S. Savard-Chambard

Agence Régionale de Santé (ARS), Lutetia Parisorum, Île-de-France, France

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Publications (2)0.69 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background This study conducted in the region of Provence-Alpes-Côte d’Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA.Methods The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers’ Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence.ResultsIn January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers’ Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA.ConclusionOur results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.RésuméPosition du problèmeAfin d’évaluer la faisabilité de la construction et de l’utilisation d’indicateurs de prescriptions potentiellement inadaptées chez les personnes âgées à partir des données de remboursement de l’Assurance maladie, cette étude réalisée en région Provence-Alpes-Côte d’Azur (Paca) présente et discute différents indicateurs chez les personnes âgées de 70 ans ou plus (prescriptions à risque, coprescriptions dangereuses ou à risque, absence de coprescription nécessaire) et présente leur prévalence en région Paca.MéthodesLes indicateurs ont été construits à partir de la liste française de prescriptions inadaptées, des recommandations des institutions nationales et de la consultation d’experts du domaine. À partir des bases de données du régime général stricto sensu de l’Assurance maladie de la région Paca, les indicateurs retenus ont été calculés en 2008 pour les bénéficiaires âgés de 70 ans ou plus et comparés selon l’âge, le sexe, le fait d’être pris en charge au titre d’une affection de longue durée (ALD) et, après standardisation sur l’âge et le sexe, selon le département de domicile.RésultatsEn janvier 2009, 500 904 bénéficiaires âgés de 70 ans ou plus ont été identifiés dans la base de remboursement du régime général de l’Assurance maladie dont 60,8 % de femmes et 52,1 % pris en charge au titre d’une ALD. Parmi les prescriptions potentiellement inadaptées étudiées, les plus fréquentes étaient par ordre décroissant l’absence de coprescription d’un protecteur gastrique avec un anti-inflammatoire non stéroïdien (AINS) (28,1 %), les traitements au long cours par benzodiazépines (21,5 %), la prescription de benzodiazépines à demi-vie longue (14,9 %) et les traitements au long cours par AINS (11,6 %). Globalement, les prévalences augmentaient significativement avec l’âge, étaient plus élevées chez les femmes et chez les personnes en ALD. Des variations significatives ont également été observées entre départements de la région Paca.Conclusion Les résultats de notre étude confirment que les prescriptions potentiellement inadaptées touchent un nombre important de personnes âgées. Ils suggèrent que les données de remboursements de l’Assurance maladie pourraient être utilisées dans certains domaines de prescription pour construire des indicateurs de suivi dans le temps des prescriptions potentiellement inadaptées au niveau populationnel et à un niveau infraterritorial, sous réserve de la prise en compte de certaines limites.
    Revue d'Épidémiologie et de Santé Publique. 04/2012; 60(2):121–130.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study conducted in the region of Provence-Alpes-Côte d'Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA. The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers' Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence. In January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers' Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA. Our results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.
    Revue d Épidémiologie et de Santé Publique 03/2012; 60(2):121-30. · 0.69 Impact Factor