selection followed a two stepped procedure: first, quick reading of the retrieved articles, then reading in depth of the potentially appropriate articles. RESULTS Fifty nine studies published between 1986 and 2001 were eligible. The majority (29 studies) used a quantitative design, having studied the statistical association between some a priori defined barriers or facilitators (collected by questionnaires or by record audits) and CPG use. The others have used a qualitative design (barriers and facilitators collected through qualitative methods or open-ended questions in questionnaires) (21 studies) or a mixed design (qualitative and quantitative) (8 studies). Study samples sizes ranked between 10 and 1878 physicians. The CPG were mostly about prevention or curative care. The retrieved barriers or facilitators were classified into three categories: 1) the CPG characteristics (form, compatibility, trialability, scientific basis, observability, adaptability, legal implications) (27 articles), 2) the physician characteristics (knowledge about CPG, attitude and agreement to CPG, psychological and socio-demographic and economic characteristics, job satisfaction, training) (38 articles), 3) the physician environment (divided into 3a the physician human environment--the patient influence and the pairs influence (16 articles)--and 3b the physician organizational environment--the internal environment and the external environment (33 articles). CONCLUSION The interpretation of the results is hampered by the absence of previous conceptual framework of the barriers or facilitators and by the absence of multifactorial analysis.
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Affiliation(s)
- F Saillour-Glenisson
- CCECQA-Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine, Hôpital Xavier-Arnozan, 33604 Pessac Cedex. florence.saillourccecqa.asso.fr
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