[Effet blouse blanche résiduel : un outil pertinent en soins premiers?] / Office white-coat effect tail: A useful tool in family practice?

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are hardly both compared in primary care. OBJECTIVE: To assess the usefulness of repeated measures of systolic blood pressure (SBP) to dissociate various forms of white-coat interactions. METHODS: An open cross-sectional study on consecutive patients treated or not for high blood pressure was made in family physicians' offices. SBP was measured 5 times by an electronic device. Measurements were performed before (SBP1) and after (SBP5) the office visit by a lay assistant and at the beginning (SBP2), middle (SBP3) and end (SBP4) of visit, by the family physician. Home BP (HBPM) was measured from 3 consecutive days by the patient. WCE and office WCE tail (OWCET) were defined, respectively, as a 10 mmHg SBP increase or decrease between SBP2-SBP1 or SBP4-SBP2. WCH was considered when HBPM was normal (SBP < 135 mmHg) at home and high during the SBP2 office visit. RESULTS: Two hundred five patients (134 women versus 71 men, ratio 1.9, aged 59.8±15.7 years) were recruited. In categorical terms, there were 51 patients (25%) who presented with WCE, OWCET was seen in 121 patients (62%) and 47 patients (23%) had WCH. Only 36 patients (18%) presented both OWCET and WCE and 32 (16%) had both OWCET and WCH. The receiver operating characteristic curves (ROCs) of OWCET in diagnosing WCE or WCH were respectively 0.67 (p<0.0001) and 0.53 (NS). CONCLUSION: Thus, OWCET was predictive of WCE and not of WCH and it is worthwhile to be measured in the family physician office.

Evaluation of a simplified pharmacovigilance tool for general practitioners: 5 years of insight.

Spontaneous reporting of adverse drug reactions (ADRs) is the cornerstone of pharmacovigilance. However, major underreporting exists. The main objective of this study was to assess the use of a pharmacovigilance simplified reporting tool (PSRT) by general practitioners (GPs) and, secondarily, to describe the quality of ADR reports during this period. The PSRT was proposed on June 1st, 2015, for the 1290 GPs in the Western Normandy Region. The number and quality of ADRs reported monthly by GPs were prospectively collected from June 1st, 2015, to May 31st, 2020 (Period 2), and compared to those reported during a control period (June 1st, 2010, to May 31st, 2015, Period 1). During all the periods, 920 reports were made by 307 GPs (198 reports in Period 1 and 722 reports in Period 2), with 477 reports (51.8%) using the PSRT. During Period 2, the monthly number of reports was multiplied by 3.5 (p < 0.0001), and the number of GPs was 1.4 compared to that in Period 1 (p = 0.01). Our PSRT showed effectiveness in quantitative and qualitative terms. It must now go further and be integrated into GP software to facilitate ADR reporting nationwide.

[ECOVIR: Study of a primary care cohort in of patients with Acute Respiratory Infections in Normandy, an example of pluri-professional hospital-primary care coordination]. / ECOVIR : mise en place d'une cohorte en soins primaires, un exemple de coopération pluri-professionnelle ville-hôpital.

Acute Respiratory Infections (ARI) need be better understood and more effectively treated, especially insofar as they are of pivotal importance in public health, particularly during a crisis such as the SARS-CoV2 pandemic. The prospective, multicentric cohort study of viral codetections in respiratory samples study known as ECOVIR was conducted in Normandy, France during two winters (2018-2019, 2019-2020). The objective of the project was to create a biobank of respiratory tract samples from patients consulting their general practitioner (GP) for ARI symptoms. ECOVIR involved 36 GP investigators (GPI), from 8 health care centers throughout Normandy. Six hundred and eighty-five patients with ARI symptoms were included; naso-pharyngeal samples were taken by the GPIs and subsequently analyzed in virology laboratories for the purposes of viral codetection. The median of inclusions was 16 patients for each of the 31 actively participating GPIs over the two winters (CI25-75% [4.75; 27]). By D7, 92% of the patients contacted had responded to our call for participation, enabling us to obtain clinical, environmental and socio-demographic data. Through this study, we created an original functional network, thereby establishing a viable link between research and primary care, which is generally underrepresented in research protocols, even though it constitutes the cornerstone of the French health care system, especially during this prolonged period of sanitary crisis.

[Antidepressive agents and hypertension: A case/no-case study in French pharmacovigilance database]. / Antidépresseurs et hypertension artérielle : étude cas /non-cas dans la base nationale de pharmacovigilance.

INTRODUCTION: Drug-induced hypertension was described with several pharmacological classes. The association between hypertension and antidepressant drugs (AD) is controversial. The objective of this study was to evaluate the link between hypertension and ADs. MATERIALS AND METHODS: A retrospective disproportionality analysis from observations consecutively reported to the French pharmacovigilance database between 1985 and 2020 was performed. The relationship between the suspected ADs and the occurrence of hypertension was assessed by calculating the reporting odds ratio (ROR) in a case/non-case design. A negative (paracetamol) and a positive (celecoxib) control were used to validated this disproportionality method. RESULTS: We compared 6725 cases (including 464 AD-related cases) to 789,483 non-cases (including 56,440 AD-related cases). The reporting of hypertension was significantly associated with serotonin/norepinephrine reuptake inhibitors (SNRI) (ROR 1.43, 95 % CI 1.26-1.64) and monoamine oxidase inhibitors (MAOI) (ROR 6.41, 95 % CI 4.25-9.67) but not with other ADs classes. Concerning ADs analyzed independently of their AD class, a significant signal was observed with many SNRIs (duloxetin, milnacipran and venlafaxin) and with all MAOIs (moclobemide, iproniazide) (ROR between 2.04 and 17.93) but not with others ADs. The ROR value of positive (celecoxib) and negative (paracetamol) controls were ROR=1.53; IC95 %=1.04-2.26 and ROR=0.72; IC95 %=0.65-0.80, respectively. CONCLUSION: We found a significant association between development or worsening of hypertension and SNRIs and MAOIs but not with others ADs, in this study performed in real conditions of life. It is therefore advisable to remain cautious when prescribing ADs and to check systematically for hypertension.

Impact on mental health of the COVID-19 outbreak among community pharmacists during the sanitary lockdown period.

OBJECTIVES: COVID-19 outbreak can impact mental health including health care workers. The aim of this study was to assess the psychological impact of COVID-19 in French community pharmacists. MATERIAL AND METHODS: We carried out a postal-based survey to assess the psychological impact of COVID-19 in French owner community pharmacists based on three validated self-report questionnaires: Perceived Stress scale, Impact of Event Scale-revised and Maslach Burnout Inventory. RESULTS: The sample consists of 135 community pharmacists. Twenty-three pharmacists reported significant post-traumatic stress symptoms (17%). High burnout symptoms were found in 33 (25%), 46 (34.9%) and 4 (3%) participants. Females scored higher than males for all questionnaires (P=0.01). CONCLUSIONS: This study is the first study which showed the psychological impact of COVID-19 in community pharmacists. Based on validated self-report questionnaires, up to 35% of pharmacists reported psychological disturbances. Interventions to promote psychological well-being of healthcare workers need to be developing.

[Impact of stopping reimbursement of olmesartan for hypertensive patients in primary care]. / Impact du déremboursement de l'olmésartan chez les patients hypertendus en soins premiers.

AIMS OF STUDY: Since January 2017, olmesartan-based treatment are no longer reimbursed by French national health insurance. Indeed, enteropathy cases, potentially lethal, were described in relation to this medication. Objectives were to study the impact of stopping the reimbursement of olmesartan for hypertensive patients. PATIENTS AND METHOD: A descriptive retrospective study was performed with data from two primary care facilities in French occidental Normandy. To evaluate the blood pressure control, different blood pressure measurements were considered during the year before (period 1) and the year after (period 2) potential stopping olmesartan. A medico-economic analysis was also realized. RESULTS: From June 2015 to July 2017, 107 hypertensive patients treated by olmesartan were included. Among them, 47 patients (44%) had an antihypertensive monotherapy. olmesartan had been mainly switched by another sartan (75%, 80/107) including valsartan (59%, 47/80). Mean blood pressures during period 1 and period 2 were not statistically different. Moreover, 83% of patients were initially controlled with olmesartan and 81% after switching medication (P=0,86). The use of olmesartan generated an additional cost of 58% compared to the other drugs that replaced it during period 2. CONCLUSIONS: Stopping olmesartan reimbursement didn't seem to have a significant impact on blood pressure control of hypertensive patients while its cost is significant. In addition to potential serious side effects, olmesartan has not shown any improvement in cardiovascular morbi-mortality.