Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study.

OBJECTIVE: Among the most significant challenges in SLE are the excessive diagnosis delay and the lack of coordinated care. The aim of the study was to investigate patient pathways in SLE in order to improve clinical and organisational challenges in the management of those with suspected and confirmed SLE. METHODS: We conducted a cross-sectional study of patients with SLE, healthcare providers and other representative stakeholders. Focus groups were conducted, and based on the collected data the most impactful disruption points in SLE patient pathways were identified. A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders. RESULTS: Six thematic clusters regarding disruption in optimal patient pathways in SLE were identified: appropriate and timely referral strategy for SLE diagnosis; the need for a dedicated consultation during which the diagnosis of SLE would be announced, and following which clarifications and psychological support offered; individualised patient pathways with coordinated care based on organ involvement, disease severity and patient preference; improved therapeutic patient education; prevention of complications such as infections, osteoporosis and cancer; and additional patient support. During the consensus meeting, the broader panel of stakeholders achieved consensus on these attributes and a framework for optimising SLE patient pathways was developed. CONCLUSIONS: We have identified significant disruption points and developed a novel conceptual framework to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organisations as well as policy makers.

Evolution of attractiveness of Medical Biology to medical students in 2022 / Attractivité du diplôme d'études supérieures de biologie médicale en 2022 chez les étudiants en médecine, quelle évolution ?

Since 2010, the postgraduate training diploma in laboratory medicine has experienced a strong decline in its attractiveness to French medical students. This work aims to objectify and quantify this decline between 2004 and 2021. To do so, we have carried out an analyze of the trend to choose laboratory medicine after the national ranking review performed by all French students. Then, we have also compiled the data on the right to change one's mind and final quits from laboratory medicine postgraduate training. The laboratory medicine reform has led to deep changes in its organization. The accreditation requirements, the laboratories grouping, as well as the financialization of this activity have strongly changed the work of laboratory physician and impacted its attractiveness for the young generations.

Depuis 2010, le diplôme d'étude spécialisé de biologie médicale (DESBM) a connu une forte baisse de son attractivité auprès des étudiants en médecine. Ce travail s'intéresse à objectiver et quantifier cette baisse d'attractivité entre 2004 et 2021. Pour cela, nous avons réalisé une analyse de l'évolution du choix de la biologie médicale à l'issue des épreuves classantes nationales (ECN) et avons compilé les données correspondantes aux droits au remords et abandons définitifs du DES. La réforme de la biologie médicale a entrainé de profondes modifications dans son organisation. L'obligation d'accréditation, la concentration des laboratoires de biologie médicale ainsi que la financiarisation du milieu ont fortement bouleversé la profession et impacté son attractivité pour les jeunes générations.

Clinical pathologists and physician in France: which partnership and which future?

Medical biology is a major area of medical specialization in French health care system. It is going through massive changes in public as in private sector since the 2010 Ballereau edict with the merging of laboratories and new quality standards based on accreditation. We have suggested that physicians had a negative feeling about the restructuring of medical biology in recent years. An electronic questionnaire has been sent to physicians so as to find out what they thought about the evolution of medical biology and to get suggestions to improve the taking care of the patient. Have answered 1364 residents and physicians from all specializations, all regions, practicing in public or private hospitals or in general practices. Doctors have on the whole a negative feeling about how medical biology has evolved in recent years thinking that it is moving towards industrialization with delay increasing. They are convinced that tests must be made on site. They remain satisfied with the quality of the tests and have a positive feeling about scientific evolutions and are in favor of a better clinical-biological cooperation. The study points out a lack of clarity concerning how private laboratories are organized and how they operate. A computer link between clinical pathologists and physicians to access results and a list of urgent medical examinations could be set up so as to have a more rapid access to results. Rapid diagnostic tests or delocalized biology could be used but doctors do not want these tests to replace the clinical pathologist.