[Continuous glucose monitoring Respective roles of healthcare professionals and quick interpretation guide]. / Mesure continue du glucose - Rôles respectifs des personnels de santé et guide d'interprétation rapide.

The use of continuous interstitial glucose measurement systems (CGM) has revolutionized the management of patients with diabetes for 15 years. This is true both for professional use (diagnostic CGM) and personal use for patients (therapeutic CGM). The role of health professionals - general practitioners, diabetologists, nurses, dieticians - is important to coordinate, with a specific role for each. The clinical situations are all different and the systematic analysis of the data has ideally to be carried out with the participation of the patient. These devices allow significant improvements in glycemic control, making this technology one of the most important advances in diabetes for many years.

L'utilisation des systèmes de mesure continue du glucose interstitiel (CGM) révolutionne la prise en charge des patients avec diabète depuis 15 ans, cela aussi bien pour l'usage professionnel (CGM diagnostique) que personnel pour le patient avec diabète de type 1 ou 2 (CGM thérapeutique). Le rôle des différents professionnels de la santé ­ médecins, infirmier-ère-s, diététicien-nes ­ est important à coordonner, avec un rôle possiblement spécifique de chacun. Les situations cliniques sont diverses et l'analyse systématique des données doit s'effectuer idéalement avec la participation du patient. Ces dispositifs permettent des améliorations importantes de l'équilibre glycémique faisant de cette technologie l'une des avancées les plus importantes en diabétologie depuis de très nombreuses années.

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data.

INTRODUCTION: In the context of an aging population, homecare visits by family physicians may contribute to maintaining older patients at home; however, home visits by family physicians have decreased in number in the last decade with the emergence of homecare-oriented healthcare services. We aimed to describe the diversity of activities and evolution over time of home visits by Swiss family physicians. METHODS: This was a retrospective observational descriptive study. We used billing data collected by the cantonal trust centre for home visits made by family physicians of the canton of Vaud, Switzerland from 2006 to 2015. We separated billed items into specific categories, including the Tarmed catalogue (Swiss pricing system for medical services), laboratory catalogue, medications, medical material and vaccines. We compared billing patterns between emergency and routine visits. We used discrete mixture models to identify cluster classes of visits, and compare their characteristics. RESULTS: From 2006 to 2015, Vaud family physicians made 451,634 home visits for which they billed a median of 5 items per visit (range 2–95). Most home visits (65%, 293,713) were routine visits consisting of consultation time without additional investigation. We identified four cluster classes of visits comprising routine visits, routine visits with laboratory tests, emergency visits during the day and emergency visits during the night. Routine visits were the main cluster class while emergency home visits were rare. CONCLUSIONS: Family physician home visits are mainly routine visits without additional investigation. Thus, we wonder if a part of this activity could be delegated to other healthcare professionals.