Étude EPATEMED : étude de la pratique de l’automesure tensionnelle en médecine générale, étude descriptive quantitative transversale en soins primaires en Gironde

Abstract : Introduction: hypertension (HTA) remains a real public health issue in France and remains insufficiently screened and controlled. The French and European recommendations concerning the management of hypertension now recommend taking ambulatory measures to confirm suspicion of hypertension, and for monitoring hypertensive patients. In 2013, the Social Security provided a blood pressure monitor to every general practitioner in order to promote the Home Blood Pressure Monitoring (HBPM). Material and method: EPATEMed is a quantitative cross-sectional descriptive study. A questionnaire was sent to all general practitioners in Gironde between January and April 2018. The primary endpoint was the frequency of use of Home Blood Pressure Monitoring before starting antihypertensive therapy. Results: 77.5% of doctors use the HBPM regularly or systematically; 22.4% of physicians report using the HBPM occasionally or never. The system put in place by the Health Insurance has changed the practice of 62 doctors (48%). The main interests in the use of HBPM are: screening for the white coat effect (20.5%), knowing the figures at home (15.2%), evaluating the effectiveness of the treatments (15.1 %) and have better measurement conditions (12.1%). Only 11 practitioners (7%) perform the AMT in all its indications (white coat, masked hypertension, follow-up). The main brake to the systematic non-use of the HBPM is the lack of tensiometer (44% of responses). The main limitations reported by physicians are: the patient's disability (37%), the risk of secondary anxiety (34%), only day-to-day measures (14%) and the cost to the patient (13%). For 40% of doctors, 3 devices would be needed to optimize the loan to patients. Discussion: this study highlights the improvement of the frequency of use of HBPM, compared to the data of the literature, but persists difficulties mainly related to tensiometers. The mechanism of the CNAM has had a positive impact. New proposals from the French Society of Arterial Hypertension have been issued recently: reimbursement of devices for patients on medical prescription and integrate the AMT in the ROSP, which could lead to progress in the control of hypertension in France.
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Master Thesis
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Lucile Jenck. Étude EPATEMED : étude de la pratique de l’automesure tensionnelle en médecine générale, étude descriptive quantitative transversale en soins primaires en Gironde. Médecine humaine et pathologie. 2018. ⟨dumas-02064358⟩

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