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Évaluation du maintien par le médecin traitant des modifications thérapeutiques effectuées dans un service de post urgence
Mémoire de Master / Thèse d'exercice   Open Access

Évaluation du maintien par le médecin traitant des modifications thérapeutiques effectuées dans un service de post urgence

Yoan Maggiorani
Masters , Université de Montpellier
31/05/2018

Résumé

Continuity of care Prescriptions Médecine générale Médecine interne Hospitalisation Sortie du patient Continuité des soins General practice Internal medicine Hospitalization Patient discharge
Hospital discharge is a critical moment for continuity of medical care. The hospital practitioners make many changes to the patient’s usual treatments. Few studies have analyzed the rates of maintenance of therapeutic modifications by the general practitioner and none according to the therapeutic subclasses. Our study pointed out the rate of maintenance of therapeutic modifications carried out in the DIAGORA department, by questioning 2 months after the patient’s discharge, their general practitioners. 1st stage: analytical, observational, retrospective study, in the DIAGORA department. Inclusion for 3 months of all discharge patients at home. The previous prescriptions and those after discharge were compared to identify therapeutic changes based on ATC subclasses. 2nd stage: follow-up at 2 months by questioning the general practitioners of the concerned patients. Evaluation of the rate of maintenance of the modifications (and the reasons) according to the subclasses ATC.64 patients (mean 79,5 yo) were included in this study. For 69% of them, a hospital therapeutic modification was made. Cardiovascular and gastrointestinal treatments have been more overhauled. Follow-up with general practitioners included 37 workable survey. 75% of therapeutic modifications were followed, 76% for adding and 74% for removals (P=0, 87). The least followed modifications were the additions of psycholeptics. For the treating physicians interviewed the information on the therapeutic modifications was paramount and it was considered globally satisfactory for the service of DIAGORA. However, a lack of communication on the justification of the changes has been reported by some doctors. Our original quantitative study has shown a coherence between hospital care and primary health care about the therapeutic changes, communication being a key element.

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