[Social insurance].
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Delivery of Health Care↗
Biomedical subjects
Hubert Allemand
Publications and source records attributed to Hubert Allemand.
Stent-graft repair for thoracic aortic disease: results of an independent nationwide study in France from 1999 to 2001.
BACKGROUND: The purpose of this study was to assess the overall short-term outcome of stent-graft repair for thoracic aortic disease in France between June 1999 and May 2001. METHODS: This retrospective study was designed by the French National Health Insurance Fund for Salaried Workers. To ensure objectivity, data were retrieved at each center and checked by a team of medical advisors. RESULTS: Between June 1999 and May 2001, a total of 166 stent-graft repairs for thoracic aortic disease were performed in 166 patients, mainly by surgeons in the operating room (88%). Patients were classified according to the American Society of Anesthesiologists as status I or II in 24% of cases, status III in 56%, and status IV or V in 20%. The diameter of the thoracic aneurysm was less than 50 mm in 17% of cases. Seventeen patients (10%) died during the first 3 months, including 8 within the first 30 days after the procedure. A total of 49 complications were noted in 34 patients (20.5%). Endoleaks occurred in 27 patients (16.3%), including 8 that necessitated further treatment. Other stent-related complications included rupture (n = 3), aortoesophageal or tracheal fistula (n = 3), paraplegia (n = 6), stent migration (n = 2), visceral embolism (n = 5), and cerebral embolism (n = 2). There were 14 delivery-related complications (8%) at the catheterization site. Non-stent-related complications occurred in 14 (8%). CONCLUSIONS: This nationwide study demonstrates that stent-graft repair for thoracic aortic disease can be performed with acceptable postoperative morbidity. However, it is not a risk-free procedure and should continue to be used in an investigative setting.
Adult↗
Geographical variations of inflammatory bowel disease in France: a study based on national health insurance data.
BACKGROUND AND AIM: A north-south gradient in inflammatory bowel disease (IBD) incidence has been found in Europe and the United States. Its existence is inferred from comparisons of registries that cover only small portions of territories. Several studies suggest that IBD incidence in the north has reached a plateau, whereas in the south it has risen sharply. This evolution tends to reduce the north-south gradient, and it is uncertain whether it still exists. In France, patients with IBD are fully reimbursed for their health expenses by the national health insurance system, which is a potential source of data concerning the incidence of IBD at the national level. The aim of this study was to assess the geographical distribution of Crohn's disease (CD) and ulcerative colitis (UC) in France and to test the north-south gradient hypothesis. METHODS: This study was conducted in metropolitan France and included patients to whom IBD reimbursement was newly attributed between January 1, 2000 and December 31, 2002. Data provided relate to age, sex, postcode area of residence, and IBD type. The mapping of geographical distribution of smoothed relative risks (RR) of CD and UC was carried out using a Bayesian approach, taking into account autocorrelation and population size in each département. RESULTS: In the overall population, incidence rates were 8.2 for CD and 7.2 for UC per 100,000 inhabitants. A clear north-south gradient was shown for CD. Départements with the highest smoothed RR were located in the northern third of France. By contrast, the geographical distribution of smoothed RR of UC was homogeneous. CONCLUSIONS: This study shows a north-south gradient in France for CD but not for UC.
Adolescent↗
[Does the new protocol for breast cancer screening modify performance indicators?].
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Breast Neoplasms↗
[Regional disparities in the management of dialysed patients in France in 2003].
Epidemiologic data on end-stage renal disease (ESRD) treated with renal dialysis remain sparse and incomplete in France because there is no national registry of dialysis patients. The aim of this study was to determine the characteristics (age, gender, comorbidities, associated handicap) of patients treated with renal dialysis and to compare the dialysis regional practices. We performed a cross-sectional descriptive study from June 2 to June 8, 2003 in all renal dialysis units by enrolling all the patients residing in France with ESRD who were dialysed during that week, irrespective of the treatment they received or where they were being treated. In 2003, the type of dialysis units available and the technique they employ were quite different from one region to another, varying from 41.1 to 70.2% for highly specialized unit, 9.4 to 48.4% for self-care hemodialysis, and 2.9 to 26.5% for peritoneal dialysis.
Aged↗
The prevalence of ESRD treated with renal dialysis in France in 2003.
BACKGROUND: The prevalence of end-stage renal disease (ESRD) treated with renal dialysis is poorly known in France because there is no national registry of dialysis patients. The specific aims of this study are to determine the total number of patients treated with renal dialysis and their social, demographic, and clinical characteristics, as well as define the overall care they received. METHODS: We performed a cross-sectional descriptive study from June 2 to June 8, 2003, in all renal dialysis units (including pediatric units) by including all patients residing in France with ESRD who were dialyzed during that week, irrespective of age or the treatment they received. We gathered sociodemographic (age, sex, place of residence, and occupation) and clinical data (year they entered dialysis therapy, initial renal disease, comorbidities, and associated handicaps) and information concerning their overall treatment plan (waiting list for kidney transplant, therapeutic regimen, and dialysis technique used). RESULTS: A total of 30,882 patients residing in France were treated with renal dialysis. The unadjusted prevalence of dialysis was 513.1 patients per million population (pmp); 498.2 pmp in metropolitan France and 1,035.7 pmp in the overseas territories. Clinical and sociodemographic characteristics of patients and their therapeutic regimens were different in metropolitan France and the overseas territories. CONCLUSION: This study constitutes the first comprehensive inventory of dialysis therapy in France, where the prevalence of ESRD is among the highest in the world.
Adolescent↗
Use of abdominal aortic endovascular prostheses in France from 1999 to 2001.
BACKGROUND: Since the introduction of endovascular repair (EVR) for infrarenal abdominal aortic aneurysm (AAA), clinical evaluation has been under way in many countries throughout the world. The main purpose of this retrospective study was to determine outcome of EVR with aortic endovascular prostheses (AEPs) and to evaluate the extent to which French practitioners have complied with regulatory and clinical guidelines for the use of these trial devices. METHODS: This retrospective study was conducted by the French National Health Insurance Fund for Salaried Workers. Data were compiled on EVR procedures performed at health care institutions all over mainland France between June 1999 and May 2001. RESULTS: A total of 1012 AEPs were deployed for AAA repair in France during the study period. Only 151 (14.9%) of these EVR procedures were carried out within an approved investigational setting with informed patient consent. Only 149 of the 861 patients (17.3%, 95% confidence interval [CI], 14.9 to 19.9%) who underwent endovascular repair in noninvestigational settings signed informed consent forms. In 452 cases (46.5%), the diameter of the AAA was 50 mm or less. Complete outcome data for the first year were available for 891 patients (88%). Complications occurred in 177 of these patients (19.9%, 95% CI, 17.3 to 22.6%). There were a total of 47 deaths (5.3%, 95% CI, 3.9 to 6.9%), including 27 during the first 30 postoperative days. Other major events during the first year after AEP implantation were ruptured AAA in 5 patients, conversion to open operation in 15, and additional endovascular treatment in 52. Data on clinical surveillance were available for 987 patients (97.5%) with a mean follow-up of 345 days. Only 294 patients (29.8%, 95% CI, 27.0 to 32.7%) underwent complete imaging within the first month after AEP implantation. A total of 184 patients (18.6%, 95% CI, 16.3 to 21.2%) received no surveillance at all. CONCLUSION: This study shows the need for improvement in the clinical evaluation of new devices and medical technologies in France. Study findings also confirm the significant incidence of adverse outcomes and necessity for routine surveillance after EVR of AAA with AEP. However, risk/benefit analysis is difficult because most procedures were not carried out within a proper investigational context.
Adult↗
Effect of a nationwide program of educational outreach visits to improve the processes of care for patients with type 2 diabetes.
OBJECTIVES: To improve processes of ambulatory care for patients with type 2 diabetes in a nationwide program. METHODS: Interrupted time-series analysis with audits of practice. To implement selected recommendations of national guidelines, educational outreach visits (office visits or phone discussions) were offered to all French physicians who diagnosed one case of type 2 diabetes during a six-month intervention period. Outcome measures were the number of HBA1c measurements recorded monthly in the medical insurance computer database and the proportion of diabetic patients for whom one test had been reimbursed during the previous six months (HBA1c, fasting blood glucose) or previous twelve months (serum cholesterol, serum creatinine, urine microalbumin, electrocardiogram, ophthalmologic examination). RESULTS: A total of 15,522 office visits and 9,062 telephone discussions were performed among 22,940 physicians. The increase in the monthly proportion of the number of HBA1c tests to the total number of laboratory tests was higher during the intervention period than during the preintervention (p value < .0001) and postintervention periods (p value < .001). Between the first audit (n = 651,574) and the third audit (n = 911,871), HBA1c measurements increased from 41.2% to 60.5% and blood glucose measurements performed alone decreased from 38.8% to 18.7%. Urine microalbumin measurements increased from 10.6% before to 15.3% after intervention. Only a slight increase was observed for other tests. CONCLUSIONS: Physician to physician outreach visits can be an effective way to improve the processes of care for diabetes and to routinize nationwide use of practice guidelines.
Ambulatory Care↗