Publication date: Available online 16 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Mahé, F. Maccari, A. Beauchet, N. Quiles-Tsimaratos, N. Beneton, J. Parier, H. Barthelemy, C. Goujon-Henry, G. Chaby, D. Thomas-Beaulieu, G. Géner, L. Wagner, V. Pallure, S. Devaux, A. Vermersch-Langlin, P. Pfister, J. Jégou, C. Livideanu, M.-L. Sigal
IntroductionLe Français est souvent considéré comme un râleur. Dans un travail récent, nous avons observé une forte proportion de patients consultant une première fois pour leur psoriasis avec comme motif une insatisfaction quant à leur prise en charge antérieure. Nous avons voulu essayer d'analyser le profil de ces patients « mécontents ».MéthodologieIl s'agissait d'une étude transversale, multicentrique, menée dans 40 centres membres du Groupe d'études multicentriques de Resopso, avec inclusions consécutives pendant 11 mois, en 2014. Tous les patients adultes (âge>18 ans) consultant pour une première fois dans le centre pour un psoriasis pouvaient être inclus.RésultatsParmi les patients, 1205 ont été inclus ; 249 (20,3 %) consultaient car ils étaient mécontents de leur prise en charge antérieure. En analyse univariée, les patients mécontents étaient plus jeunes (p=0,02) et avaient un psoriasis qui avait débuté plus tôt (p<0,0001). Il s'agissait plus souvent de psoriasis en plaques (p=0,047) et de formes plus sévères de psoriasis (PASI et/ou DLQI >10, p<0,02). Ils souffraient moins souvent de rhumatisme psoriasique (p=0,01) et déclaraient plus fréquemment avoir reçu des traitements locaux (p<0,0001), moins souvent des biothérapies (p=0,006) ; ils déclaraient aussi avoir une durée de soins plus élevée (p=0,0005). Ils consultaient à l'hôpital (p=0,01) et avaient vu plus de médecins généralistes et de dermatologues (p ≤ 0,0008). Il n'y avait pas de relation entre le sexe des patients, leurs comorbidités (métaboliques, hypertension, consommation de tabac et d'alcool, et dépression) ou leurs caractéristiques socioéconomiques et leur insatisfaction. En analyse multivariée, seuls un DLQI>10 (p=0,01 ; IC95 : 1,01–1,07) et une durée de soins prolongée (p=0,004 ; IC95 : 1,23–2,99) étaient associés au mécontentement.ConclusionVingt pour cent des patients psoriasiques semblent insatisfaits de leur prise en charge. Il est difficile de dessiner un profil démographique ou socioéconomique du patient mécontent. Seule la sévérité de la maladie et peut-être l'insuffisance de traitement sont associées, lors d'une première consultation, au mécontentement du patient. Des causes liées aux médecins et aux patients peuvent être proposées. Enfin, si le Français est reconnu comme râleur, les chiffres de mécontentement observés dans notre étude ne semblent pas supérieurs à ceux observés dans d'autres pays.BackgroundThe French are frequently regarded as grouchy. In a recent study, we observed a high proportion of patients initially consulting for psoriasis because they were dissatisfied with their previous therapy. We analyzed the characteristics of these patients.Patients and methodsThis was a cross-sectional multicenter study in 40 centers belonging to the ResoPso (psoriasis treatment network) multicenter study group, with consecutive inclusions over a period of 11months in 2014. All adults (age>18 years) consulting for the first time for psoriasis at a center were included in the study.ResultsAmong patients, 1205 were included, of whom 249 (20.3%) were consulting because of their dissatisfaction with treatment. In the univariate analysis, these patients were younger (P=0.02) and presented psoriasis that had begun earlier in life (P<0.0001). It consisted mostly of generalized plaque psoriasis (P=0.047) and more severe forms of psoriasis (PASI and/or DLQI score>10, P<0.02). There were fewer cases of psoriatic arthritis (P=0.01). The "dissatisfied" patients reported significantly more frequent use of topical treatments (P<0.0001) and alternative medicines (P=0.02), and more infrequent use of biologics (P=0.006) as well as longer treatment periods (P=0.0005). They consulted at hospitals (P=0.01) and had previously seen more GPs and dermatologists (P≤0.0008). There was no impact of gender on the dissatisfaction profile by either comorbidities (metabolic, blood pressure, alcohol and tobacco consumption, and depression), or socio-economic data. In the multivariate analysis, DLQI>10 (P=0.01; 95% CI: 1.01–1.07) and longer duration of care (P=0.004; 95% CI: 1.23–2.99) were associated with dissatisfaction.ConclusionTwenty percent of our psoriatic patients seem dissatisfied with their treatment. It is difficult to draw a specific demographic and socioeconomic profile of dissatisfied patients. Only disease severity and possibly inadequate treatment at the initial consultation are associated with patient dissatisfaction. Explanations related to the individual patients and doctors may be proposed. Finally, while the French may be considered grouchy, the frequency of patient dissatisfaction seen in our study does not appear to be any greater than that observed in other countries.
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Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174
Παρασκευή 16 Ιουνίου 2017
Patients atteints de psoriasis : analyse de la population insatisfaite de sa prise en charge
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