Évaluation des pratiques professionnelles relatives aux motifs de prescription du dosage de la troponine en médecine de ville

Abstract : The Acute Coronary Syndrom (ACS) is a pathology posing a major health issue. Moreover, diagnosing it isn’t always easy, troponin dosage remains the preferred exam ensuring a diagnosis. The publication of a recommendation by the French National Health Authority (HAS) regarding outpatient management of ACS suspicion only dates back to 2010. The prescription of troponin as a marker of myocardial necrosis is no longer recommended for outpatient care, the only exception being “the case where an asymptomatic patient presenting with chest pain that occurred more than 72 hours beforehand, suspected to have been an ACS without complications”. We have conducted a retrospective study evaluating professional practices regarding prescriptions of troponin dosage of 94 office-based general practitioners in or near Marseilles. Based on the results of this study: -Almost half of the doctors act as recommended by the HAS: 40% of the office-based practitioners, 85% of SASPAS medical interns and 65% of locum doctors. -Less than 10% of doctors prescribe a dosage following chest pains that occurred more than 72 h beforehand, three-quarters of them citing reasons such as “atypical chest pain”, the other quarter invoking “ACS suspicion”. -SASPAS medical interns and locum doctors rarely participate in continuous medical training, but are well-informed regarding the HAS recommendations., contrary to settled office-based practitioners who participate in a lot more training but are less informed regarding these recommendations. This study brought to light some situations where the prescription of troponin dosage wasn’t in accordance with current recommendations.
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https://dumas.ccsd.cnrs.fr/dumas-02047906
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Clément Panefieu. Évaluation des pratiques professionnelles relatives aux motifs de prescription du dosage de la troponine en médecine de ville. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02047906⟩

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