Serge Bismuth

Effectiveness of drug tests in outpatients starting opioid substitution therapy

We aimed to assess the effectiveness of drug tests for treatment retention in outpatients starting opioid substitution therapy. A retrospective cohort was created from the data of the French health insurance system database for the Midi-Pyrenees region. Patients starting opioid substitution treatment (OST) were included and followed for 18 to 30 months. Two groups of patients were defined: the drug test group (at least one drug test reimbursement) and a control group (no drug test reimbursement). The cohort included 1507 patients. During follow-up, 39 subjects (2.6%) had at least one drug test reimbursement. Mean treatment retention was 207 days in the control group and 411 days in the drug test group (p < 0.001). With a multivariate Cox model, drug tests were associated with treatment retention: hazard ratio 0.55 (95% CI: 0.38-0.80). Use of a drug test in follow-up of opioid substitution treatment, although rarely prescribed, significantly improved treatment retention.

On-Site Drugs of Abuse Urinary Screening Tests for the Management of Opiate-Addicted Patients: A Survey among French General Practitioners

In France, opiate-addicted patients are mainly managed by general practitioners (GPs). Because on-site abuse drugs urinary screening tests (ODUTs) are now on the market, we investigated French GPs’ knowledge and practices concerning drug tests with a focus on ODUTs. We conducted a descriptive cross-sectional study in ambulatory practice. Postal questionnaires were sent to a random sample of GPs in the Midi-Pyrénées area of France in December 2009. Of the 482 GPs in the sample, 116 (24.1%) regularly treated opiate- addicted patients. Only 31 of them (26.7%) used drug tests and 4 of them (3.4%) performed ODUTs in their consultation rooms. Most of the GPs did not perform ODUTs because they were unaware of whether such tests were reliable or available. Many French GPs treating opiate-addicted patients regularly did not perform ODUTs and lacked knowledge of them.

L'aménagement du domicile des personnes âgées est-il bénéfique ? Une revue systématique de la littérature

Among 920 papers which were found and evaluated according to CONSORT grid, 16 trials and 4 meta-analyzes were included in this review. Home adjustment is effective in the prevention of falls for patients with severe visual impairment (high level of evidence) and among fallers (intermediate level). It is beneficial in preserving the autonomy in patients with a loss of autonomy (intermediate level of evidence). In all these situations, the beneficial interventions are conducted by an occupational therapist. Further studies are needed to clarify the risk-benefit on other criteria (mortality, independence, quality of life) and other patient populations such as those with Alzheimer disease or at high risk for falls. The adjustments made by other carers than occupational therapists remain to be evaluated.