La prescription des interventions non médicamenteuses

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A report by the French Health Authority in 2011 reports on progress and barriers to the prescription of non-drug interventions in France.

The report of the French Health Authority (HAS) of April 2011 takes stock of the development of prescription non-drug treatment in France. The first part of the report is based on a literature review on the role of non-drug interventions target the management of cardiovascular risk and insomnia as an example. The report deplored the low level of evidence since they are mainly based on collective expert opinion. Part II concludes that the appeal on the ground for the prescription of non-drug treatment is inadequate compared to what scientists recommend authorities and health agencies.

The Report Rationale

Non-pharmacological interventions (NPIs) are still difficult to define. According to the experts of the French National Authority for Health (HAS), these therapies are divided into three categories:

1 diet and lifestyle rules:

– Dietary regimens,

– Sport and physical activity,

– Changes in eating behavior

– The hygiene rules.

2 psychological treatments:

– Analytical therapies inspiration

– Cognitive-behavioral therapies

3 physical therapy:

– Technical rehabilitation (physical therapy, occupational therapy, etc.)

The authors of the 2011 report of the National Health Authority exclude this categorization medical devices and surgical procedures. The objective of this evaluation report is to make recommendations of a high level of evidence. It brings together arguments for considering ways of improving for the development of prescription non-pharmacological interventions (NPIs).

The Question

What is the state of prescription non-drug therapies in France?

The Method

Two expert groups for the Health Authority were established. A group provided a working document following several meetings in 2009 based on the consultation of the international scientific literature. One group was instructed to read the work on the substance and form. These groups were multidisciplinary and multi-professional: general practitioners, cardiologists, psychiatrists, neurologists, nurses, psychologists, dieticians, pharmacists, economists, sociologists, anthropologists, patient representatives, representatives of users of the health system. The report was released by the Health Authority in April 2011.

Main Results

The first part of the report is based on a literature review on the role of non-pharmacological interventions targeted the management of cardiovascular risk and insomnia as an example. These interventions are based on the scientific and medical literature a basic treatment for the management of patients at risk of cardiovascular disease or sleep. However, the authors conclude that these recommendations are based on a low level of evidence as they are based primarily on collective expert opinion. Randomized controlled trials are lacking. The second part of the report is devoted to analysis of the use of these recommendations in daily practice. The report finds that the action on the ground to the requirement of non-drug treatment is inadequate compared to what scientists recommend authorities and health agencies.

The General Message

Many unknowns remain about the effectiveness of non-pharmacological interventions in many diseases and / or at risk of disease. This lack of medical and scientific evidence undermines the credibility, control of their condition and their application requirement. Care should therefore be taken when using particular by talking to her doctor.

What it means for Healthcare Professionals

The report of the National Health Authority (2011) emphasizes the central role of symbolic drug prescription in the medical consultation. Non-drug interventions do not currently have equivalent status. This difference affects the patients and physicians. The former can doubt the effectiveness of these interventions. The latter evoke a time of extended consultation and patient waiting to get a drug to treat their ailments in the short term.

What it means for Researchers

The report of the French Health Authority (2011) highlights the current limitations in the demonstration of the effectiveness of non-drug treatments, “according to the criteria usually considered to evaluate the effectiveness of medical treatments, studies evaluating the effectiveness of non-drug treatments have mostly methodological shortcomings “(p.40) (…)” some of these methodological shortcomings, such as no double-blind, even the actual control group can be explained by the nature even non-drug therapies. “(p.41) (…)” the methodological difficulties in the comparative evaluation of alternative therapeutics results in the fact that the recommendations in this area are associated with a low level of evidence. As indicated in the literature review on the recommendations in the management of cardiovascular risk and sleep disorders, they are mostly based on agreements of experts. “(p.41). The report of the French Health Authority (2011) encourage researchers and clinicians to conduct non-pharmacological intervention studies to further demonstrate their effectiveness and determine their mode of prescription: “the development of the requirement of non-drug treatment is conditioned by production of scientific data on the comparative effectiveness of drug and non-drug strategies through public funding for clinical trials and real people, in research laboratories and observation practices “structures (p.56). Implicitly, the report calls on INM to follow the principles of evidence-based medicine so that their effectiveness can be truly recognized.

What it means for Policymakers

Care organization founded in France on fee for service limits recognition and prescription non-drug interventions (“diet and lifestyle rules,” “psychological treatment”, “physical therapy”). The report of the National Health Authority (2011) calls to change the French health system in four areas:

1. improve the economic and organizational framework

2 improve information for healthcare professionals and patients about non-drug treatments,

3 improve adherence of health professionals recommendations on non-drug treatments,

4. improve access to supply in the non-drug treatments.“(p. 52)

The reference

Haute Autorité de Santé (2011). Développement de la prescription de thérapeutiques non médicamenteuses validées. Paris: Haute Autorité de Santé.

To reference this Blog en Sante © article.

Ninot G (2014). La prescription des interventions non médicamenteuses. Blog en Sante, A4.

© Copyright 2014 Grégory Ninot. All rights reserved.