État des lieux de la prescription de furosémide en médecine générale: enquête de pratique prospective en situation réelle auprès des médecins généralistes Maîtres de Stage des Universités de Bordeaux

Abstract : Introduction: furosemide is a loop diuretic frequently prescribed in city medicine. Despite high actual benefit, this molecule is known to have significant iatrogenic properties. Heart failure is one of the main indications of this drug, and remains a prevalent pathology, expensive, with significant mortality. Objective: to improve the knowledge of the prescription of furosemide and its management in city medicine. Material and method: this is a prospective descriptive practice survey in real life situation for interns in the Aquitaine region in ambulatory training from May to July 2017. Results: we obtained 119 questionnaires. Furosemide prescriptions are mainly prescription renewals without dose modification (68%) in rural areas, in polypathological and polydrug patients older than 80 years of age. The main indication retained is heart failure, progressive or stabilized. When furosemide is increased or introduced, an acute heart failure is usually the reason (58%). When its dosage is decreased or treatment stopped, the iatrogeny of the drug is responsible (67%). Iatrogeny is observed in almost half of the cases (40%) without necessarily a change in treatment. The main planned project is the continuation of treatment at the same dosage (57%). More than half of the consultations (60%) are not subject to therapeutic education. Conclusion: in our study, furosemide is indicated primarily in the management of heart failure, and concerns fragile patients in rural locations. Important iatrogeny is associated with it. Several elements are proposed to improve the prescription: the writing of new recommendations, the development of therapeutic education, the creation of online help tools to prescription.
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Master Thesis
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Pierre Lalanne. État des lieux de la prescription de furosémide en médecine générale: enquête de pratique prospective en situation réelle auprès des médecins généralistes Maîtres de Stage des Universités de Bordeaux. Médecine humaine et pathologie. 2019. ⟨dumas-02101511⟩

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