Brigitte Escourrou

Off-label prescribing in pediatric outpatients.

OBJECTIVE: To study the characteristics of off-label prescribing and adverse drug reaction (ADR) occurrence in a sample of pediatric outpatients treated by general practitioners. METHODS: A survey on pediatric drug prescribing was implemented in 46 general practices in southwestern France. All consecutive patients aged 0 to 16 years were included. Patient characteristics, reasons for consultation, and drug prescribed (including indications) were collected. ADRs occurring ≤10 days after the date of consultation were recorded by the general practitioners (spontaneous notification). Off-label prescription was defined as prescribing outside the specifications of the Summary of Product Characteristics. RESULTS: Among the 2313 children seen between March 8, 2011 and July 31, 2011, 1960 were exposed to ≥1 prescribed drug. Mean age was 5.6 years, with a gender ratio of 1.1. Among children with prescriptions, 37.6% (n = 736) were exposed to ≥1 off-label prescription and 6.7% (n = 132) to ≥1 unlicensed drug. Off-label prescribing involved an unapproved indication in 56.4% of cases (n = 416), a lower dosage (26.5%, n = 195) or higher dosage (19.5%, n = 144) than specified, age not labeled (7.2%, n = 53), incorrect route of administration (3.5%, n = 26), and contraindication (0.3%, n = 2). A total of 23 ADRs were reported (1.5% of patients with off-label prescriptions). ADR occurrence was not significantly related to off-label drug prescribing. CONCLUSIONS: Despite the numerous initiatives implemented for promoting rational medicine use in children, the prevalence of off-label prescription in outpatient pediatric practice remains high.

Identifying competencies required for medication prescribing for general practice residents: a nominal group technique study

BackgroundTeaching of medication prescribing is a specific challenge in general practice curriculum. The aim of this study was to identify and rank the competencies required for prescribing medication for general practice residents in France.MethodsQualitative consensus study using the nominal group technique. We invited different stakeholders of the general practice curriculum and medication use in primary care to a series of meetings. The nominal group technique allowed for the quick development of a list of consensual and ranked answers to the following question: “At the end of their general practice curriculum, in terms of medication prescribing, what should residents be able to do?”.ResultsFour meetings were held that involved a total of 31 participants, enabling the creation of a final list of 29 ranked items, grouped in 4 domains. The four domains identified were ‘pharmacology’, ‘regulatory standards’, ‘therapeutics’, and ‘communication (both with patients and healthcare professionals)’. Overall, the five items the most highly valued across the four meetings were: ‘write a legible and understandable prescription’, ‘identify specific populations’, ‘prescribe the doses and durations following the indication’, ‘explain a lack of medication prescription to the patient’, ‘decline inappropriate medication request’. The ‘communication skills’ domain was the domain with the highest number of items (10 items), and with the most highly-valued items.ConclusionThe study results suggest a need for developing general practice residents’ communication skills regarding medication prescribing.

La plagiocéphalie : Quelle information donner aux parents ?

La plagiocephalie positionnelle est un probleme de plus en plus frequent, notamment depuis la campagne de prevention de la mort subite du nourrisson. Des mesures de prevention efficaces avaient pourtant fait l’objet de recommandations. Le but de ce travail est d’evaluer l’information recue par les parents concernant ces mesures.A partir d’un questionnaire adresse aux parents de Haute Garonne par le biais des creches de janvier a mars 2015, seuls 33 % des parents declarent avoir ete informes des mesures de prevention. Les conseils de positionnement lors du coucher sont incompletement delivres et les mesures proposees en periodes d’eveil peu abordees. La pertinence de l’information delivree varie en fonction des professionnels de sante. Les parents declarent que leur informateur principal est le pediatre suivi de tres pres par l’osteopathe. Le medecin generaliste arrive en derniere position apres la sage-femme. Le medecin generaliste, acteur du premier recours, doit retrouver toute sa place dans cette prevention.

Utilisation pédagogique de l'outil CALD Étude pilote de faisabilité par l'interne de médecine générale

Context: The annual thorough consultation for patients in Long Term Affection (CALD) which is the tool for monitoring patients suffering from chronic diseases, could be used for the training of general practice residents in (SASPAS) Stage Ambulatoire en Soins Primaires et Autonomie Supervisee or Outpatient Training in primary care with supervised autonomy .Method:A descriptive study was conducted between November 2009 and October 2010, recruiting all SASPAS residents in the Midi-Pyrenees area. A meeting at the beginning of the course presented the protocol and the CALD, another at end of the course evaluated the feasibility of CALD from the study results and self-administered questionnaire. Results: Thirty three internal analyzed 611 records of ALD patients and performed 517 CALD. On average, each carried 8.7 syntheses of ALD guidelines, 15.7 consultations during a mean length of 33 minutes and 15.9 written reports, 87% (n = 27) felt that CALD was “useful for their training”. Conclusion: This initial work showed that CALD is achievable by interns in SASPAS. The immediate and long term educational benefit will still have to be assessed.