Etude contrôlée randomisée évaluant l’efficacité et l’efficience d’une action d’éducation thérapeutique chez des patients  BPCO diagnostiqués par spirométrie chez le médecin généraliste.  

La Broncho-pneumopathie Chronique Obstructive (BPCO) est une pathologie pulmonaire longtemps non ressentie par le malade et provoquant 16 000 décès par an. Elle évolue à bas bruit entrainant des lésions bronchiques majeures qui pourraient être prévenues par un dépistage précoce. Actuellement, en France, on estime que 3,5 millions de personnes (5% de la population) souffrent de BPCO, dont un tiers seulement sont diagnostiquées. Seize pourcents des sujets hospitalisés pour exacerbation de BPCO ne se savaient pas malades.

Le dépistage se fait actuellement par un questionnaire proposé par la Haute Autorité de santé (HAS), reposant sur 5 items peu spécifiques. En cas d’obtention d’un score positif, la HAS recommande d’effectuer une spirométrie chez le médecin généraliste ou d’orienter le patient chez un spécialiste. Cependant, la spirométrie reste en retrait en soin de premier recours, et quarante-quatre pourcents des EFR demandées par les Médecin Généraliste n’ont pas été effectuée, souvent à cause du refus des patients.

Dans un rapport récent, l experts américains de l’UPSPTF (US Preventive Services Task Force) soulèvent précisément la balance bénéfices/risques du sur-diagnostique de BPCO. Un traitement médicamenteux inadéquat expose par exemple les patients aux effets secondaires des bronchodilatateurs ou des corticoïdes.

Dans ses recommandations l’HAS rappelle l’importance fondamentale d’associer une action d’Education Thérapeutique du Patient (ETP) (discours de prévention et aide au sevrage tabagique) à toutes les étapes du parcours de soin.

Nous posons l’hypothèse qu’un diagnostic précoce par spirométrie accompagné d’une action d’ETP seraient bénéfiques sur la santé des personnes atteintes de BPCO, le système de soins et la société en permettant de réduire les symptômes respiratoires et d’améliorer la qualité de vie des patients.

Originalité et Caractère Innovant

  • Etude d’efficience de l’ETP dans la partie initiale du parcours de soin BPCO.
  • Recherche en soins primaires (ambulatoire) s’inscrivant dans la réorganisation de l’offre de soins de premier recours à travers les maisons de santé pluridisciplinaires (MSP)
  • Recherche évaluant un parcours de soins pluridisciplinaire
  • Projet associant des structures locales déjà engagées dans la démarche de réhabilitation respiratoire

Objet de la Recherche

Evaluer l’efficacité d’une intervention d’éducation thérapeutique pour améliorer l’activité physique des patients souffrant de BPCO nouvellement diagnostiqués en médecine générale.

 

Objectifs Secondaires

  • Evaluer la qualité de vie des patients souffrant de BPCO nouvellement diagnostiqués initiale, à 3 mois, 6 mois et 1 an.
  • Evaluer l’acquisition des compétences d’autogestion de la maladie par le patient à 1 an en comparant l’intervention d’éducation thérapeutique associée au diagnostic par spirométrie par rapport à la prise en charge classique
  • Identifier les facteurs d’adhésion à participer à l’ETP auprès des patients, évalués après la consultation d’annonce.
  • Identifier des facteurs aggravants évitables (exposition aux agents toxiques et infectieux (environnement, tabac, professionnel, animaux), stress et anxiété, sédentarité).
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