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Master Thesis

Inhibiteurs de la pompe à proton chez les sujets âgés, évaluation des pratiques professionnelles en médecine générale

Abstract : The Proton Pump Inhibitors (PPI) makes up an effective therapy very frequently. On long-term use basis, heavy and not well-known adverse side effects seem to occur, mainly in the elderly. This pharmacotherapeutic group is very expensive for the health insurance and frequently used in an inappropriate way. The HAS (French High Authority of Health) made a broadcast guidelines about good clinical practices in 2009. The main goal of our study was to analyze the professional practices and theirs modifications with the HAS guidelines. This prospective study was conducted in general practice with 75 years old patients and older. The questionnaires were allocated with reminders to 5 Doctors and without any recommendations to 5 other doctors, selected randomly. The questionnaire evaluated the conditions of PPI prescriptions, treatment associated to gastric risks and adverse side effects detected. The main assessment criterion was revealing a difference of prescription, between both groups of doctors, before (June 1st, 2012 to January 1st, 2013) and after implementation of the report (June 1st, 2013 to January 1st, 201). Number of prescription was collected from the CPAM (Caisse Primaire d'Assurance Maladie).Ten general practitioners (GP) fulfilled 236 questionnaires-patients : 97 questionnaires associated to the recommendations and 139 questionnaires without recommendations. There is no evidence for any decrease in PPI prescription numbers before and after our intervention (p=0,8). The analysis of these questionnaires confirmed a significant ratio of unsuitable prescriptions (68%). The treatment duration was too long (more than 2 years for the majority) and the dose was too high. It seems that a regular reminder of the recommendations would allow a better respect of the indications. This study suggests the need of guidelines more adapted for the GP and also the need of regular evaluation of the prescriptions. A wider use of the endoscopy would allow to check the necessity of this treatment and avoid the long term use. It is also necessary to wonder about the best cost-effectiveness ratio.
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Master Thesis
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Submitted on : Tuesday, July 8, 2014 - 11:55:41 AM
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  • HAL Id : dumas-01020591, version 1


Sarah Lafaye de Micheaux. Inhibiteurs de la pompe à proton chez les sujets âgés, évaluation des pratiques professionnelles en médecine générale. Médecine humaine et pathologie. 2014. ⟨dumas-01020591⟩



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