La pratique médicale est-elle basée sur les preuves ou sur les recommandations ? (notice n° 750449)
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| fixed length control field | 05608cam a2200421 4500500 |
| 005 - DATE AND TIME OF LATEST TRANSACTION | |
| control field | 20250123094253.0 |
| 041 ## - LANGUAGE CODE | |
| Language code of text/sound track or separate title | fre |
| 042 ## - AUTHENTICATION CODE | |
| Authentication code | dc |
| 100 10 - MAIN ENTRY--PERSONAL NAME | |
| Personal name | Boussageon, Rémy |
| Relator term | author |
| 245 00 - TITLE STATEMENT | |
| Title | La pratique médicale est-elle basée sur les preuves ou sur les recommandations ? |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. | |
| Date of publication, distribution, etc. | 2024.<br/> |
| 500 ## - GENERAL NOTE | |
| General note | 74 |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | Résumé Contexte : Actuellement, les guides de pratique clinique (GPC) préconisent la prescription de metformine en première intention chez les patients diabétiques de type 2. Cependant, une revue systématique et méta-analyse en réseau d’essais cliniques randomisés, publiée en 2022 remet en question la place de la metformine comme traitement de première intention. L’objectif de ce travail était de mesurer l’impact des preuves scientifiques dans la décision de prescription. Méthodes : Étude expérimentale randomisée à 4 bras 1.1.1.1, sur vignettes cliniques, réalisée en juin 2023 à la Faculté de médecine de Lyon, auprès de 160 internes en médecine générale, lors de leur journée d’étude facultaire. Les vignettes cliniques décrivaient le même contexte. Neufs médicaments anti-diabétiques étaient proposés avec leur profil d’efficacité et de sécurité. La question portait sur son choix du traitement à instaurer en première intention, et ses motifs. Les 4 bras de l’étude étaient constitués ainsi : 2 bras témoins avec noms des classes pharmacologiques (l’un avec bénéfices et effets indésirables [EI], l’autre sans les EI) ; 2 bras intervention sans les noms des classes pharmacologiques (l’un avec les EI, l’autre sans les EI). Résultats : Dans tous les groupes, le choix des traitements était strictement limité aux 3 classes pharmacologiques suivantes : inhibiteurs du SGLT2 (ISGLT2), agonistes du récepteur au GLP1 (AGLP1) et biguanides (metformine). Dans le bras témoins avec EI, les intentions de prescription étaient de 10 %, 30 % et 60 %, respectivement. Dans le bras témoins sans EI, ils étaient respectivement de 44,2 %, 16,3 % et 39,5 %. Dans le bras intervention avec EI, les intentions de prescription étaient respectivement de 48,7 %, 51,3 % et 0 %. Dans le bras intervention sans EI, ils étaient respectivement de 68,4 %, 28,9 % et 2,6 %. Il y avait une différence significative seulement pour les ISGLT2 et la metformine, avec et sans mention des EI (p = 0,002 et p = 0,029 respectivement). Conclusion : Ces résultats montrent que les choix thérapeutiques des internes ne sont pas basés sur les preuves mais plutôt sur leurs habitudes et les GPC. |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | Context: Currently, clinical practice guidelines (CPGs) recommend the prescription of metformin as a first-line treatment for patients with type 2 diabetes. However, a systematic review and network meta-analysis of randomized clinical trials published in 2022 question the role of metformin as a first-line treatment. The objective of this work was to assess the impact of scientific evidence on the prescription choice. Methods: A randomized experimental study with four arms (1.1.1.1), using clinical vignettes, was conducted in June 2023 at the Faculty of Medicine of Lyon, France, involving 160 general medicine interns present at the faculty for a teaching day. The clinical vignettes all described the same context. Nine antidiabetic medications were presented with their efficacy and safety profiles. The question focused on the choice of first-line treatment and the reasons behind it. The four arms of the study were constituted as follows: two control arms with the names of pharmacological classes (one with benefits and adverse effects (AEs), the other without AEs); two intervention arms without the names of pharmacological classes (one with benefits and AEs, the other without AEs). Results: In all groups, the choice of treatments was strictly limited to the following three pharmacological classes: SGLT2 inhibitors (ISGLT2), GLP1 receptor agonists (AGLP1), and Biguanides (metformin). In the control arm with AEs, the prescription intentions were 10%, 30%, and 60%, respectively. In the control arm without AEs, they were 44.2%, 16.3%, and 39.5%, respectively. In the intervention arm with AEs, the prescription intentions were 48.7%, 51.3%, and 0%, respectively. In the intervention arm without AEs, they were 68.4%, 28.9%, and 2.6%, respectively. There was a significant difference only for ISGLT2 and metformin, with and without mention of AEs. Conclusion: These results suggest that the therapeutic reasoning of interns in general practice is not primarily based on EBM data, but probably on their own knowledge, mainly derived from CPGs. |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | prise de décision clinique |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | balance bénéfice/risque |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | médecine générale |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | méta-analyses |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | vignette clinique |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | diabète type 2 |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | médecine fondée sur les preuves |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | recommandations |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | case reports |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | clinical decision-making |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | type 2 |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | diabetes mellitus |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | guidelines |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | evidence-based medicine |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | meta-analysis |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | benefit/risk assessment |
| 690 ## - LOCAL SUBJECT ADDED ENTRY--TOPICAL TERM (OCLC, RLIN) | |
| Topical term or geographic name as entry element | general practice |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Deleigue, Chloé |
| Relator term | author |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Pouchain, Denis |
| Relator term | author |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Yves Meunier, Pierre |
| Relator term | author |
| 700 10 - ADDED ENTRY--PERSONAL NAME | |
| Personal name | Blanchard, Clara |
| Relator term | author |
| 786 0# - DATA SOURCE ENTRY | |
| Note | Médecine | 20 | 5 | 2024-06-18 | p. 232-237 | 1777-2044 |
| 856 41 - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href="https://shs.cairn.info/revue-medecine-2024-5-page-232?lang=fr&redirect-ssocas=7080">https://shs.cairn.info/revue-medecine-2024-5-page-232?lang=fr&redirect-ssocas=7080</a> |
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