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Willner N, Nguyen V, Prosperi-Porta G, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Dreyfus J, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Aortic valve replacement for aortic stenosis: Influence of centre volume on TAVR adoption rates and outcomes in France. Arch Cardiovasc Dis 2024:S1875-2136(24)00053-6. [PMID: 38670869 DOI: 10.1016/j.acvd.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Transcatheter (TAVR) has supplanted surgical (SAVR) aortic valve replacement (AVR). AIM To evaluate whether adoption of this technology has varied according to centre volume at the nationwide level. METHODS From an administrative hospital-discharge database, we collected data on all AVRs performed in France between 2007 and 2019. Centres were divided into terciles based on the annual number of SAVRs performed in 2007-2009 ("before TAVR era"). RESULTS A total of 192,773 AVRs (134,662 SAVRs and 58,111 TAVRs) were performed in 47 centres. The annual number of AVRs and TAVRs increased significantly and linearly in low-volume (<152 SAVRs/year; median 106, interquartile range [IQR] 75-129), middle-volume (152-219 SAVRs/year; median 197, IQR 172-212) and high-volume (>219 SAVRs/year; median 303, IQR 268-513) terciles, but to a greater degree in the latter (+14, +16 and +24 AVRs/centre/year and +16, +19 and +31 TAVRs/centre/year, respectively; PANCOVA<0.001). Charlson Comorbidity Index and in-hospital death rates declined from 2010 to 2019 in all terciles (all Ptrend<0.05). In 2017-2019, after adjusting for age, sex and Charlson Comorbidity Index, there was a trend toward lower death rates in the high-volume tercile (P=0.06) for SAVR, whereas death rates were similar for TAVR irrespective of tercile (P=0.27). Similar results were obtained when terciles were defined based on number of interventions performed in the last instead of the first 3years. Importantly, even centres in the lowest-volume tercile performed a relatively high number of interventions (150 TAVRs/year/centre). CONCLUSIONS In a centralized public healthcare system, the total number of AVRs increased linearly between 2007 and 2019, mostly due to an increase in TAVR, irrespective of centre volume. Progressive declines in patient risk profiles and death rates were observed in all terciles; in 2017-2019 death rates were similar in all terciles, although lower in high-volume centres for SAVR.
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Affiliation(s)
- Nadav Willner
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Graeme Prosperi-Porta
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Helene Eltchaninoff
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Ian G Burwash
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Morgane Michel
- Paris-Cité, 75006 Paris, France; Unité d'Épidémiologie Clinique, Hôpital Robert-Debré, AP-HP, 75019 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France
| | - Eric Durand
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Christel Dindorf
- Paris-Cité, 75006 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Bernard Iung
- Paris-Cité, 75006 Paris, France; Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alain Cribier
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Alec Vahanian
- Paris-Cité, 75006 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Karine Chevreul
- Paris-Cité, 75006 Paris, France; Department of Cardiology, Brest University Hospital, 29200 Brest, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
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Durand E, Beziau-Gasnier D, Michel M, Iung B, Tchetche D, Bonnet G, Lhermusier T, Gilard M, Souteyrand G, Bouleti C, Ohlmann P, Lefevre T, Beygui F, Chassaing S, Chevreul K, Eltchaninoff H. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J 2024; 45:952-962. [PMID: 38437633 DOI: 10.1093/eurheartj/ehae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND AIMS The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS after transfemoral TAVI. METHODS FAST-TAVI II is a prospective, multicentre, cluster, randomized, controlled study including patients with severe symptomatic aortic stenosis, who had transfemoral TAVI. The intervention consisted in a dedicated training programme to implement 10 quality of care measures to reduce LOS with an implementation phase of eight weeks. The primary endpoint was the proportion of patients discharged early within 3 days. Secondary endpoints included: LOS, 30-day mortality and 30-day incidence of readmission for cardiovascular events. RESULTS During the study period, 969 patients were enrolled in the intervention group and 860 patients in the control group. Mean age was 81.9 ± 6.6 years and mean EuroSCORE II was 4.4 ± 4.5%. Early discharge was achieved in 563 (58.1%) patients in the intervention group vs. 364 (42.3%) patients in the control group (P < .0001). Median LOS was significantly reduced in the intervention group compared to the control group [3 (IQR: 3) vs. 4 days (IQR: 3), P < .0001]. Thirty-day mortality was low and similar in the two groups (0.5% vs. 0.9%, P = .30), as were 30-day readmissions (4.6% vs. 2.8%, P = .28). CONCLUSIONS The intervention was simple and fast to implement, and was effective and safe to reduce LOS and increase the proportion of patients discharged early after TAVI (NCT04503655).
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Affiliation(s)
- Eric Durand
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Delphine Beziau-Gasnier
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Morgane Michel
- Université Paris Cité, Paris, France
- Inserm, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat-Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Guillaume Bonnet
- Unité médico-chirurgicale des valvulopathies, CHU de Bordeaux, 33600 Pessac, France
| | | | - Martine Gilard
- Department of Cardiology, CHRU Brest, 29200 Brest, France
| | | | - Claire Bouleti
- Clinical Investigation Center (INSERM 1204), Cardiology Department, ACTION and FACT study groups, University of Poitiers, Poitiers Hospital, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Générale de santé, Massy, France
| | - Farzin Beygui
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Stephan Chassaing
- Cardiology Department, Clinique NCT+-Saint Gatien-Alliance, Tours, France
| | - Karine Chevreul
- Université Paris Cité, Paris, France
- Inserm, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Eltchaninoff
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
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Prosperi-Porta G, Nguyen V, Eltchaninoff H, Dreyfus J, Burwash IG, Willner N, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Impact of the coronavirus disease 2019 pandemic on aortic valve replacement and outcomes in France. Arch Cardiovasc Dis 2024; 117:143-152. [PMID: 38267317 DOI: 10.1016/j.acvd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The coronavirus disease of 2019 (COVID-19) pandemic lockdowns limited access to medical care. The impact on surgical (SAVR) and transcatheter (TAVR) aortic valve replacement (AVR) has been poorly described. AIM We sought to evaluate the impact of the COVID-19 pandemic on the number and modalities of AVR, patient demographics and in-hospital outcomes at the nationwide level. METHODS Using the French nationwide administrative hospital discharge database, we compared projected numbers and proportions of AVR and hospital outcomes, obtained using linear regressions derived from 2015-2019 trends, with those observed in 2020. RESULTS In 2020, 21,382 AVRs were performed (13,051 TAVRs, 5706 isolated SAVRs and 2625 SAVRs combined with other cardiac surgery). Compared with the 2020 projected number of AVRs (24,586, 95% confidence interval [CI] 23,525-25,646), TAVRs (14,866, 95% CI 14,164-15,568), isolated SAVRs (6652, 95% CI 6203-7100) and SAVRs combined with other cardiac surgery (3069, 95% CI 2822-3315), there were reductions of 13.0%, 12.2%, 14.2% and 14.5%, respectively. These trends were similar regardless of sex or age. In 2020, the mean age, Charlson Comorbidity Index and hospital admission duration continued to decline, and the proportion of females remained constant, following 2015-2019 trends. Overall, 2020 in-hospital mortality was higher than projected (2.0% observed vs. 1.7% projected; 95% CI 1.5-1.9%), with no increased pacemaker implantation, but more acute kidney injury and cerebrovascular accidents in some surgical subsets. CONCLUSIONS During the COVID-19 pandemic, fewer TAVR and SAVR procedures were performed, with increased in-hospital mortality and periprocedural complications. Extended follow-up will be important to establish the long-term effect of the COVID-19 pandemic on patient management and outcomes.
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Affiliation(s)
- Graeme Prosperi-Porta
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Helene Eltchaninoff
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Morgane Michel
- Université Paris-Cité, 75006 Paris, France; Unité d'Épidémiologie Clinique, Hôpital Robert Debré, AP-HP, 75019 Paris, France; INSERM, ECEVE, U1123, 75010 Paris, France
| | - Eric Durand
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Christel Dindorf
- Université Paris-Cité, 75006 Paris, France; INSERM, ECEVE, U1123, 75010 Paris, France; URC Eco Ile de France, Hôtel Dieu, AP-HP, 75004 Paris, France
| | - Bernard Iung
- Université Paris-Cité, 75006 Paris, France; Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alain Cribier
- Department of Cardiology, CHU Rouen, Normandie University, UNIROUEN, U1096, 76000 Rouen, France
| | - Alec Vahanian
- Université Paris-Cité, 75006 Paris, France; INSERM U1148, Bichat Hospital, 75018 Paris, France
| | - Karine Chevreul
- Université Paris-Cité, 75006 Paris, France; Department of Cardiology, Brest University Hospital, 29200 Brest, France; URC Eco Ile de France, Hôtel Dieu, AP-HP, 75004 Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada.
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Roelandt JL, Vinet MA, Delissen S, Askevis-Leherpeux F, Chevreul K. Impact of follow-up by peer support workers on mental health service users' global functioning and self-stigmatisation. Encephale 2023:S0013-7006(23)00174-4. [PMID: 37985258 DOI: 10.1016/j.encep.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/06/2023] [Accepted: 08/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The introduction of the first French professional peer support workers training program. (« Médiateurs de santé pairs en santé mentale ») led to a series of evaluations. After a number of qualitative studies demonstrating benefits of peer support for all stakeholders, our objective was to evaluate its direct effects for users by focusing on repeated quantitative measures: global functioning and self-stigma scores. The hypothesis was that peer support would improve the former and decrease the latter. METHOD The procedure was based on a one-year follow-up of two groups of mental health service users. Both groups received usual care, either with or without additional peer support. All of them were asked to respond to three questionnaires at the beginning of the study and 6 and 12 months later: a sociodemographic and clinical questionnaire, a global functioning scale and a self-stigmatization scale. Samples included 85/64/35 participants at the three stages for the PHM group, and 205/157/105 for the control group. RESULTS Peer support improved global functioning. Nevertheless, it had no impact on self-stigmatization scores which remained rather low throughout the observational period. CONCLUSIONS Despite difficulties concerning follow-up of service users during the course of the study and the reluctance to integrate a new profession based on experiential knowledge, it appears that the hope of recovery can improve global functioning of people with mental disorders. The reasons for low self-stigmatization and its stability over time remain to be explored.
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Affiliation(s)
- Jean-Luc Roelandt
- CCOMS/EPSM Lille-Métropole, Armentières, France; Inserm, ECEVE, université Paris-Cité, Paris, France.
| | - Marie-Amélie Vinet
- Inserm, ECEVE, université Paris-Cité, Paris, France; URC Eco, AP-HP, 75004 Paris, France
| | | | - Françoise Askevis-Leherpeux
- CCOMS/EPSM Lille-Métropole, Armentières, France; Inserm, ECEVE, université Paris-Cité, Paris, France; Laboratoire PSITEC, université de Lille, Lille, France
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5
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Prosperi-Porta G, Nguyen V, Willner N, Dreyfus J, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Association of Age and Sex With Use of Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2023; 82:1889-1902. [PMID: 37877906 DOI: 10.1016/j.jacc.2023.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Current guidelines recommend selecting surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) based on age, comorbidities, and surgical risk. Nevertheless, reports from the United States suggest a rapid expansion of TAVR in young patients. OBJECTIVES The authors sought to evaluate the trends in TAVR uptake at a nationwide level in France according to age and sex. METHODS Using a nationwide administrative database, we evaluated age- and sex-related trends in TAVR uptake, patient demographics, and in-hospital outcomes between 2015 and 2020. RESULTS A total of 107,397 patients (44.0% female) underwent an isolated aortic valve replacement (AVR) (59.1% TAVR, 40.9% SAVR). In patients <65 years of age, the proportion of TAVR increased by 63.2% (P < 0.001) from 2015 to 2020 but remained uncommon at 11.1% of all AVR by 2020 (12.4% in females, 10.6% in males) while TAVR was the dominant modality in patients ≥65 years of age. In patients undergoing TAVR, the Charlson comorbidity index (CCI) (P = 0.119 for trend) and in-hospital mortality (P = 0.740 for trend) remained unchanged in patients <65 years of age but declined in those ≥65 years of age irrespective of sex (all P < 0.001 for trends). Females were older (P < 0.001), had lower CCI (P < 0.001), were more likely to undergo TAVR (P < 0.001), and experienced higher in-hospital mortality (TAVR, P = 0.015; SAVR, P < 0.001) that persisted despite adjustment for age and CCI. CONCLUSIONS In France, the use of TAVR remained uncommon in young patients, predominantly restricted to those at high risk. Important sex differences were observed in patent demographics, selection of AVR modality, and patient outcomes. Additional research evaluating the long-term impact of TAVR use in young patients and prospective data evaluating sex differences in AVR modality selection and outcomes are needed.
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Affiliation(s)
- Graeme Prosperi-Porta
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Helene Eltchaninoff
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Morgane Michel
- Université Paris-Cité, Paris, France; Unité d'épidémiologie Clinique, Hôpital Robert Debré, AP-HP, Paris, France; INSERM, ECEVE, U1123, Paris, France
| | - Eric Durand
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Christel Dindorf
- Université Paris-Cité, Paris, France; INSERM, ECEVE, U1123, Paris, France; URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France
| | - Bernard Iung
- Université Paris-Cité, Paris, France; Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Alain Cribier
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Alec Vahanian
- Université Paris-Cité, Paris, France; INSERM U1148, Université Paris-Cité, Paris, France
| | - Karine Chevreul
- Université Paris-Cité, Paris, France; Department of Cardiology, Brest University Hospital, Brest, France; URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Michel M, Hariz AJ, Chevreul K. Association of mental disorders with costs of somatic admissions in France. Encephale 2023; 49:453-459. [PMID: 35973851 DOI: 10.1016/j.encep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mentally ill patients have worse health outcomes when they suffer from somatic conditions compared to other patients. The objective of this study was to assess the association of mental illness with hospital inpatient costs for somatic reasons. METHODS All adult inpatient stays for somatic reasons in acute care hospitals between 2009 and 2013 were included using French exhaustive hospital discharge databases. Total inpatient costs were calculated from the all-payer perspective and compared in patients with and without a mental disorder. Only patients who had been admitted at least once for a mental disorder (either full-time or part-time) were considered to be mentally ill in this study. Generalized linear models with and without interaction terms studied the factors associated with hospital inpatient costs. RESULTS 17,728,424 patients corresponding to 37,458,810 admissions were included. 1,163,972 patients (6.57%) were identified as having a mental illness. A previous full-time or part-time admission for a mental disorder significantly increased hospital inpatient costs (+32.64%, 95%CI=1.3243-1.3284). Interaction terms found an increased impact of mental disorders on costs in patients with low socio-economic status, as well as in men, patients aged between 45 and 60, and patients with a cardiovascular disease or diabetes. CONCLUSION Mentally ill patients have higher hospital costs than non-mentally ill patients. Improving curative and preventive treatments in those patients could improve their health and decrease the burden on healthcare systems.
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Affiliation(s)
- M Michel
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France.
| | - A J Hariz
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France
| | - K Chevreul
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France
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Bocquier A, Bruel S, Michel M, Le Duc‐Banaszuk A, Bonnay S, Branchereau M, Chevreul K, Chyderiotis S, Gauchet A, Giraudeau B, Hagiu D, Mueller JE, Gagneux‐Brunon A, Thilly N. Co-development of a school-based and primary care-based multicomponent intervention to improve HPV vaccine coverage amongst French adolescents (the PrevHPV Study). Health Expect 2023; 26:1843-1853. [PMID: 37312280 PMCID: PMC10485335 DOI: 10.1111/hex.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high-income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co-develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. OBJECTIVE To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. METHODS To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real-world contexts. RESULTS We co-developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e-learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. CONCLUSION We co-developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. PATIENT OR PUBLIC CONTRIBUTION The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.
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Affiliation(s)
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- Health, Systemic, Process UR 4129 Research Unit, University Claude BernardUniversity of LyonLyonFrance
| | - Morgane Michel
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | | | | | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers‐Pays de la LoireAngersFrance
| | - Karine Chevreul
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | - Sandra Chyderiotis
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
| | - Aurélie Gauchet
- LIP/PC2SUniversité Grenoble AlpesGrenobleFrance
- LIP/PC2SUniversité Savoie Mont BlancChambéryFrance
| | - Bruno Giraudeau
- SPHERE U1246, Université de Tours, Université de NantesINSERMToursFrance
- INSERM CIC 1415CHRU de ToursToursFrance
| | - Dragos‐Paul Hagiu
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- CIC‐INSERM 1408, CHU deSaint‐EtienneFrance
| | - Judith E. Mueller
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes ‐ UMR 6051RSMS (Recherche sur les Services et Management en Santé) ‐ U 1309RennesFrance
| | - Amandine Gagneux‐Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 VaccinologieCHU de Saint‐EtienneSaint‐EtienneFrance
| | - Nathalie Thilly
- APEMACUniversité de LorraineNancyFrance
- Département Méthodologie, Promotion, InvestigationUniversité de Lorraine, CHRU‐NancyNancyFrance
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Yang JS, Michel M, Cogo H, Malorey D, Poey N, Caseris M, Chevreul K, Faye A. Impact of Deprivation on the Incidence and Severity of Tuberculosis in Children: A Retrospective Study from 2007 to 2020 in a Tertiary Care Center in Paris, France. J Pediatr 2023; 259:113395. [PMID: 37001636 DOI: 10.1016/j.jpeds.2023.113395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the association between deprivation and the incidence and clinical severity of tuberculosis (TB) in children. STUDY DESIGN Children ≤18 years old who were admitted for TB between 2007 and 2020 at a tertiary hospital were included in this retrospective study. Deprivation was assessed using the French Deprivation Index. TB severity was assessed using the Wiseman classification. Multivariate analyses were carried out. RESULTS In total, 222 patients were included. The median age was 10.8 years (IQR 4.5-14.4). TB was considered severe in 126 patients (56.8%), with 50% of the patients included in the 2 most deprived groups. The most-deprived children had a TB incidence that was 58 times greater than that of the least-deprived children (95% CI 28.49-119.40). There was no significant association between deprivation and severity in the multivariable analysis after adjusting for age and circumstances of diagnosis. Deprivation was associated with an increased length of stay in the most-deprived groups (OR 3.79, 95% CI 1.55-10.23). There was a trend toward a greater proportion of symptomatic children in the most-deprived group. CONCLUSIONS TB incidence and hospital length of stay increased with deprivation levels but not with the severity of TB.
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Affiliation(s)
- Jee-Seon Yang
- Service de Pédiatrie générale et maladies infectieuses, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Morgane Michel
- Inserm, ECEVE, Paris, France; Université Paris Cité, Paris, France; Unité d'épidémiologique clinique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Haude Cogo
- Service de Pédiatrie générale et maladies infectieuses, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Malorey
- Service de Pédiatrie générale et des urgences pédiatriques, Hôpital Femme Enfant Adolescent, Nantes, France
| | - Nora Poey
- Service de Pédiatrie générale et maladies infectieuses, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Service de Pédiatrie générale et maladies infectieuses, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Chevreul
- Inserm, ECEVE, Paris, France; Université Paris Cité, Paris, France; URC Eco Ile de France, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France
| | - Albert Faye
- Service de Pédiatrie générale et maladies infectieuses, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France; Inserm, ECEVE, Paris, France; Université Paris Cité, Paris, France
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9
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Or Z, Gandré C, Seppänen AV, Hernández-Quevedo C, Webb E, Michel M, Chevreul K. France: Health System Review. Health Syst Transit 2023; 25:1-276. [PMID: 37489947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
This review of the French health system analyses recent developments in health organisation and governance, financing, healthcare provision, recent reforms and health system performance. Overall health status continues to improve in France, although geographic and socioeconomic inequalities in life expectancy persist. The health system combines a social health insurance (SHI) model with an important role for tax-based revenues to finance healthcare. The health system provides universal coverage, with a broad benefits basket, but cost-sharing is required for all essential services. Private complementary insurance to cover these costs results in very low average out-of-pocket (OOP) payments, although there are concerns regarding solidarity, financial redistribution and efficiency in the health system. The macroeconomic context in the last couple of years in the country has been affected by the Covid-19 pandemic, which resulted in subsequent increases of total health expenditure in France in 2020 (3.7%) and 2021 (9.8%). Healthcare provision continues to be highly fragmented in France, with a segmented approach to care organization and funding across primary, secondary and long-term care. Recent reforms aim to strengthen primary care by encouraging multidisciplinary group practices, while public health efforts over the last decade have focused on boosting prevention strategies and tackling lifestyle risk factors, such as smoking and obesity with limited success. Continued challenges include ensuring the sustainability of the health workforce, particularly to secure adequate numbers of health professionals in medically underserved areas, such as rural and less affluent communities, and improving working conditions, remuneration and career prospects, especially for nurses, to support retention. The Covid-19 pandemic has brought to light some structural weaknesses within the French health system, but it has also provided opportunities for improving its sustainability. There has been a notable shift in the will to give more room to decision-making at the local level, involving healthcare professionals, and to find new ways of funding healthcare providers to encourage care coordination and integration.
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Affiliation(s)
| | | | | | | | - Erin Webb
- Technical University of Berlin and European Observatory on Health Systems and Policies
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Le Jeannic A, Turmaine K, Gandré C, Vinet MA, Michel M, Chevreul K. Defining the Characteristics of an e-Health Tool for Suicide Primary Prevention in the General Population: The StopBlues Case in France. Int J Environ Res Public Health 2023; 20:6096. [PMID: 37372683 DOI: 10.3390/ijerph20126096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
With over one million deaths per year in the world, suicide is a major public health problem that could be significantly reduced by effective prevention programs. E-health tools are of particular interest for primary prevention as they can address a broad population including people unaware of their own risk and provide information and help without the fear of stigma. Our main objective was to define the overall characteristics of an e-health tool for suicide primary prevention in the French general population by defining the characteristics of the IT features; the content of the information delivered; the best way to structure it; and how it should be relayed and by whom. The research was carried out through a literature review and a co-construction phase with stakeholders. Four types of strategies may guide the construction of e-health tools for suicide primary prevention: education and awareness, (self-)screening, accessing support, and mental health coping. They should be accessible on different devices to reach the most users, and language and content should be adapted to the target population and to the issue being addressed. Finally, the tool should be consistent with ethical and quality best practices. The e-health tool StopBlues was developed following those recommendations.
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Affiliation(s)
- Anaïs Le Jeannic
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
| | | | - Coralie Gandré
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
| | - Marie-Amélie Vinet
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
| | - Morgane Michel
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité D'épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019 Paris, France
| | - Karine Chevreul
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
- Unité D'épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019 Paris, France
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11
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Bocquier A, Branchereau M, Gauchet A, Bonnay S, Simon M, Ecollan M, Chevreul K, Mueller JE, Gagneux-Brunon A, Thilly N. Promoting HPV vaccination at school: a mixed methods study exploring knowledge, beliefs and attitudes of French school staff. BMC Public Health 2023; 23:486. [PMID: 36918854 PMCID: PMC10011782 DOI: 10.1186/s12889-023-15342-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND HPV vaccine coverage in France remained lower than in most other high-income countries. Within the diagnostic phase of the national PrevHPV program, we carried out a mixed methods study among school staff to assess their knowledge, beliefs and attitudes regarding HPV, HPV vaccine and vaccination in general, and regarding schools' role in promoting HPV vaccination. METHODS Middle school nurses, teachers and support staff from four French regions participated between January 2020 and May 2021. We combined: (i) quantitative data from self-administered online questionnaires (n = 301), analysed using descriptive statistics; and (ii) qualitative data from three focus groups (n = 14), thematically analysed. RESULTS Less than half of respondents knew that HPV can cause genital warts or oral cancers and only 18% that no antiviral treatment exists. Almost 90% of the respondents knew the existence of the HPV vaccine but some misunderstood why it is recommended before the first sexual relationships and for boys; 56% doubted about its safety, especially because they think there is not enough information on this topic. Schools nurses had greater knowledge than other professionals and claimed that educating pupils about HPV was fully part of their job roles; however, they rarely address this topic due to a lack of knowledge/tools. Professionals (school nurses, teachers and support staff) who participated in the focus groups were unfavourable to offering vaccination at school because of parents' negative reactions, lack of resources, and perceived uselessness. CONCLUSIONS These results highlight the need to improve school staff knowledge on HPV. Parents should be involved in intervention promoting HPV vaccination to prevent their potential negative reactions, as feared by school staff. Several barriers should also be addressed before organizing school vaccination programs in France.
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Affiliation(s)
| | - Marion Branchereau
- Centre Régional de Coordination Des Dépistages Des Cancers-Pays de La Loire, Angers, France
| | - Aurélie Gauchet
- Université Grenoble Alpes, LIP/PC2S, EA 4145, Grenoble, France
- Université Savoie Mont Blanc, LIP/PC2S, Chambéry, France
| | | | - Maïa Simon
- Université de Lorraine, APEMAC, F-54000, Nancy, France
| | - Marie Ecollan
- Département de Médecine Générale, Université de Paris, Faculté de Santé, UFR de Médecine, F-75014, Paris, France
| | - Karine Chevreul
- Université de Paris, ECEVE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France / Hôpital Robert Debré, Unité d'épidémiologie Clinique, Paris, France
- INSERM, ECEVE UMR 1123, Paris, France
| | - Judith E Mueller
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015, Paris, France
- Université Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche Sur Les Services Et Management en Santé) - U 1309, Rennes, F-35000, France
| | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Université Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, F-54000, France
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12
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Michel M, Arvis Souaré M, Dindorf C, Danguy V, Chevreul K. Health check-ups for the French under-consuming agricultural population: A pilot evaluation of the Instants santé MSA program. Rev Epidemiol Sante Publique 2023; 71:101420. [PMID: 36610246 DOI: 10.1016/j.respe.2022.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The social protection scheme in charge of farmers and agricultural employees (MSA) in France has developed a two-step health promotion program with a nurse appointment followed by a consultation with a doctor of the participant's choosing to reach its under-consuming beneficiaries and enroll them back into a care pathway. Our objective was to carry out a pilot evaluation of this program. METHODS The evaluation was carried out on the population invited during the second semester of 2017 using data from the program's service providers (date of invitation, of nurse appointment…), regional MSA bodies (consultation voucher), and reimbursement data (other care consumption). Participation rates were calculated overall and by participant characteristics. Medical needs were identified during the nurse appointment and new care pathways were assessed using reimbursement data. Multivariable regression models identified factors associated with participation. RESULTS 2366 beneficiaries were included in the analysis. 1559 (65.89%) were men and mean age was 52.41 (standard deviation = 14.86). 409 (17.29%) attended the nurse appointment. There was a significant increase in participation with age, in farmers vs. employees (odds ratio = 1.905, 95% confidence interval = 1.393-2.604), and in people living in the most disadvantaged areas (odds ratio = 1.579, 95% confidence interval=1.079-2.312). Participation to the consultation following the nurse appointment was high (62.35%-73.11%). 87.53% of participants had at least one medical need, and new care pathways were more frequent among those who had attended the nurse appointment (55.50% vs. 34.80%, p < 0.0001). CONCLUSIONS This pilot evaluation shows promising results which need to be confirmed with a national evaluation of the program and longer-term evidence.
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Affiliation(s)
- Morgane Michel
- Université Paris Cité, ECEVE, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, 75019 Paris, France; INSERM, ECEVE UMR 1123, 75010 Paris, France.
| | - Mariam Arvis Souaré
- Direction du contrôle médical et de l'offre de soins, Caisse centrale de la Mutualité Sociale Agricole, 93000 Bobigny, France
| | - Christel Dindorf
- Université Paris Cité, ECEVE, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, 75004 Paris, France; INSERM, ECEVE UMR 1123, 75010 Paris, France
| | - Véronique Danguy
- Département Études et évaluation en santé, Caisse centrale de la Mutualité Sociale Agricole, 93000 Bobigny, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, 75019 Paris, France; INSERM, ECEVE UMR 1123, 75010 Paris, France
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Willner N, Nguyen V, Eltchaninoff H, Burwash I, Michel M, Durand E, Gilard M, Iung B, Cribier A, Chevreul K, Messika-Zeitoun D. Aortic valve replacement for aortic stenosis in France – Influence of centers’ volumes on TAVR adoption rate and outcomes. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Ketterer F, Roelandt JL, Chevreul K. Le tabagisme en psychiatrie : réalités et implications pour sa prise en charge. Sante Publique 2022; 34:643-651. [PMID: 36577663 DOI: 10.3917/spub.225.0643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study looks at tobacco use among persons with psychiatric disorders and its management in public psychiatric units in France. METHODS A thematic analysis based on semi-directive interviews with 10 patients and 9 caregivers was carried out. RESULTS Patients use tobacco to deal with their emotions and mood swings. However, mental health professionals, who only focus on mental disorders and addictions that have a direct impact on behaviors, disregard smoking addiction. Moreover, tobacco is sometimes integrated into the way services operate. However, it would be too simplistic to reduce the issue of smoking cessation to a matter of goodwill of caregivers. The structural dimension of smoking was evident, particularly in psychiatric hospitals, where it was an important bargaining chip and activity. CONCLUSIONS Patients desire to receive individualized smoking-cessation interventions. This underlines the relevance of a public health intervention co-construction that goes beyond simply prescribing nicotine substitutes. This intervention should take into account characteristics of tobacco consumption among psychiatric patients, and the need to offer such interventions when patients are stabilized. In the meantime, psychiatric caregivers should be encouraged to engage in shared decision-making processes with patients for tobacco-use reduction and cessation.
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15
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Bocquier A, Bonnay S, Bruel S, Chevreul K, Gagneux-Brunon A, Gauchet A, Giraudeau B, Le Duc-Banaszuc AS, Mueller JE, Thilly N. Codevelopment and evaluation of a multicomponent intervention to improve HPV vaccination in France. Eur J Public Health 2022. [PMCID: PMC9594634 DOI: 10.1093/eurpub/ckac131.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. The French authorities launched in 2018 the PrevHPV national research program aimed at codeveloping with stakeholders and evaluating the impact of a multicomponent intervention to improve HPV VC among French adolescents. Methods We identified three components to address main barriers to HPV vaccination in France: adolescents’ and parents’ education and motivation (component 1); general practitioners (GPs)’ training (component 2); and access to vaccination at school (component 3). We developed the intervention using the UK Medical Research Council framework for developing complex interventions as a guide. We used (i) findings from published evidence; (ii) primary data on knowledge, attitudes, behavior and preferences collected through a mixed methods approach (quantitative/qualitative studies, discrete choice experiment); (iii) the advice of stakeholders (e.g., adolescents, parents, school nurses, GPs) involved in working groups. We will evaluate the effectiveness, efficiency and implementation of the components (applied alone or in combination) through a pragmatic cluster randomized controlled trial. The primary endpoint is the HPV VC (≥ 1 dose) among adolescents aged 11-14 years, 2 months after the end of the intervention, at the municipality level. Results Primary data highlighted the need to improve adolescents, parents and school staff knowledge on HPV and to help GPs communicate with patients on this topic. They provided guidance on the most effective communication contents. For each component, we codeveloped tools with a participatory approach (e.g., eHealth tools for adolescents, a decision aid tool for GPs). The trial will end in June 2022; 90 middle schools (i.e., about 40,000 adolescents) and 46 GPs accepted to participate. Conclusions Should the intervention prove effective, results from the implementation evaluation will help us refine it before scaling it up. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • It will add to the small number of studies that compared the effectiveness of various strategies to promote HPV vaccination and will provide key results on cost-effectiveness and implementation.
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Affiliation(s)
- A Bocquier
- APEMAC, Université de Lorraine , Nancy, France
| | - S Bonnay
- APEMAC, Université de Lorraine , Nancy, France
| | - S Bruel
- Département de Médecine Générale, Université Paris , Paris, France
- HESPER EA7425 , Saint-Etienne- , Saint-Etienne, France
- Lyon University , Saint-Etienne- , Saint-Etienne, France
- CIC-INSERM 1408, University Hospital of Saint-Etienne , Saint-Etienne, France
| | - K Chevreul
- Université de Paris ECEVE UMR 1123, , Paris, France
- URC Eco Ile-de-France, Hôpital Robert Debré , Paris, France
| | | | - A Gauchet
- LIP/PC2S, University Savoie Mont Blanc , Chambéry, France
| | - B Giraudeau
- SPHERE U1246, Université de Tours, Université de Nantes, INSERM , Tours, France
- CHRU de Tours INSERM CIC 1415, , Tours, France
| | | | - JE Mueller
- Unité Epidémiologie des Maladies Émergentes, Institut Pasteur , Paris, France
- EHESP French School of Public Health , Rennes, France
| | - N Thilly
- APEMAC, Université de Lorraine , Nancy, France
- Université de Lorraine, CHRU-Nancy Méthodologie, Promotion, Investigation, , Nancy, France
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Willner NA, Nguyen V, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Aortic valve replacement for aortic stenosis in France – influence of centers' volumes on TAVR adoption rate and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Over the last decade, transcatheter aortic valve replacement (TAVR) became extensively used, now being the recommended as first line procedure for aortic valve replacement (AVR) in selected patients' populations. It is unknown whether TAVR adoption rate and variability in outcomes is influenced by centers' volume.
Methods
From a French administrative hospital-discharge database, we collected all AVR performed in France between 2007 and 2019. Centers were stratified to terciles based on their annual SAVR per year per center during 2007–2009 (“pre TAVR era”).
Results
There was 218,489 AVRs (153,747 SAVR and 74,732 TAVR) performed in 46 centers between 2007–2019. Number of total AVR and even more so number of number of TAVR significantly and linearly increased from 2007 to 2019 in all terciles but faster in the high volume tercile (+17, +17 and +31 AVR/center/year in the low, middle and high terciles respectively, P [ANCOVA]<0.001; +11, + 19 and +33 TAVR/center/year in the low, medium and high tercile respectively, P [ANCOVA] <0.00, Figure 1). The age of patients underwent TAVR remained grossly unchanged in all three terciles, however, the Charlson index declined from 2010 to 2019 (from 1.35±1.42 to 0.65±1.04, from 1.21±1.40 to 0.65±1.05 and from 1.53±1.58 to 0.81±1.21, in the low, middle and high terciles, P for trend <0.001, 0.021, and <0.001, respectively). Charlson score in the years 2017–2019, was higher in the high than middle and low terciles (0.87±1.22, 0.76±1.11 and 0.65±1.04, respectively, P<0.0001). The in-hospital mortality rate for TAVR significantly declined from 2010 to 2019 for TAVR in all terciles (from 8.3% to 2.1%, from 7.5% to 2.5% and from 8.2% to 2.1% for low, middle and high TAVR terciles, respectively; p for trend = 0.002, 0.001 and <0.001, respectively, Figure 2). Average mortality in 2017–2019 was similar in all terciles (2.3%, 2.5% and 2.2% for low, middle and high terciles, respectively, P=0.47). After adjusting for age, sex and Charlson score, mortality was higher in the low tercile compared with middle and high terciles (OR 1.15, P<0.001, confidence interval [CI] 1.0–1.2, and OR 1.18, P<0.001, CI 1.1–1.2, respectively).
Conclusions
From 2007 to 2019 total AVR linearly increased, mostly due to increase in TAVR, irrespective of centers' volume, but increase rate was higher in high volume centers. A constant decline in patients risk profile, with a striking decrease in mortality rate, was observed in all volume terciles. High-volume centers patients' have higher risk profile, with adjusted mortality slightly lower than medium and low volume centers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - V Nguyen
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | | | | | | | | | - M Gilard
- University Hospital of Brest , Brest , France
| | | | - B Iung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | | | - A Vahanian
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - K Chevreul
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
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Roussel A, Faye A, Lefevre-Utile A, De Pontual L, Chevreul K, Michel M. A comparison of individual and ecological indicators of social deprivation and their association with hospital efficiency in the context of infectious diseases in two French general paediatric departments. Int Health 2022; 14:405-412. [PMID: 31990348 PMCID: PMC9248052 DOI: 10.1093/inthealth/ihz102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 07/29/2019] [Accepted: 10/28/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To identify deprivation indicators usable in everyday practice and included in medico-administrative databases, particularly with infectious diseases, which represent the greatest proportion of hospitalizations. Our objective was to compare ecological indicators to individual questionnaires and apply both types to the study of the impact of deprivation on hospital efficiency. METHODS We conducted an epidemiological observational prospective multicentre study in two French public hospitals between 20 October 2016 and 20 March 2017. Children hospitalized for one of the four most common infectious diseases were included and their parents were asked to answer the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. The ecological indicator French DEPrivation index (FDep) was derived from patients' address, both at the zip code and at a smaller geographical area (IRIS [ilôts de regroupement pour l'information statistique]) level. Correlation and concordance between the three indicators were assessed. The endpoint used to assess the impact on hospital efficiency was the ratio between patients' length of stay (LOS) and the national LOS of their disease-related group. RESULTS Data were available for 540 patients with a mean age of 9 mo. A total of 56.1% of patients were considered deprived with EPICES, 50.4% with zip code FDep and 45.7% with IRIS FDep. Concordance between EPICES and either type of FDep was <0.1. There was no increase in LOS compared with national LOS with any of the indicators. CONCLUSIONS Individual and ecological indicators do not measure the same aspects of deprivation. The decision to use one or the other must be carefully weighed when studying the impact of deprivation on the healthcare system.
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Affiliation(s)
- Aphaia Roussel
- Service de Pédiatrie Générale, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France
- Inserm, ECEVE, U1123, 10 boulevard de Verdun, 75010 Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, 10 boulevard de Verdun, 75010 Paris, France
| | - Albert Faye
- Service de Pédiatrie Générale, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France
- Inserm, ECEVE, U1123, 10 boulevard de Verdun, 75010 Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, 10 boulevard de Verdun, 75010 Paris, France
| | - Alain Lefevre-Utile
- Service de Pédiatrie Générale, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France
| | - Loic De Pontual
- Service de Pédiatrie Générale, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Avenue du 14 Juillet, 93140 Bondy, France
| | - Karine Chevreul
- Inserm, ECEVE, U1123, 10 boulevard de Verdun, 75010 Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, 10 boulevard de Verdun, 75010 Paris, France
- URC Eco Ile de France, DRCD, Hôtel Dieu, 1 place du Parvis de Notre Dame, 75004 Paris, France
| | - Morgane Michel
- Inserm, ECEVE, U1123, 10 boulevard de Verdun, 75010 Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, 10 boulevard de Verdun, 75010 Paris, France
- URC Eco Ile de France, DRCD, Hôtel Dieu, 1 place du Parvis de Notre Dame, 75004 Paris, France
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Michel M, Alberti C, Carel JC, Chevreul K. Social inequalities in access to care at birth and neonatal mortality: an observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:380-385. [PMID: 34656994 DOI: 10.1136/archdischild-2021-321967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality. DESIGN Retrospective analysis of a prospective cohort constituted using hospital discharge databases. SETTING France POPULATION: Live births in 2012-2014 in maternity hospitals in mainland France followed until discharge from the hospital. MAIN OUTCOME MEASURE Unsuitability of the maternity to newborns' needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality. RESULTS 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584). CONCLUSIONS Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.
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Affiliation(s)
- Morgane Michel
- ECEVE, Université de Paris, Paris, France .,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
| | - Corinne Alberti
- ECEVE, Université de Paris, Paris, France.,Unité d'épidémiologie clinique / Unité de recherche clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123 / CIC-EC 1426, Inserm, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,NeuroDiderot, Inserm, Université de Paris, Paris, France
| | - Karine Chevreul
- ECEVE, Université de Paris, Paris, France.,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
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19
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Turmaine K, Dumas A, Chevreul K. Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis. J Med Internet Res 2022; 24:e30218. [PMID: 35451977 PMCID: PMC9077507 DOI: 10.2196/30218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-04464-2
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Affiliation(s)
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris, URC Eco Ile-de-France, Paris, France, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
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- See Authors' Contributions,
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20
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Bocquier A, Michel M, Giraudeau B, Bonnay S, Gagneux-Brunon A, Gauchet A, Gilberg S, Le Duc-Banaszuk AS, Mueller JE, Chevreul K, Thilly N. Impact of a school-based and primary care-based multicomponent intervention on HPV vaccination coverage among French adolescents: a cluster randomised controlled trial protocol (the PrevHPV study). BMJ Open 2022; 12:e057943. [PMID: 35332045 PMCID: PMC8948396 DOI: 10.1136/bmjopen-2021-057943] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Vaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) infection and related harms. Despite various efforts by French authorities to improve HPV vaccine coverage (VC) these past few years, VC has remained far lower than in most other high-income countries. To improve it, we have coconstructed with stakeholders a school-based and primary care-based multicomponent intervention, and plan to evaluate its effectiveness, efficiency and implementation through a cluster randomised controlled trial (cRCT). METHODS AND ANALYSIS This pragmatic cRCT uses an incomplete factorial design to evaluate three components applied alone or in combination: (1) adolescents and parents' education and motivation at school, using eHealth tools and participatory learning; (2) general practitioners' training on HPV using motivational interviewing techniques and provision of a decision aid tool; (3) free-of-charge access to vaccination at school. Eligible municipalities (clusters) are located in one of 14 preselected French school districts and must have only one secondary school which enrols at least 2/3 of inhabitants aged 11-14 years. A randomisation stratified by school district and deprivation index allocated 90 municipalities into 6 groups of 15. The expected overall sample size estimate is 41 940 adolescents aged 11-14 years. The primary endpoint is the HPV VC (≥1 dose) among adolescents aged 11-14 years, at 2 months, at the municipality level (data from routine databases). Secondary endpoints include: HPV VC (≥1 dose at 6 and 12 months; and 2 doses at 2, 6 and 12 months); differences in knowledge, attitudes, behaviours, and intention among adolescents, parents and general practitioners between baseline and 2 months after intervention (self-administered questionnaires); incremental cost-effectiveness ratio. Implementation measures include dose, fidelity, adaptations, reached population and satisfaction (activity reports and self-administered questionnaires). ETHICS AND DISSEMINATION This protocol was approved by the French Ethics Committee 'CPP Sud-Est VI' on 22 December 2020 (ID-RCB: 2020-A02031-38). No individual consent was required for this type of research; all participants were informed of their rights, in particular not to participate or to oppose the collection of data concerning them. Findings will be widely disseminated (conference presentations, reports, factsheets and academic publications). TRIAL REGISTRATION NUMBER NCT04945655.
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Affiliation(s)
| | - Morgane Michel
- Université de Paris, ECEVE UMR 1123, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France / Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, INSERM CIC 1415, CHRU de Tours, Tours, France
| | | | - Amandine Gagneux-Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Aurélie Gauchet
- Université Grenoble Alpes, LIP/PC2S, EA 4145, Grenoble, France
- Univ. Savoie Mont Blanc, LIP/PC2S, Chambéry, France
| | - Serge Gilberg
- Département de Médecine Générale, Université Paris - 24 rue du Faubourg, Paris, France
| | | | - Judith E Mueller
- Unité Epidémiologie des maladies émergentes, Institut Pasteur, 25 rue du Dr Roux, Paris, France
- EHESP French School of Public Health, Paris, France
| | - Karine Chevreul
- Université de Paris, ECEVE UMR 1123, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile-de-France / Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France
- Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
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21
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Nguyen V, Willner N, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Trends in aortic valve replacement for aortic stenosis: a French nationwide study. Eur Heart J 2021; 43:666-679. [PMID: 36282793 DOI: 10.1093/eurheartj/ehab773] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS Transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement (SAVR) has profoundly changed the management of patients with aortic valve stenosis (AS). Large unbiased nationwide data regarding TAVR implementation, impact on SAVR and their respective outcomes are scarce. METHODS AND RESULTS Based on a French administrative hospital-discharge database, we collected data on all consecutive aortic valve replacements (AVRs) performed in France for AS between 2007 and 2019 [106 253 isolated SAVR (49%), 46 514 combined SAVR (21%), and 65 651 TAVR (30%)]. The number of AVR linearly increased between 2007 and 2019 (from 10 892 to 23 109, P for trend < 0.0001) due to a marked increase in TAVR (from 253 to 13 030, P for trend < 0.0001), while SAVR increased up to 2013 and then declined (10 892 in 2007, 12 699 in 2013, and 10 079 in 2019). The Charlson index decreased linearly for TAVR, but in two steps for SAVR (2011 and 2017). In-hospital mortality rates of both SAVR and TAVR declined (both P for trend < 0.0001) and were similar or lower for TAVR than for isolated SAVR in patients 75 years or above in the last 3 years (2017-19). Complication rates of TAVR also declined but permanent pacemaker rates remained high and length of stay substantial (16.7% and median 6 days, respectively, in 2017-19). CONCLUSION The number of AVR has doubled in a decade and TAVR has become the dominant form of AVR in 2018. The improvement in patient profiles seems to have anticipated the demonstrated benefit of TAVR in intermediate and low-risk patients. In patients 75 years or older, TAVR should be considered as the first option. We also highlight two important areas for improvement, the high permanent pacemaker rates, and the long length of stay even in the contemporary era. Our results may have major implications for clinical practice and policymakers.
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Affiliation(s)
- Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, F-76000 France
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Morgane Michel
- Université de Paris, Paris, France.,URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France.,INSERM, ECEVE, U1123, Paris, France
| | - Eric Durand
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, F-76000 France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Christel Dindorf
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, F-76000 France.,Université de Paris, Paris, France.,URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France
| | - Bernard Iung
- Université de Paris, Paris, France.,Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France
| | - Alain Cribier
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, F-76000 France
| | - Alec Vahanian
- Université de Paris, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France
| | - Karine Chevreul
- Université de Paris, Paris, France.,URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France.,INSERM, ECEVE, U1123, Paris, France
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22
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Bouleti C, Michel M, Jobbe Duval A, Hemery T, Nicol PP, Didier R, Zeyons F, Zouaghi O, Tchetche D, Delon C, Delomez M, Dibie A, Attias D, Le Breton H, Cormier B, Obadia JF, Tribouilloy C, Lansac E, Chevreul K, Naccache N, Eltchaninoff H, Gilard M, Iung B. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age? Arch Cardiovasc Dis 2021; 114:624-633. [PMID: 34600866 DOI: 10.1016/j.acvd.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II<4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. AIM The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. METHODS In September and October 2016, 1049 consecutive patients aged ≥ 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. RESULTS Mean age was 84±5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II>8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II≤4%) in 48%. TAVI was preferred in 71% of patients, SAVR in 19% and medical treatment in 10%. The choice of TAVI over SAVR was associated with older age (P<0.0001) and a higher EuroSCORE II (P=0.008). However, the weight of EuroSCORE II in therapeutic decision making markedly decreased after the age of 80 years. Indeed, 77% of patients aged ≥ 80 years were referred for TAVI, despite a low estimated surgical risk. CONCLUSIONS The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention.
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Affiliation(s)
- Claire Bouleti
- CIC Inserm 1402, Cardiology Department, Poitiers University Hospital, Poitiers University, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - Morgane Michel
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | | | | | | | | | | | | | | | | | | | - Alain Dibie
- Institut Mutualiste Montsouris, 75014 Paris, France
| | - David Attias
- Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | | | | | | | | | - Karine Chevreul
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | - Nicole Naccache
- Commission des Registres, French Society of Cardiology, Paris, France
| | | | | | - Bernard Iung
- Bichat Hospital, DHU Fire, Université de Paris, AP-HP, 75018 Paris, France
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Daval L, Nze Ossima A, Clément MC, Michel M, Chevreul K. Estimation of the Width of Uncertainty in Care Consumption and Costs When Using Common Data Collection Tools in Economic Evaluations: A Benchmark for Sensitivity Analyses. Value Health 2021; 24:1416-1422. [PMID: 34593164 DOI: 10.1016/j.jval.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/19/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to evaluate the uncertainty related to the use of common collection tools to assess costs in economic evaluations compared with an exhaustive administrative database. METHODS A pragmatic study was performed using preexisting cost-effectiveness studies. Patients were probabilistically matched with themselves in the French National Health Data System (Système National des Données de Santé [SNDS]), and all their reimbursed hospital and ambulatory care data during the study were extracted. Outcomes included the ratio of the number of each type of resources consumed using trial data (case report forms for ambulatory care and local hospital data for hospital care) versus the SNDS and the ratio of corresponding costs. Mean ratios and 95% confidence intervals (CIs) were calculated using bootstrapping. The impact of the collection tool on the result of the economic evaluation was calculated with the difference in costs between the 2 treatment arms with both collection methods. RESULTS Five cost-effectiveness studies were included in the analysis. A total of 397 patients had the SNDS hospital data, and 321 had ambulatory care data. Common collection tools underestimated hospital admissions by 13% (95% CI 8-20), corresponding costs by 5% (95% CI 2-14), and ambulatory acts by 41% (95% CI 33-51), with large variations in costs depending on the study. There was no change in the economic conclusion in any study. CONCLUSIONS The use of common collection tools underestimates healthcare resource consumption and its associated costs, particularly for ambulatory care. Our results could provide useful evidence-based estimates to inform sensitivity analyses' parameters in future cost-effectiveness analyses.
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Affiliation(s)
- Laure Daval
- Hôtel-Dieu, URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; INSERM, ECEVE, U1123, Paris, France; Université de Paris, Paris, France.
| | - Arnaud Nze Ossima
- Hôtel-Dieu, URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; INSERM, ECEVE, U1123, Paris, France; Université de Paris, Paris, France
| | - Marie-Caroline Clément
- Hôtel-Dieu, URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Morgane Michel
- Hôtel-Dieu, URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; INSERM, ECEVE, U1123, Paris, France; Université de Paris, Paris, France; Unité d'Epidémiologie Clinique, Hôpital Robert Debré, AP-HP, Paris, France
| | - Karine Chevreul
- Hôtel-Dieu, URC Eco Ile-de-France, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; INSERM, ECEVE, U1123, Paris, France; Université de Paris, Paris, France; Unité d'Epidémiologie Clinique, Hôpital Robert Debré, AP-HP, Paris, France
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24
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Michel M, Le Page E, Laplaud DA, Wardi R, Lebrun C, Zagnoli F, Wiertlewski S, Coustans M, Edan G, Chevreul K, Veillard D. Cost-utility of oral methylprednisolone in the treatment of multiple sclerosis relapses: Results from the COPOUSEP trial. Rev Neurol (Paris) 2021; 178:241-248. [PMID: 34598781 DOI: 10.1016/j.neurol.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have shown that oral high-dose methylprednisolone (MP) is non-inferior to intravenous MP in treating multiple sclerosis relapses in terms of effectiveness and tolerance. In order to assist with resource allocation and decision-making, its cost-effectiveness must also be assessed. Our objective was to evaluate the cost-utility of per os high-dose MP as well as the cost-savings associated with implementing the strategy. METHODS A cost-utility analysis at 28 days was carried out using data from the French COPOUSEP multicenter, double-blind randomized controlled non-inferiority trial and the statutory health insurance reimbursement database. Costs were calculated using a societal perspective, including both direct and indirect costs. An incremental cost-effectiveness ratio was calculated and bootstrapping methods assessed the uncertainty surrounding the results. An alternative scenario analysis in which MP was administered at home was also carried out. A budgetary impact analysis was carried at five years. RESULTS In the conditions of the trial (hospitalized patients), there was no significant difference in utilities and costs at 28 days. The incremental cost-effectiveness ratio was €15,360 per quality-adjusted life-year gained. If multiple sclerosis relapses were treated at home, oral MP would be more effective, less costly and associated with annual savings up to 25 million euros for the French healthcare system. CONCLUSIONS Oral MP is cost-effective in the treatment of multiple sclerosis relapses and associated with major savings.
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Affiliation(s)
- M Michel
- AP-HP, URC Eco Ile-de-France, DRCI, Paris, France/Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, ECEVE, Inserm, 75010 Paris, France; Inserm, ECEVE, U1123, Paris, France
| | - E Le Page
- Clinical Neuroscience Centre, CIC-P 1414 Inserm, Rennes University Hospital, Rennes, France
| | - D A Laplaud
- UMR1064, Inserm, and CIC015, Inserm, Nantes, France
| | - R Wardi
- Neurology Department, Saint Brieuc Hospital, Saint-Brieuc, France
| | - C Lebrun
- Neurology Department, Nice University Hospital, Nice, France
| | - F Zagnoli
- Neurology Department, Military Hospital, Brest, France
| | - S Wiertlewski
- Neurology Department, Nantes University Hospital, Nantes, France
| | - M Coustans
- Neurology Department, Quimper Hospital, Quimper, France
| | - G Edan
- Clinical Neuroscience Centre, CIC-P 1414 Inserm, Rennes University Hospital, Rennes, France
| | - K Chevreul
- AP-HP, URC Eco Ile-de-France, DRCI, Paris, France/Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, ECEVE, Inserm, 75010 Paris, France; Inserm, ECEVE, U1123, Paris, France
| | - D Veillard
- Epidemiology and Public Health Department, Rennes University Hospital, Rennes, France.
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Prigent A, Vinet MA, Michel M, Rozé M, Riquin E, Duverger P, Rousseau D, Chevreul K. The cost of child abuse and neglect in France: The case of children in placement before their fourth birthday. Child Abuse Negl 2021; 118:105129. [PMID: 34058479 DOI: 10.1016/j.chiabu.2021.105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available. OBJECTIVE To estimate the cost of abuse and neglect in children in placement before their 4th birthday in France. PARTICIPANTS AND SETTING A cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care. METHODS Child protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery. RESULTS 129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors. CONCLUSION More research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.
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Affiliation(s)
- Amélie Prigent
- Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, Paris, France; INSERM, ECEVE UMR 1123, Paris, France; Université de Paris, ECEVE, Paris, France
| | - Marie-Amélie Vinet
- Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, Paris, France; INSERM, ECEVE UMR 1123, Paris, France; Université de Paris, ECEVE, Paris, France
| | - Morgane Michel
- Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, Paris, France; INSERM, ECEVE UMR 1123, Paris, France; Université de Paris, ECEVE, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France.
| | | | | | | | | | - Karine Chevreul
- Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco Ile-de-France, Paris, France; INSERM, ECEVE UMR 1123, Paris, France; Université de Paris, ECEVE, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
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Salvador-Carulla L, Fernandez A, Sarma H, Mendoza J, Wands M, Gandre C, Chevreul K, Lukersmith S. Impact of Ed-LinQ: A Public Policy Strategy to Facilitate Engagement between Schools and the Mental Health Care System in Queensland, Australia. Int J Environ Res Public Health 2021; 18:ijerph18157924. [PMID: 34360229 PMCID: PMC8345643 DOI: 10.3390/ijerph18157924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Ed-LinQ is a mental health policy initiative to enhance the early detection and treatment of children with mental illness by improving the liaison between schools and health services in Queensland, Australia. We measured its impact from policy to practice to inform further program developments and public strategies. We followed a mixed quantitative/qualitative approach. The Adoption Impact Ladder (AIL) was used to analyse the adoption of this initiative by end-users (decision makers both in the health and education sectors) and the penetration of the initiative in the school sector. Survey respondents included representatives of schools (n = 186) and mental health providers (n = 78). In total, 63% of the school representative respondents were at least aware of the existence of the Ed-LinQ initiative, 74% were satisfied with the initiative and 28% of the respondent schools adopted the initiative to a significant extent. Adoption was higher in urban districts and in the health sector. The overall level of penetration in the school sector of Queensland was low (3%). The qualitative analysis indicated an improvement in the referral and communication processes between schools and the health sectors and the importance of funding in the implementation of the initiative. Mapping of existing programs is needed to assess the implementation of a new one as well as the design of different implementation strategies for urban and rural areas. Assessing the adoption of health policy strategies and their penetration in a target audience is critical to understand their proportional impacts across a defined ecosystem and constitutes a necessary preliminary step for the evaluation of their quality and efficiency.
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Affiliation(s)
- Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
| | - Ana Fernandez
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Agencia de Salut Publica, 08023 Barcelona, Spain
| | - Haribondhu Sarma
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
| | - John Mendoza
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Marion Wands
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Coralie Gandre
- IRDES, Institut de Recherche et Documentation en Économie de La Santé, 75019 Paris, France;
| | | | - Sue Lukersmith
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Correspondence:
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Turmaine K, Jeannic AL, Dumas A, Chevreul K. Lessons learned from an e-mental health intervention: The promotion of stopblues in 41 french cities. Eur Psychiatry 2021. [PMCID: PMC9470417 DOI: 10.1192/j.eurpsy.2021.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionFor more than a decade, digital health has held promise for enabling a much broader population to have access to health information, education and services. However, the increasing number of studies on the subject show mixed results and currently, there is a certain disillusionment regarding its benefits. And yet, the Covid-19 crisis has revealed the importance of developing digital-based complementary support to existing resources.ObjectivesFactors associated with higher utilization rates among the target audience need to be investigated.MethodsIn 2018, 41 French cities enrolled in an intervention program aimed at promoting StopBlues®, a digital health tool that helps prevent mental distress and suicide among the general population. After two years of experimentation, a Multiple Correspondence Analysis (MCA) was performed using quantitative and qualitative data collection methods from institutional sources, questionnaires and web analytics tools.ResultsFinding trends show that higher utilization rates were associated with the involvement of general practitioners (GPs) in the promotion of StopBlues and the use of digital marketing channels. Context-specific characteristics also played an important role in the adoption of the tool.ConclusionsThe local context has a strong influence on how digital tools are locally promoted and accepted. Further research is needed to understand how local actors and specifically GPs can be involved in suicide prevention. More broadly, the challenge today is to ensure acceptance of digital health technology among targeted populations by adapting the digital offer to their needs and promoting the available tools.DisclosureNo significant relationships.
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Jeannic AL, Turmaine K, Chevreul K. The benefits of involving general practitioners in the promotion of e-health tools for primary prevention of suicide in the general population: The stopblues case. Eur Psychiatry 2021. [PMCID: PMC9470483 DOI: 10.1192/j.eurpsy.2021.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction In France about 10,000 suicides/year are recorded. General practitioners (GPs) have an important role in prevention, with consultation rates between 20% and 76% the day preceding suicide. StopBlues is an application/website for primary prevention of suicide in the general population. Its promotion was supported by municipalities and involved GPs. Objectives To evaluate how the involvement of GPs in the promotion of StopBlues had an impact on its utilization. Methods StopBlues was promoted in 25 French municipalities randomly assigned to a ‘basic’ promotion group organized by municipalities only or an ‘intensified’ promotion group that also includes promotion in GPs’ waiting rooms. StopBlues users were asked how they found out about StopBlues. After two years, an ad hoc questionnaire was sent to all GPs (N=2,111). Results StopBlues users from those municipalities (N=885) were 16% to learn about StopBlues from GPs, 93% of them living in municipalities with ‘intensified’ promotion. In the ‘basic’ group, where no GPs have heard about StopBlues, 15% would like to know more about it/will have a look at it and 8% will use it and recommend it to colleagues. Half of GPs from the ‘intensified’ group had heard about the program, with 24% who recommended StopBlues to some patients. 21% of GPs agreed that they will use it and recommend it to colleagues. Conclusions Involving GPs in the use of e-health tools is of major interest to improve their utilization. Our results show that GPs are in need of those in dealing with patients with psychological pain/distress. Disclosure No significant relationships.
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Daval L, Jeannic AL, Picot-Ngo C, Turmaine K, Chevreul K. Adaptation of a french e-health tool for suicide prevention in young populations: Modalities and benefits. Eur Psychiatry 2021. [PMCID: PMC9470867 DOI: 10.1192/j.eurpsy.2021.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction France’s suicide rate is among the highest in Europe, with the young among the more at risk than others. Several European projects have demonstrated the effectiveness of using e-tools in suicide prevention particularly for hard-to-reach populations. Lessons from StopBlues, an e-health tool (application/website) for suicide prevention in the general population developed in 2018 which was promoted by municipalities and general practitioners, shows the necessity to adapt its content for young people. Objectives The objective is to develop an e-health tool, BlueZberry, for suicide prevention targeting adolescents and young adults with psychological pain by adapting StopBlues and its promotional plan. Methods The detailed content of BlueZberry and its promotional plan were determined via a literature review and 26 individual and group interviews with experts and youth with StopBlues as a starting part. Results The literature review and interviews confirmed the need to adapt the tool according to age of the user since the context and source of psychological pain vary rapidly at this time of life. BlueZberry consists of three modules for age groups 12-14, 15-17 and 18-25 years with specific graphics and messages. Its locally organized promotion should include youth hangouts on top of usual places. Conclusions This adaptation of StopBlues will reach a larger audience by offering a more suitable solution for this vulnerable population. A web-portal will serve as an entry point for both StopBlues and BlueZberry where users will be redirected to one of the tools/modules according to their profile and respective needs.
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Picot-Ngo C, Kivits J, Chevreul K. Réduire le tabagisme dans les prisons : éléments théoriques et méthodologiques nécessaires à la co-construction d’une intervention en contexte pénitentiaire. Glob Health Promot 2021. [DOI: 10.1177/1757975921993434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Révélateur des inégalités sociales de santé, le tabagisme en établissement pénitentiaire exige des interventions visant sa réduction d’être adaptées aux spécificités du milieu carcéral. Dans le cadre de la recherche interventionnelle TABAPRI, nous avons mobilisé une première étude sociologique afin d’apporter des connaissances sur cette problématique. Une enquête a été réalisée au sein de trois établissements pénitentiaires, précédant les phases de construction, d’implémentation et d’évaluation de l’intervention. Cet article décrit d’une part la démarche méthodologique et d’autre part, la contribution de la sociologie, tant dans ses apports conceptuels que méthodologiques, à la construction d’une intervention. Notre travail a notamment souligné l’importance d’aménager des espaces d’échange permettant aux professionnels et aux personnes détenues de construire ensemble les modalités d'intervention qui participent à la réduction du tabagisme en détention.
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Affiliation(s)
- Clément Picot-Ngo
- UMR 1123 Eceve, Institut national de la santé et de la recherche médicale (Inserm), Université de Paris, Paris, France
- Observatoire français des drogues et des toxicomanies (OFDT), Paris, France
| | - Joëlle Kivits
- Université de Lorraine, Unité « Adaptation, mesure et évaluation en santé. Approches interdisciplinaires » (APEMAC), Nancy, France
| | - Karine Chevreul
- UMR 1123 Eceve, Institut national de la santé et de la recherche médicale (Inserm), Université de Paris, Paris, France
- URC Eco Île-de-France (AP-HP, Hôtel Dieu), Paris, France
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Turmaine K, Picot Ngo C, Le Jeannic A, Roelandt JL, Chevreul K, Dumas A. Integration of eMental health technologies into traditional community-based interventions. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Very little research has been conducted to appraise the merits of including municipalities and their local health providers in the promotion of digital health programmes. While more and more municipalities have locally implemented a health strategic plan and have focused on building local network of professionals, how do the latter react to the implementation of innovative e-mental health community-based programmes?
Methods
In 2018, 42 French municipalities volunteered to promote StopBlues, a digital health tool aimed at preventing mental distress and suicide. In each municipality, a local delegate was responsible for the promotion of the tool. Using observations, questionnaires and interviews with the delegates, we analysed how the promotion of StopBlues® was conducted in each setting. 2/3 of these municipalities started the promotion directly, and in 2019, a second wave of municipalities launched the promotion with a stronger support from the research team backed by the French World Health Organization Collaborating Centre for Research and Training in Mental Health (WHOCC).
Results
The use of digital technology in the implementation of a mental health programme received a mixed reception from the local health professionals because of its innovative aspect. 2/3 of the delegates declared that they were struggling to create a stronger network of local partners including private medical practioners. 63% of the respondents stated that their municipalities got involved in the programme for networking purposes.
Conclusions
Digital technologies have initiated a paradigm shift in the way community-based health programmes are set up but need to strengthen their territorial anchorage in order to be accepted and used at the local level.
Key messages
Digital technology can be a strong lever against health inequities but its effectiveness has to be studied carefully. Digital technolgy has to be implemented in local settings with the collaboration of local actors in order to be accepted and used.
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Affiliation(s)
- K Turmaine
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
| | - C Picot Ngo
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
| | - A Le Jeannic
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
- URC-ECO, APHP, Paris, France
| | - J L Roelandt
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
- WHOCC, WHOCC, Lille, France
| | - K Chevreul
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
- URC-ECO, APHP, Paris, France
| | - A Dumas
- ECEVE, Inserm/Université Paris Sorbonne, Paris, France
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Gandré C, Le Jeannic A, Vinet MA, Turmaine K, Courtet P, Roelandt JL, Vaiva G, Giraudeau B, Alberti C, Chevreul K. The PRINTEMPS study: protocol of a cluster-randomized controlled trial of the local promotion of a smartphone application and associated website for the prevention of suicidal behaviors in the adult general population in France. Trials 2020; 21:553. [PMID: 32571432 PMCID: PMC7309990 DOI: 10.1186/s13063-020-04464-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Effective promotion has the potential to maximize the uptake of such programs. However, few e-health programs have been combined with promotion campaigns. The primary objective of this trial is to assess the effectiveness of a tailored promotion, at a local level, of a mobile application and website offering evidence-based content for suicide prevention (the StopBlues program), and to compare the effectiveness of two types of local promotion in terms of their impact on suicidal acts. Secondary objectives focus on the effectiveness of the promotion in terms of the intensity of utilization of the StopBlues program, help-seeking behaviors and the level of psychological impairment of program users. METHODS/DESIGN This is a three-arm, parallel-group, cluster-randomized controlled trial, with before-and-after observation. Thirty-four clusters, corresponding to geographical areas sharing a common local authority in France, will be included. They will be randomly assigned to one of the following arms with a ratio of 1:1:1: a control group; a basic promotion group in which promotion of the StopBlues program will be done by local authorities; and an intensified promotion group in which basic promotion will be supplemented by an additional one in a general practitioner's waiting room. The primary outcome measure will be the number of suicidal acts within each cluster over a 12-month period following the launch of the intervention. Baseline data will be collected for each cluster over the 12-month period prior to the trial. Secondary outcomes will include length of use of the StopBlues program, measures of help-seeking behaviors and level of psychological distress among users of the program, as well as the cost-effectiveness and budgetary impact of its promotion. A more sustained promotion by local authorities will also be implemented after 12 months in the control group and assessed using the same outcome measures. DISCUSSION This research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03565562. Registered on 11 June 2018.
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Affiliation(s)
- Coralie Gandré
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
| | - Anaïs Le Jeannic
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | - Marie-Amélie Vinet
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | | | - Philippe Courtet
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Jean-Luc Roelandt
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, Lille, Hellemmes, France
| | - Guillaume Vaiva
- Department of Adult Psychiatry, CHU Lille, Lille, France
- Centre National de Ressources et Résilience pour le Psychotraumatisme (Cn2r Lille Paris), Lille, France
| | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France
- Tours University, Nantes University, INSERM SPHERE, U1246, Tours, France
| | - Corinne Alberti
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Chevreul
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France.
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France.
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Evans-Lacko S, Courtin E, Fiorillo A, Knapp M, Luciano M, Park AL, Brunn M, Byford S, Chevreul K, Forsman A, Gulacsi L, Haro J, Kennelly B, Knappe S, Lai T, Lasalvia A, Miret M, O'Sullivan C, Obradors-Tarragó C, Rüsch N, Sartorius N, Švab V, van Weeghel J, Van Audenhove C, Wahlbeck K, Zlati A, McDaid D, Thornicroft G. The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature. Eur Psychiatry 2020; 29:381-9. [DOI: 10.1016/j.eurpsy.2014.02.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractStigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
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Michel M, Alberti C, Carel JC, Chevreul K. Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods. Value Health 2020; 23:335-342. [PMID: 32197729 DOI: 10.1016/j.jval.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. METHODS A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. RESULTS A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%. CONCLUSIONS Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.
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Affiliation(s)
- Morgane Michel
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France.
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France; French National Institute of Health and Medical Research, Clinical Investigation Centers, CIC, Paris, France
| | - Jean-Claude Carel
- AP-HP, Hôpital Robert Debré, Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France; INSERM, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France
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Friedl N, Krieger T, Chevreul K, Hazo JB, Holtzmann J, Hoogendoorn M, Kleiboer A, Mathiasen K, Urech A, Riper H, Berger T. Using the Personalized Advantage Index for Individual Treatment Allocation to Blended Treatment or Treatment as Usual for Depression in Secondary Care. J Clin Med 2020; 9:jcm9020490. [PMID: 32054084 PMCID: PMC7073663 DOI: 10.3390/jcm9020490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/02/2023] Open
Abstract
A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based elements in the sense of blended treatment is a new approach to treatment for depression. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to treatment as usual or blended treatment? and (2) Would model-determined treatment allocation using this predictive information and the personalized advantage index (PAI)-approach result in better treatment outcomes? Bayesian model averaging (BMA) was applied to the data of a randomized controlled trial (RCT) comparing the efficacy of treatment as usual and blended treatment in depressive outpatients. Pre-treatment symptomatology and treatment expectancy predicted outcomes irrespective of treatment condition, whereas different prescriptive predictors were found. A PAI of 2.33 PHQ-9 points was found, meaning that patients who would have received the treatment that is optimal for them would have had a post-treatment PHQ-9 score that is two points lower than if they had received the treatment that is suboptimal for them. For 29% of the sample, the PAI was five or greater, which means that a substantial difference between the two treatments was predicted. The use of the PAI approach for clinical practice must be further confirmed in prospective research; the current study supports the identification of specific interventions favorable for specific patients.
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Affiliation(s)
- Nadine Friedl
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
- Correspondence:
| | - Tobias Krieger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
| | - Karine Chevreul
- URC Eco Ile-de-France (AP-HP), Hotel Dieu, 1, Place du Parvis Notre Dame, 75004 Paris, France
| | - Jean Baptiste Hazo
- Eceve, Unit 1123, Inserm, University of Paris, Health Economics Research Unit, Assistance Publique-Hôpitaux de Paris, 75004 Paris, France
| | - Jérôme Holtzmann
- University Hospital Grenoble Alpes, Mood Disorders and Emotional Pathologies Unit, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, 38043 Grenoble, France
| | - Mark Hoogendoorn
- Department of Computer Science, VU University Amsterdam Faculty of Sciences, De Boelelaan 1081m, 1081 HV Amsterdam, The Netherlands
| | - Annet Kleiboer
- Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Kim Mathiasen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense M, Denmark
- Center of Telepsychiatry, University of Southern Denmark, 5000 Odense, Denmark
| | - Antoine Urech
- INSELSPITAL, University Hospital Bern, University Clinic for Neurology, University Acute-Neurorehabilitation Center, 3010 Bern, Switzerland
| | - Heleen Riper
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Thomas Berger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
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Hazo JB, Brunn M, Wykes T, McDaid D, Dorsey M, Demotes-Mainard J, van der Feltz-Cornelis CM, Wahlbeck K, Knappe S, Meyer-Lindenberg A, Obradors-Tarragó C, Haro JM, Leboyer M, Chevreul K. European mental health research resources: Picture and recommendations of the ROAMER project. Eur Neuropsychopharmacol 2019; 29:179-194. [PMID: 30579654 DOI: 10.1016/j.euroneuro.2018.11.1111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis®, On-Course® and Meril® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.
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Affiliation(s)
- Jean-Baptiste Hazo
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France; World Health Organization Collaborating Centre for Research and Training in Mental Health, CCOMS, Lille 59260, Hellemmes, France.
| | - Matthias Brunn
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust, UK
| | - David McDaid
- PSSRU, London School of Economics and Political Science, London, UK
| | - Maya Dorsey
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France
| | | | - Christina M van der Feltz-Cornelis
- Department of Health Sciences, MHARG, University of York, York, United Kingdom; Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | | | - Susanne Knappe
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Andreas Meyer-Lindenberg
- Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, 68159 Mannheim, Germany
| | | | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Sant Boi de llobregat, Universitat de Barcelona, Barcelona, Spain
| | - Marion Leboyer
- Fondation FondaMental, French Scientific Foundation, Créteil, France; AP-HP, Department of Psychiatry of Mondor Hospital, DHU PePSY, Paris-Est-Créteil University (UPEC), Créteil, France; INSERM, U955, Translational Psychiatry, Créteil, France
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France
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Chevreul K, Shand A, Korb D, LeRoux E, Nassar N, Sibony O, Bisits A, Alberti C. Variations in the use of caesarean section: a Comparison between France and Australia. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There has been a rise in obstetric intervention during labour and birth including rates of caesarean section around the world. The rates of caesarean section are lower in France (20%) than Australia (34%). Both countries have universal health care systems. Australia has a well-established program of obstetric benchmarking and national data collection for comparing maternal and perinatal outcomes taking into account maternity units and maternal characteristics. Although the optimal caesarean section rate is not known, variation in caesarean section rates raise questions about what is driving variation in practice and whether the right care is being delivered. The World Health Organisation has recently released non-clinical recommendations aiming to reduce unnecessary caesarean sections, including that births are classified by Robson classification for easier comparison.
Methods
We aim to compare rates of mode of birth in 2 tertiary hospitals- one in France and one in Australia using Robson classification. This project will investigate differences in patient casemix, and obstetric management that may lead to differences in outcome. In addition, we will try to explore differences in the health systems including clinical activity, induction rates, staffing (number, type (medical, nursing, midwifery)), and models of care.
Outcomes
Caesarean section is one of the most common operations performed in hospitals. Important variations of surgical rates raise question regarding whether access to this procedure is optimized. Determining current practice and outcomes of women in two different settings will provide important data to inform hospital practice and further research. In addition, this research may inform national guidelines about indications for caesarean section.
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Affiliation(s)
- K Chevreul
- AP-HP, Hospital Universitaire Robert-Debré, CIC-EC 1426, Obstetrics Department, Paris, France
- Université de Paris, UMR 1123 ECEVE, INSERM, Paris, France
| | - A Shand
- The University of Sydney, Sydney, Australia
- Royal Hospital for Women, Sydney, Australia
| | - D Korb
- AP-HP, Hospital Universitaire Robert-Debré, CIC-EC 1426, Obstetrics Department, Paris, France
- Université de Paris, INSERM U1153, EPOPé, INSERM, Paris, France
| | - E LeRoux
- AP-HP, Hospital Universitaire Robert-Debré, CIC-EC 1426, Obstetrics Department, Paris, France
- Université de Paris, UMR 1123 ECEVE, INSERM, Paris, France
| | - N Nassar
- The University of Sydney, Sydney, Australia
| | - O Sibony
- AP-HP, Hospital Universitaire Robert-Debré, CIC-EC 1426, Obstetrics Department, Paris, France
| | - A Bisits
- Royal Hospital for Women, Sydney, Australia
| | - C Alberti
- AP-HP, Hospital Universitaire Robert-Debré, CIC-EC 1426, Obstetrics Department, Paris, France
- Université de Paris, UMR 1123 ECEVE, INSERM, Paris, France
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Michel M, Hammami AJ, Chevreul K. Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it.
Methods
An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms.
Results
37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients.
Conclusions
Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance.
Key messages
There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.
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Affiliation(s)
- M Michel
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d’Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - A J Hammami
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - K Chevreul
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d’Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
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Le Jeannic A, Gandré C, Vinet MA, Turmaine K, Roelandt JL, Giraudeau B, Alberti C, Chevreul K. StopBlues: a French e-health device to prevent suicide in the general population. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
France is one of the Western European countries most affected by suicide, an epidemiological burden and high societal cost of several million euros/year. Several European projects have either implemented web-based interventions for care of mental disorders or recommended online actions which have demonstrated their effectiveness for suicide prevention.
The objective of the project was the construction of an application and website to prevent suicide in the general population, with its promotion being supported at the local authority level.
Methods
The detailed content of the devices and promotional tools available to local authorities was determined through literature reviews and expert groups (psychiatrists, local authorities’ workers and potential users).
Results
An application and website were constructed with two parts: a public interface with videos (psychological suffering, coping strategies and help available), an emergency button, a map with local resources and contact information (psychiatrists, psychologists, associations...), tips and videos to overcome a period of psychological suffering; and a private interface requiring registration giving access to self-assessment questionnaires and a safety plan to fill in case of crisis. 40 local authorities are involved in StopBlues promotion, with a referent each, responsible of contact with our team, and local organization of promotion.
Conclusions
Since 04-2018, StopBlues is available at www.stopblues.fr and can be downloaded on iOs and Android. Its promotion is part of a cluster randomized trial with 3 arms: a control group with no promotion, a group with promotion by local authorities, and a group with promotion by local authorities and general practitioner’s waiting room. As promotion could have different intensities depending on budgets and referent’s involvement, we decided to extend it for another year, with local authorities of group control receiving additional financial and organizational support.
Key messages
As the first e-health program for suicide primary prevention in the French general population, StopBlues’ main goal is to help people find solutions that suit them and direct them to the right help. Local authorities are a key level to promote primary health prevention programs.
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Affiliation(s)
- A Le Jeannic
- URC Eco, Assistance Publique-Hôpitaux de Paris, Inserm, Paris, France
- UMR1123, Inserm, Paris, France
| | | | - M A Vinet
- URC Eco, Assistance Publique-Hôpitaux de Paris, Inserm, Paris, France
- UMR1123, Inserm, Paris, France
| | | | - J L Roelandt
- UMR1123, Inserm, Paris, France
- Centre Collaborateur de l’Organisation Mondiale de la Santé, Etablissement Public de Santé Mentale Lille-Métropole, Lille, France
| | | | - C Alberti
- UMR1123, Inserm, Paris, France
- UEC CIC 1426, Assistance Publique-Hôpitaux de Paris, Inserm, Paris, France
| | - K Chevreul
- URC Eco, Assistance Publique-Hôpitaux de Paris, Inserm, Paris, France
- UMR1123, Inserm, Paris, France
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Michel M, Hammami J, Vinet MA, Picot-Ngo C, Debroucker F, Gilard M, Chevreul K. Using e-health to shorten treatment delay in patients with severe aortic stenosis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve replacement (TAVR) is a relatively new alternative to open surgery in patients with a severe aortic stenosis at high risk of surgery but there are important variations in treatment delay which can lead to increased morbidity and mortality. Those delays have many causes, including patients’ unawareness of the urgency, delays in obtaining the necessary preoperative tests and organizational factors at the hospital level. The aim of our study was to co-construct an e-health tool for patients and their families to empower them and improve knowledge on the disease and TAVR to ultimately decrease the delay between the medical decision for TAVR and the actual procedure.
Methods
A prospective study was first carried out to identify organizational factors associated with variations in treatment delay (both at the patient and hospital level). A preliminary survey was sent to all TAVR centers in France to understand and describe their organization. Descriptive analyses were then carried out on the answers. In a second step, two focus groups were carried with, the first with patients and carers and the second with healthcare professionals in order to elaborate the e-health tool.
Results
A website has been developed for patients and their families. It includes information in video form on aortic stenosis and its different treatments, on TAVR, the necessary tests required prior to TAVR (with a geolocalisation of available facilities nearby so that patients may know where to go), and what they can expect during the hospital admission and after their release. Patients undergoing TAVR will be informed of the website’s existence by their cardiologist. Web pages intended for healthcare professionals who are not TAVR specialists (general practitioners…) will also be available on the website.
Conclusions
A cluster randomized controlled trial will now test the efficacy and efficiency of the e-health tool in reducing TAVR treatment delay.
Key messages
We built a e-health tool in collaboration with patients, carers and healthcare professionals to increase patients’ knowledge on aortic stenosis and TAVR. The website will provide information through videos to empower patients and ultimately decrease treatment delay and its associated morbi-mortality.
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Affiliation(s)
- M Michel
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - J Hammami
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - M A Vinet
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - C Picot-Ngo
- UMR 1123, INSERM, Université de Paris, Paris, France
| | - F Debroucker
- Économie de la Santé & Remboursement, Medtronic France SAS, Boulogne-Billancourt, France
| | - M Gilard
- Department of Cardiology, University Hospital of Brest, Brest, France
| | - K Chevreul
- URC Eco, Assistance Publique-Hôpitaux de Paris, Paris, France
- UMR 1123, INSERM, Université de Paris, Paris, France
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Abstract
IMPORTANCE In health care systems in which hospital reimbursement is based on a national mean length of stay (LOS), disadvantaged patients with an increased LOS may be a source of inefficiency. This implication has been reported in adult patients, but pediatric data have been scarce. OBJECTIVE To examine the association of patient socioeconomic status with hospital efficiency and financial balance in pediatrics. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the French national hospital discharge database covering a 3-year period, from January 1, 2012, to December 31, 2014. Statistical analyses were performed between June 2016 and December 2018. All inpatient stays in hospital pediatric wards in mainland France by children older than 28 days or younger than 18 years (n = 4 121 187) were included. Admissions with coding errors or missing values for social disadvantage and/or cost calculations were excluded. EXPOSURE Social disadvantage was estimated with an ecological indicator, the FDep, available at the patient's postcode of residence and divided into national quintiles. MAIN OUTCOMES AND MEASURES Efficiency was assessed through the variations in patient LOS compared with different national mean LOS (for pediatric patients, pediatric patients with a similar condition, and pediatric patients with a similar condition and severity level). Hospital financial balance was assessed at the admission level through the ratio of production costs to revenues and at the hospital level through the difference between aggregated revenues and production costs. Multivariate regression models examined the association between these indicators and socioeconomic status. RESULTS A total of 4 121 187 admissions were included (2 336 540 [56.7%] male; mean [SD] age, 7.4 [5.8] years). In all, 1 561 219 patients (37.9%) were in the 2 most disadvantaged quintiles. Patient LOS was shorter than the national mean LOS (mean [SD], 1.73 [4.21] days) for patients in the least disadvantaged quintile and longer for those in the more disadvantaged quintile (mean [SD], 1.67 [4.33] days vs 1.82 [4.14] days). This difference was higher for diagnosis related groups that included both adult and pediatric patients (mean [SD], 1.46 [4.22] days vs 1.61 [4.13] days) compared with those dedicated to pediatric patients (2.22 [4.13] days vs 2.12 [4.53] days). Patients in the most disadvantaged quintile were associated with a 3.2% increase in LOS (odds ratio, 1.0322; 95% CI, 1.0302-1.0341) compared with the national mean LOS. Social disadvantage was also associated with a significant increase in financial deficit for hospitals with 20% to 60% of patients in the 2 most disadvantaged quintiles (estimate: -€146 389; 95% CI, -€279 566 to -€13 213). CONCLUSIONS AND RELEVANCE Patient socioeconomic status appears to be statistically significantly associated with an increase in LOS and cost in French hospitals with pediatric departments. This finding suggests that initiating reform in hospital payment methods may improve resource allocation efficiency and equity in access to pediatric care.
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Affiliation(s)
- Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
| | - Corinne Alberti
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
- Inserm, Centre d'Investigation Clinique (CIC) 1426, Paris, France
| | - Jean-Claude Carel
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Department of Pediatric Endocrinology and Diabetology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Inserm, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
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Nze Ossima A, Michel M, Daval L, Vinet M, Clément M, Chevreul K. Comparaison des méthodes de recueil des consommations de soins des patients inclus dans les projets de recherche clinique intégrant une évaluation médico-économique. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hammami A, Michel M, Gervaix J, Haour G, Chevreul K. Impact des troubles mentaux sur la prise en charge somatique hospitalière et coûts associés. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Daval L, Michel M, Hazo J, Dorsey M, Holtzmann J, Prigent A, Chevreul K. Évaluation médico-économique d’un traitement mixte de la dépression combinant un module de e-santé et une thérapie cognitivo-comportementale en face à face. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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45
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Michel M, Alberti C, Carel J, Chevreul K. Impact de la précarité sur l’efficience hospitalière et la balance financière des établissements en pédiatrie. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Didier R, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lièvre M, Prat A, Teiger E, Lefevre T, Tchetché D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Cuisset T, Le Breton H, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Lognoné T, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. Five-Year Clinical Outcome and Valve Durability After Transcatheter Aortic Valve Replacement in High-Risk Patients. Circulation 2018; 138:2597-2607. [DOI: 10.1161/circulationaha.118.036866] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Karine Chevreul
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Pascal Leprince
- Department of Surgery, Pitié Salpêtrière University Hospital, Paris, France (P.L.)
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | - Michel Lièvre
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Emmanuel Teiger
- Department of Unité de Recherche Clinique en Économie de la Santé D’île-de-France and Cardiology, Creteil University, Paris, France (K.C., E.T.)
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France (P.D.-G., T.L.)
| | - Didier Tchetché
- Department of Cardiology, Clinique Pasteur, Toulouse, France (J.F., D.T.)
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, France (D.C.)
| | - Dominique Himbert
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, France (B.A.)
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, France (H.E., A.C.)
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, France (A.P., A.S.)
| | - Didier Blanchard
- Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris Descartes, France (D.B.)
| | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, France (M.L., G.R.)
| | - Frederic Collet
- Department of Surgery, Clairval Hospital, Marseille, France (F.C.)
| | - Remi Houel
- Department of Cardiology, Saint Joseph Hospital, Marseille, France (R.H.)
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, France (P.D.S.)
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, France (N.M.)
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis-Robinson, France (S.G.)
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, France (T.M.)
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique Nord, Saint Denis, France (P.G.)
| | - Thomas Cuisset
- Department of Cardiology, Marseille University Hospital, France (T.C.)
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, France (A.L., H.L.B.)
| | | | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France (X.F.)
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, France (G.S.)
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, France (P.O.)
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France (V.D.)
| | - Thérèse Lognoné
- Department of Cardiology, Saint-Malo Hospital, France (T.L.)
| | | | | | - Francois Bourlon
- Department of Cardiology, Centre Cardio-Thoracique, Monaco (F.B.)
| | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, France (B.B.)
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat Hospital, Paris-Diderot University, DHU Fire, France (D.H., B.I.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (R.D., M.G.)
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Bastian K, Hollinger A, Mebazaa A, Azoulay E, Féliot E, Chevreul K, Fournier MC, Guidet B, Michel M, Montravers P, Pili-Floury S, Sonneville R, Siegemund M, Gayat E. Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study. Intensive Care Med 2018; 44:2025-2037. [PMID: 30353380 PMCID: PMC7095041 DOI: 10.1007/s00134-018-5412-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/10/2018] [Indexed: 11/25/2022]
Abstract
Purpose Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible for poor long-term outcomes would be beneficial in designing targeted interventions for at-risk populations. Methods For an endpoint analysis, 1834 intensive care unit patients with known French Deprivation Index (FDep) scores were included from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study, which was a prospective, observational, multicenter cohort study performed in 20 French intensive care units in 13 different hospitals. Socioeconomic status was defined by using the FDep score [represented as quintiles when referring to the general French population, as quintiles when referring to the FROG-ICU cohort, or as dichotomized data (which was defined as a FDep ≤ 0 for nondeprived patients)] and by using a detailed social questionnaire that was completed 3 months after discharge. The primary outcome included an all-cause, 1-year mortality after ICU discharge when regarding socioeconomic status. The secondary outcomes included both ICU and hospital lengths of stay, both short- and medium-term mortality, and the quality of life, as assessed during the 1-year follow-up by using the Medical Outcome Survey Short Form-36 (SF-36). The Revised Impact of Event Scale (IES-R) was used to evaluate the symptoms of post-traumatic stress disorder, and the Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Results Of the 1447 patients who were discharged alive from the ICU, 19.2% died over the following year. No association was found between 1-year mortality and socioeconomic status, regardless of whether this association was analyzed in quintiles (p = 0.911 in the quintiles of the general French population; p = 0.589 in the quintiles of the FROG-ICU cohort itself) or as dichotomized data [nondeprived (n = 177; 1-year mortality of 18.2%) versus deprived (n = 97; 1-year mortality of 20.5%; p = 0.304)]. Moreover, no differences were found between the nondeprived and the deprived patients in the ICU and hospital lengths of stay, ICU mortalities, in-hospital mortalities, or 28-day mortalities. The SF-36 was below the score for the normal French population throughout the follow-up period. Socially deprived patients showed significantly lower median scores in the physical function subscale [55, interquartile range (IQR) (28.8–80) vs. 65, IQR (35–90); p = 0.014], the physical role subscale [25, IQR (0–75) vs. 33.3, IQR (0–100); p = 0.022], and the overall physical component scale [47.5, IQR (30–68.8) vs. 54.4, IQR (35–78.8); p = 0.010]. Up to 31.6% of survivors presented symptoms that indicated post-traumatic stress disorder, and up to 31.5% of survivors reported clinically meaningful symptoms of anxiety or depression. Conclusions A lower socioeconomic status was associated with lower self-reported physical component scores in the nondeprived patients. Psychiatric symptoms are frequently reported after an ICU stay, and subsequent interventions should target those fields. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1007/s00134-018-5412-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen Bastian
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexa Hollinger
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elodie Féliot
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Karine Chevreul
- INSERM UMR1123, Paris, France
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Marie-Céline Fournier
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Philippe Montravers
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
- Department of Anesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, Besançon, France
- EA 3920, University of Bourgogne Franche-Comté, Besançon, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude, Paris, France
| | - Martin Siegemund
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Etienne Gayat
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
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48
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Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, Park AL, McDaid D, Sfetcu R, Kalseth J, Kalseth B, Hope Ø, Brunn M, Chevreul K, Straßmayr C, Hagmair G, Wahlbeck K, Amaddeo F. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci 2018; 29:e6. [PMID: 30328401 PMCID: PMC8061296 DOI: 10.1017/s2045796018000574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/17/2018] [Accepted: 09/10/2018] [Indexed: 12/02/2022] Open
Abstract
AIMS Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. 'Core health care' refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. 'Other care' is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, 'other care' does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify 'core health' and 'other care' services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services. METHODS The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or 'Main Types of Care' (MTC) as the standard for international comparison, following the DESDE-LTC system. RESULTS In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as 'other care', significant variation was found in the typology and characteristics of these services across the eight study areas. CONCLUSIONS The functional distinction between core health and other care overcomes the traditional division between 'health' and 'social' sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
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Affiliation(s)
- G. Cetrano
- Social Care Workforce Research Unit, King's Policy Institute, King's College London, London, UK
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- PSICOST Research Association, Jerez de la Frontera, Spain
| | - F. Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M. R. Gutiérrez-Colosía
- PSICOST Research Association, Jerez de la Frontera, Spain
- Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain
| | | | - A.-L. Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - D. McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - R. Sfetcu
- Institute for Economic Forecasting, Bucharest, Romania
- Faculty of Psychology and Educational Sciences, University Spiru Haret, Bucharest, Romania
| | - J. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - B. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Ø. Hope
- Department of Health Research, SINTEF, Trondheim, Norway
| | - M. Brunn
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | - K. Chevreul
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | | | - G. Hagmair
- IMEHPS.research, Vienna, Austria
- Department for Cultural Analysis, Universitaet Klagenfurt, Klagenfurt, Austria
| | - K. Wahlbeck
- Department of Mental Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - F. Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Chevreul K, Gandré C, Gervaix J, Thillard J, Alberti C, Meurs D. Gender and access to professorships in academic medical settings in France. Med Educ 2018; 52:1073-1082. [PMID: 30125395 DOI: 10.1111/medu.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/21/2017] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Previous studies, mainly originating from North America, suggest that women are less likely than men to obtain professorships in academic medical settings. However, research providing a comprehensive picture of such gender disparities in other national contexts and addressing associated contextual factors is lacking. OBJECTIVES Our objectives were to assess gender differences in access to professorships in academic medical settings in France, to determine their evolution across regions and medical specialties and over time, and to identify the factors associated with the likelihood of a professor being a woman. METHODS We carried out a national administrative cohort study of all new professors appointed during 1989-2015 in all medical specialties in the whole of France. We first conducted a descriptive analysis of the percentage of professorships awarded to women and its variations by time, region and specialty. We then ran a logistic regression model to determine factors significantly associated with the likelihood of a professor being a woman. RESULTS Between 1989 and 2015, 3950 professors were appointed, of whom fewer than one in five were women. Female professors consistently represented a minority in all French regions and specialties over the study period. Although a small increase was observed over the years, women never represented more than 29% of newly appointed professors. After adjustments for other factors, the likelihood of a professor being a woman was significantly higher in specialties with a higher percentage of women among hospital practitioners, in regions with higher numbers of appointed professors and in recent years. CONCLUSIONS Gender inequalities in career evolution exist in academic medical settings in France and have continued over time despite moderate improvements. Increased awareness based on scientific evidence is a first step towards reducing such inequalities.
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Affiliation(s)
- Karine Chevreul
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Coralie Gandré
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Jeanne Gervaix
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Julien Thillard
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- URC-Eco, Public Service Hospitals of Paris (Assistance Publique-Hopitaux de Paris [AP-HP]), Paris, France
| | - Corinne Alberti
- UMRS 1123, Clinical Epidemiology and Economic Evaluation applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
- French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [Inserm]), U1123, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert-Debré Hospital, AP-HP, Paris, France
| | - Dominique Meurs
- EconomiX, University of Paris Nanterre, Paris, France
- National Institute for Demographic Studies (Institut National d'Études Démographiques [INED]), Paris, France
- Centre for Applied Economic Research (Centre pour la Recherche Économique et ses Applications [CEPREMAP]), Paris, France
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Roussel A, Michel M, Lefevre-Utile A, De Pontual L, Faye A, Chevreul K. Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments. Arch Pediatr 2018; 25:359-364. [PMID: 30041884 DOI: 10.1016/j.arcped.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris. METHODS We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint. RESULTS A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation. CONCLUSION There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.
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Affiliation(s)
- A Roussel
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France.
| | - M Michel
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - A Lefevre-Utile
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - L De Pontual
- Service de pédiatrie générale, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France
| | - K Chevreul
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
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