[Costs of healthcare resource consumption after a myocardial infarction in France: An estimate from a medicoadministrative database (GSB)]. / Coût des consommations de soins après un infarctus du myocarde en France : une estimation à partir de l'échantillon généraliste des bénéficiaires (EGB).

OBJECTIVE: To estimate the costs of healthcare resource consumption in the year preceding and the year following a myocardial infarction (MI). PATIENTS AND METHODS: A historical cohort of patients experiencing an MI in France between 2007 and 2011 was extracted from the échantillon généraliste de bénéficiaires, a 1/97th sample of all beneficiaries of public health insurance in France. RESULTS: A total of 1920 patients experiencing an MI were identified. Two-thirds were men and the mean age was 67 years; 20.6% had diabetes, 37.6% hypercholesterolaemia and 82.4% hypertension. From a societal perspective, the annual costs of medical consumption related to hospitalisations increased from € 4548 before the MI to € 6470 in the following year. Costs of community care rose from € 2932 to € 6208. This increase concerned all components of community healthcare: costs associated with medical transportation increased fourfold, those associated with consultations and laboratory tests tripled, medication costs doubled and costs of paramedical services also increased, but to a lesser extent. It should be noted that the cost of hospitalisation for the index MI (€ 5876) is not included in the above costs. CONCLUSION: From a society perspective, the cost of healthcare resource consumption increased threefold in the year following an MI.

Parkinson's disease incidence and prevalence assessment in France using the national healthcare insurance database.

BACKGROUND AND PURPOSE: The incidence and prevalence of Parkinson's disease are important for public health planning yet there is a lack of representative, up-to-date estimations for France. METHODS: For this cross-sectional study, subjects with suspected Parkinson's were identified in the EGB database, a 1/97 random sample of the national healthcare insurance database, linked to the national hospital-discharge summary database. Incidence and prevalence were estimated using a specific definition that included those with a diagnosis (hospitalization or listed as a long-term chronic disease for full reimbursement) and a sensitive definition that also included those with an indicative drug reimbursement profile. Estimations were extrapolated to the national population, standardizing on age and gender. RESULTS: According to either the specific or the sensitive definitions, the annual incidence of Parkinson's disease during the study period was respectively 36 and 49 per 100,000 person-years and prevalence in 2010 was 308-410 per 100,000 persons in the population as a whole. According to the age groups 55-64, 65-74, 75-84 and ≥85 years incidence was respectively 33-46, 139-172, 301-363 and 442-560 per 100,000 person-years amongst men and 32-55, 81-117, 203-270 and 251-313 per 100,000 person-years amongst women. The 2010 prevalence stratified by the same age groups was 293-376, 898-1161, 2524-3011 and 3760-4578 per 100,000 persons amongst men and 199-351, 618-889, 1910-2433 and 2504-3263 per 100,000 persons amongst women. CONCLUSIONS: The specific and sensitive definitions of disease bracket the true values; the relatively small range indicates that the current study provides good estimations of incidence and prevalence of Parkinson's disease for recent years in France.

PT1-7 Balneotherapy for common metabolic conditions - the French experience / 日本温泉気候物理医学会雑誌

  Overweight, obesity and the metabolic syndrome are usual conditions treated in french balneotherapy care facilities. 42,507 patients were treated last year in France for metabolic conditions, most of them benefiting a social security reimbursed treatment. The therapeutic intervention core is made of hydro-thermal cares: drinking mineral water (alkaline sodium bicarbonated water), individual mineral water bathing, showers, massages under mineral water, mineral water pool collective exercise; education on nutritional concepts, adapted physical activity are also essential informations delivered in group or customized sessions. AFRETH promoted two clinical studies investigating the topic.   The randomised controlled trial Maathermes (1) assessed the benefit of the intervention on 257 overweight or obese patients randomized between balneotherapy (delivered in Brides, Capvern, Vals, Vichy, Vittel) and a control group (usual care and booklet on nutrition from the french health autorithy). At month 14th, the patients treated in the balneotherapy group showed a significant weight reduction (5.17 kg vs .54 kg ; p<.001) and they had more perspective to reach a stable weight loss of 5% (57.1% vs 18.6 % ; p<.001).   Prisme (2), a feasability cohort study, investigated the results of the intervention in 93 patients with a metabolic syndrome treated in Eugenie les Bains. At month 12th, 67 patients could be assessed. Metabolic syndrome had disappeared in 76% of the patients (glycemia normalised in 15%, waist circumference returned to acceptable in 15%, lipidic disorders disappeared in 33% ; blood pressure had acceptable values, without increased drug intake, in 67%.). 75 % of the patients were continuing the adapted physical activity, 65 % had a correct lipid intake.   Balneotherapy is useful for patients with overweight or obesity. Education during the stay is helpful for the weight and metabolic syndrome control. The medico-economic benefit of such an intervention remains to be established on scientific basis.

[Who are patients suffering from bipolar disorders in France? The TEMPPO survey: patients' sociodemographic and clinical characteristics data]. / Caractéristiques sociodémographiques et cliniques de patients souffrant de troubles bipolaires suivis en ambulatoire en France métropolitaine.

AIM: One of the aims of the TEMPPO study was to describe the sociodemographic and clinical characteristics of a cohort of adult outpatients with type I or type II bipolar disorders (as defined by DSM-IV criteria) in France. METHODS: TEMPPO is a multicenter, cross-sectional, non-interventional study conducted in France between November 2008 and May 2009, with a random sample of academic and private practice psychiatrists. Each psychiatrist who agreed to participate in the study had to: complete a register with data on all consecutive patients (up to 20 patients) consulting during a 2-month period and fulfilling inclusion criteria; include in the study the first five patients of the register with an on-going consultation for at least 6 months; for each of which a detailed questionnaire had been assessed, notably their sociodemographic and bipolar clinical characteristics. Adult outpatients diagnosed with bipolar disorders (BD) were enrolled if fulfilling the following inclusion criteria: man or woman, aged 18 and above, diagnosed bipolar type I or II according to DSM-IV criteria, treated (whatever the treatment strategy) or not, and followed-up for at least 6 months by the participating psychiatrist. RESULTS: One hundred and thirty-five psychiatrists included 619 patients with bipolar disorder (197 and 422 followed-up in public and private practice respectively). The estimated prevalence of patients with bipolar disorders consulting psychiatrists was 0.43%. Type I bipolar disorder was the most frequent condition (58% of the patients). As a whole, bipolar disorder was associated with severe handicap (mean global disease Clinical Global Impression [CGI]-Severity score of 4.4 and mean GAF [Global Assessment of Functioning] score of 59), with more depressive episodes than manic episodes (6 vs. 4) or hypomania (6 vs. 3), a high proportion of rapid cycles (11%), psychiatric comorbidities (45% of patients), obesity (16% of patients), libido dysfunction and associated psychotic symptoms. Current manic phase was associated with more pronounced illness severity and lowest functioning. More than half of the patients (57%) had a family history of psychiatric disorders. CONCLUSION: This study could shed some light for a better understanding of demographics and clinical patterns of patients with bipolar disorders consulting psychiatrists in France. The results emphasize the severity of bipolar disorders with mainly depressive episodes, a high proportion of rapid-cycling, comorbidities and associated psychotic symptoms; these characteristics being more marked in patients suffering from BD I. Furthermore, this study confirms the strong negative impact on social and professional life of French bipolar patients, requiring specific management in addition to the symptomatic treatment.

[Treatment practices in the management of patients with bipolar disorder in France. The TEMPPO study]. / Pratiques thérapeutiques dans la prise en charge des patients souffrant de troubles bipolaires en France. Étude TEMPPO.

TEMPPO is an observational, cross-sectional and multicentre study, initiated in the French metropolitan territory in 2009. Set up from a random sample of 135 psychiatrists, it has observed the procedures for therapeutic management of a population (n=619) of their outpatients (respectively 197 and 422 in public and private practice) with bipolar disorder type I or II disorders (DSM-IV). The patients who were followed were mostly very sick. Every patient received a pharmacological treatment. The prescription included at least one mood stabilizer or an antipsychotic (71 % atypical) in 78 % and 56 % of cases respectively. Treatment regimen changes were frequent (61 % of patients had at least one change in treatment during the last 12 months). A single molecule by therapeutic class was generally prescribed. The presence of an antipsychotic in combination therapy was often associated with the severity or difficulty of care of the patient (mixed states, severity of the global functioning impairment, manic states, high number of hospitalizations and history of suicide attempt). The combination of two antipsychotics is found only in the difficult situations of manic states. Patients with severe depressive phase are those who benefit from the combination mood stabilizer+antipsychotic+antidepressant (16 % of the sample). In this study, the prescription of antidepressants significantly differs from recommendations for good prescribing practices. Indeed antidepressants were commonly prescribed in mixed-phase (63 %), particularly as a monotherapy in 5 % of cases. It was also found in patients in euthymic phase (48 %), manic phase (12 %) and hypomanic phase (29 %). The prescription of atypical antipsychotics (monotherapy or combination) is now fully established in the management of all phases of the disease. The importance of non-pharmacological treatment is acknowledged by psychiatrists and proposed whether a psychotherapeutic support, information about the disease and/or lifestyle changes. The data collected in this study allowed to demonstrate that the participant psychiatrists have a pharmacological management of patients with bipolar disorder mostly in line with national and international guidelines.

Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database.

AIMS/HYPOTHESIS: Using the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010. METHODS: We used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥ 80% use time) users of insulin glargine compared with equivalent human insulin users. RESULTS: Only type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87). CONCLUSIONS/INTERPRETATION: There was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.

When patients report diseases that prescribers seem unaware of: discordance between patient and physician reporting of risk-related previous history in NSAID users from the CADEUS study.

Prescribers are often unaware of possibly dangerous previous medical histories (PMHs) of their patients. Data from a study of nonsteroidal anti-inflammatory drug (NSAID) users served to identify factors associated with this lack of awareness. In this study, we analyzed the factors that may have led prescribers to report the absence of some PMHs that the patients reported as being present. Of 26,618 patients prescribed an NSAID, 469 (1.7%) reported a PMH of unstable angina, 648 (2.4%) reported heart failure, 2,244 (8.4%) reported gastric or duodenal ulcer, 489 (1.8%) reported upper gastrointestinal tract bleeding (UGIB), 5,343 (20.0%) reported gastroesophageal reflux disease (GERD), and 7,832 (29.4%) reported dyspepsia. Between 64 (GERD) and 92% (UGIB) of these patient-reported PMHs were absent in the corresponding prescribers' reports. This discordance was associated with the following factors: patients of younger age, female patients, less frequent patient-prescriber contact, prescription of NSAID by a specialist, no recent specialist consultation, hospitalization or surgery related to the PMH, and no dispensation of proton-pump inhibitors (PPIs) for digestive disorder-related PMHs. The study showed that a substantial proportion of prescribers seemed unaware of the presence of risk-related PMHs that the patient reported when asked.

Channelling of COX-2 inhibitors to patients at higher gastrointestinal risk but not at lower cardiovascular risk: the Cox2 inhibitors and tNSAIDs description of users (CADEUS) study.

PURPOSE: To describe the characteristics of users of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective non-steroidal anti-inflammatory drugs (tNSAIDs) in France. METHODS: Between 1 August 2003 and 31 July 2004, patients who received at least one dispensing of celecoxib, rofecoxib or tNSAIDs were randomly sampled with a 1:1:2 target ratio within the French National Healthcare Insurance database. Patients and prescribers were asked to fill a questionnaire on socio-demographic characteristics, NSAID indication and use and previous medical history. For each respondent, healthcare resources used in the 6 months before inclusion were extracted from the database. Multivariate logistic regression was used to study the determinants of a first COX-2 inhibitor dispensing. RESULTS: Of the 45 217 patients included, 13 065 COX-2 inhibitors and 13 553 tNSAID users had prescriber data. Ninety seven per cent of COX-2 inhibitor prescriptions were for 'rheumatological' indications, whereas 37% of tNSAIDs use was for benign diseases (n = 2643) or analgesia (n = 2318). Among patients with rheumatological indications (n = 4730) and a first COX-2 inhibitor (n = 2427) or tNSAID (n = 2303) dispensing, multivariate analysis of factors associated with COX-2 inhibitors dispensing showed that, compared to new tNSAID users, new COX-2 inhibitor users were older, more often female, on sick leave or unemployed. COX-2 use was also associated with previous gastrointestinal history and previous gastroprotective agent dispensing, but not with previous cardiovascular (CV) history. CONCLUSION: The choice of NSAID depended largely on indication and on previous gastrointestinal history, in line with the recommendations of the French health authorities. Possible knowledge of CV risk associated with COX-2 inhibitors did not influence prescribing.

The CADEUS study: methods and logistics.

PURPOSE: At the request of the French Health authorities, a study called CADEUS (COX-2 inhibitors and NSAIDs: description of users) aimed to describe the users of cyclo-oxygenase (COX)-2 inhibitors and traditional non-selective non-steroidal anti-inflammatory drugs (tNSAIDs). We report here the methodology, logistics and study design performances. METHODS: CADEUS is a cohort study designed to include 40,000 patients randomly sampled monthly in the French National Healthcare Insurance database, who received at least one dispensation of celecoxib, rofecoxib or tNSAIDs (1:1:2), from September 2003 to August 2004. Patients and prescribers were asked to fill a questionnaire on indication, medical history, risk factors and hospitalizations since drug acquisition. There was no reminder. For each respondent, healthcare resources used for the 6 months before and after inclusion were extracted from the database. Response rate, response delay, responders and non-responders characteristics were assessed. RESULTS: Of the 222,879 patients and their prescribers contacted, 20.8% patients and 32.6% prescribers responded. Median response delay was 16 days for patients and 17 days for physicians. Factors associated with patient response were age, cohort, type of prescriber and period of inclusion. CONCLUSION: This is the first study of this design in France, combining data from a claims database and direct patient and prescriber questionnaires.

A prospective study of the evolution of lamivudine resistance mutations in patients with chronic hepatitis B treated with lamivudine.

Lamivudine resistance has been described in subjects with chronic hepatitis B infections, associated with mutations in the viral polymerase gene. The objective of this study was to estimate the emergence rate of lamivudine-resistant viral strains and their consequences over a 2-year period. We evaluated 283 lamivudine-naïve subjects with chronic hepatitis B. Clinical and virological features were assessed at inclusion and every 6 months thereafter. Viral DNA was characterized using polymerase chain reaction (PCR)-based sequencing. Potential risk factors for the emergence of lamivudine resistance mutations were assessed using logistic regression analysis. The annualized incidence rate for viral polymerase mutations was 22%. The only independent risk factor identified was high viral load, at inclusion. Detectable viral DNA and elevated transaminases were more frequent in subjects harbouring mutant viral strains, and these underwent a lower rate of hepatitis B e seroconversion. All subjects responded favourably to treatment, with no difference in symptoms between the two groups. This prospective cohort study identified lamivudine-resistant mutations emerging in 22% of subjects, yearly, which were apparently not associated with clinical aggravation over the study period.

[Neuroleptic drug utilization among schizophrenic outpatients]. / Utilisation des neuroleptiques chez les patients ambulatoires souffrant de schizophrénie.

BACKGROUND: Our objective was to describe and compare neuroleptic drug utilization patterns among French schizophrenic outpatients in public and private care settings. METHODS: A cross sectional survey was carried out by a random sample of 61 public and 112 private psychiatrists who registered for one month all schizophrenic adult outpatients treated with a neuroleptic drug. Among registered patients, each psychiatrist was to include a maximum of 18 patients (public setting) or 9 patients (private setting). Statistical analysis was weighted to take into account for psychiatrist activity level, assessed by patient registration. RESULTS: Psychiatrists included 934 patients in the public care setting and 927 patients in the private care setting. Patients were (mean+/-sd) 40.1+/-12.1 years old, 60.9% men. The patients' social and clinical characteristics were less favorable in the public setting than in the private setting: no professional activity (78.9% vs 65.1%), living in institution (7.2% vs 3.7%), under legal protection (35.1% vs 14.5%), drug abuse (9.6% vs 5.6%). An atypical neuroleptic was prescribed for 63.0% of patients and a classic neuroleptic for 49.7%, an association of neuroleptics for 22.0%. In both settings, the most prescribed neuroleptics were olanzapine (28.0%) and risperidone (18.6%) with a higher mean daily dosage in the public care setting. At least one neuroleptic treatment change (drug and/or dosage) occurred during the previous year for 44.9% and 39.2% patients, in public and private settings, respectively. In both settings, reasons for changes were mainly lack of efficacy (55.1%) and side effects (49.8%). CONCLUSION: Public and private care populations were different but not as much as expected. In both settings, atypical neuroleptics were the predominant drugs used in the treatment of schizophrenia outpatients. The high frequency of drug change for lack of efficacy or side effects demonstrates the difficulties with the use of the present neuroleptic armamentarium.

Assessment of migraine severity using the MIGSEV scale: relationship to migraine features and quality of life.

We have recently developed an instrument to describe and categorize severity of migraine attacks from patient self-report, the MIGSEV questionnaire. We have now performed a large prospective survey using this tool to evaluate migraine severity in 2979 patients consulting for headache in France, included by 1164 general practitioners, 174 neurologists and 82 gynaecologists. The objective of the study was to determine the prevalence of severity grades in a large population who consults for migraine, to test the concordance between severity calculated from physician-derived and patient-derived data, and to test the relevance of the concept of severity as applied to diagnosis, other measures of the burden of migraine, and to health-related quality of life. Severe attacks were reported in around one-fifth of the sample. Physician- and patient-derived data provided concordant estimates of severity in 71% of cases, the discordant cases representing principally an underestimate by the physician of headache severity. Migraine severity was associated with frequent, long-lasting and treatment-resistant attacks, and with poor quality of life. The MIGSEV questionnaire is proposed as a simple measure of severity for the diagnosis and management of migraineurs, suitable for use both by physicians and patients.

[Compliance with hormone replacement therapy in menopausal women: results of a two-year prospective French study comparing transdermal treatment with fixed oral combination therapy]. / Observance du traitement hormonal substitutif de la ménopause: résultats d'une étude prospective française de deux ans, comparant un traitement transdermique et une association fixe par voie orale.

OBJECTIVES: To evaluate rates of continuation with hormone replacement therapy (HRT) at 2 years in 2 cohorts of female patients, one of which was treated with a set combination of oral oestradiol valerate and medroxyprogesterone acetate and the other with percutaneous 17 beta-oestradiol gel combined with an oral progestogen selected by the prescribing doctor. PATIENTS AND METHODS: A prospective, randomised, open study, including 885 patients followed for 2 years whose 477 were in the oral HRT cohort and 408 were in the dermal cohort. Randomisation was done by group with prescription of the selected HRT for the cohort. The 2 treatment groups were compared using chi(2) tests and Fisher's exact test for qualitative variables, Student's t test or Wilcoxon's test for qualitative variables and Kaplan-Meier survival curves for continuation of HRT, with comparisons using the log-rank test. The prognostic value of baseline parameters on subsequent continuation of HRT was studied using the Cox model (Wald test, odds ratio). RESULTS; Among the 885 treated patients, 711 received the HRT assigned to their cohort (382 in the oral HRT cohort, 329 in the dermal HRT cohort). After 2 years, 77.9% of the patients in the oral HRT cohort and 73.4% of the patients in the dermal HRT cohort were continuing to take their prescribed HRT (P = 0. 076): 37.9% of patients in the oral HRT cohort and 20.2% of patients in the dermal HRT cohort (P < 0.001) continued taking their treatment without any modification. CONCLUSION: Although there was no significant difference in the level of compliance in the 2 groups, it is nonetheless worth noting that the HRT compliance with a sequential fixed estroprogestogen combination was, in this trial, at least equal to that with the free combination of a transdermal estrogen and a progestogen whose nature, dosage and sequence duration are selected by the prescriber. On the other hand, treatment modifications occurred more frequently in the cutaneous HRT group, which is logical as free combination affords to adapt the treatment to each patient.

[Infections by Candida sp. in intensive care. Survey of French practices]. / Infections à Candida sp en réanimation. Enquête sur les pratiques françaises.

OBJECTIVE: The isolation of Candida sp in nosocomial infections is on the increase and over the past 10 years many guidelines for "good" practices and recommendations have been published on the modalities for the management of systemic candidiasis. The aim of this paper was to assess the habits in the intensive care units in this domain in France. METHOD: A transversal survey on the habits was conducted from March to May 2001, using a questionnaire mailed to 200 intensive care units. RESULTS: One hundred eighty questionnaires (surgical reanimation: 12%, medical: 18%, medico-surgical: 70%) out of 200 (92.5%) were returned. The indirect diagnostic examinations: serology, search for antigenemia and PCR (Polymerase Chain Reaction) were never used in 21, 35 and 65% of cases. The systematic search for colonisation (a mean of 4 areas sampled) was conducted in all the patients by 19% of the investigators, in some patients by 53%, and never by 28%. An antifungal treatment was prescribed: in the presence of a positive haemoculture alone, once out of twice if the sample had been taken from a central catheter and in 2 cases out of 3 when the sample was peripheral. It was prescribed 6 times out of 10 after isolation of Candida sp following surgery or on needle aspiration of an intra-abdominal abscess, varyingly in the case of cadiduria, isolation of a Candida sp in a broncho-pulmonary sample or in abdominal draining and positive culture of a catheter, depending on the intensity of the colonisation, the severity of the clinical picture and the presence of factors of risk for Candida infection. It is still prescribed empirically depending on the same elements and the absence of explanation for worsening. When faced with candidemia in a non-neutropenic patient, a central catheter is not changed in 18% of cases. Depending on the microbiology, fluconazole is prescribed in: the identification of yeast without further precision (78% of cases), Candida sp without further precision (86% of cases), Candida non albicans without further precision (57% of cases), C. albicans (93% of cases), Candida non albicans other than C. krusei and C. glabrata (62% of cases), C. glabrata (36% of cases) with an increase in dose in 1 out of 2 cases. In the presence of C. glabrata or C. krusei, amphotericin B is the choice in respectively 51 and 75% of cases. To adapt the treatment.

Conventional antihypertensive drug therapy does not prevent the increase of pulse pressure with age.

Increased pulse pressure (PP), an independent predictor of cardiovascular risk, may be quantified on the basis of the prevalence of isolated systolic hypertension (ISH) in the population at large. The purpose of this study was to estimate the prevalence of ISH and its relation to age and drug therapy in a large group of outpatient hypertensive subjects in France. Between March and December 1999, 2975 French general practitioners included 17 716 consecutive patients with uncontrolled hypertension (systolic blood pressure [SBP] >140 mm Hg and/or diastolic blood pressure [DBP] >90 mm Hg), either treated or not treated. They were asked to complete a questionnaire concerning associated cardiovascular risk factors and ongoing antihypertensive therapy. Subjects were classified according to 5 age ranges (from 18 to 103 years). In each age range, SBP, DBP, mean blood pressure, and PP were significantly lower (P<0.001) in treated subjects than in untreated subjects, with the exception of PP in subjects >75 years. The latter finding resulted from a significant increase of SBP and PP with age, together with a significant lowering of DBP with age, irrespective of drug treatment. Subsequently, the prevalence of ISH increased with age from 20.4% to 35.2% in men and women. In any given age range, drug therapy for hypertension is associated with marginally lower values of PP. In the studied populations, the increase of PP with age is independent of gender and of the presence of antihypertensive drug treatment, leading to an increased prevalence of ISH and a subsequent increase of cardiovascular risk with age.

[Two years follow-up of a heroin users cohort treated with high dosage buprenorphine. Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice Subutex)]. / Suivi à 2 ans d'une cohorte de patients sous buprénorphine haut dosage. Résultats de l'étude SPESUB (suivi pharmaco-épidémiologique du Subutex en médecine de ville).

BACKGROUND: Since February 1996, French GPs are allowed to prescribe high dosage buprenorphine for maintenance treatment of major opioid drug addiction. A prospective cohort of major opioid addicts was initiated in order to assess patient outcomes: follow-up, retention rate in treatment, drug use, intravenous injection and social situation evolution. METHODS: Each GP, known to be involved in drug user management, had to include the first 10 opioid drug addict patients to whom he prescribed high dosage buprenorphine, with a maximum inclusion period of 3 months. Patients were followed up for two years and a regular standardized information was collected (usual data on drug users and prescription modalities). RESULTS: Between May and July 1996, 919 patients (664 men and 255 women, mean age: 30 years) were included by 101 GPs. They had a long and serious history of drug addiction, important parallel consumption of cocaine, codeine and other illicit drugs and psychiatric problems (28% of definite problems and 45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepatitis C: 21%). Two years later, 55% of patients were still followed-up by the same GP and an additional 12% were followed by another GP or in a health care service (hospitalized or receiving methadone in a specialized centre). 13% were not followed, but GPs were able to describe their situation. 8% had been included by GPs who had dropped the study. Finally, 12% of patients were lost to follow-up. Among the 508 patients still followed-up by the same GP after 2 years, the substitution treatment rate was 84%. The dosage bracket had widened (inclusion: mean dosage=7.8 mg +/-4.5, minimum=0.8, maximum=28, median=8; after 2 years: mean=7.6 mg +/-5.4, minimum=0.4, maximum=28, median=8) and the duration of the prescription and dispensing had increased. Declaration of heroin intake in the previous month had fell from 40% to 11% and declaration of drug intake from 53% to 20%. Social situation had improved on average (housing conditions and work). There were 12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% of patients had declared intravenous injection of high dosage buprenorphine in the previous month. CONCLUSION: After two years of follow-up, 55% of patients were still followed-up by the same GP and an additional 12% was followed by another GP or in a health care service. Among patients still followed up by the same GP, a reduction of drug related harm (seroconversions for hepatitis B, hepatitis C and HIV) was observed.