ABSTRACT
OBJECTIVES: To assess the impact of HAS (French national health authority) physician guides dedicated to diabetes on general practice, and the impact of additional individual information feedback. METHODS: 51 MSA funds participated in the study, consisting in two periods (April 2006-March 2007 and April 2007-March 2008). In total, 91 case physicians (who benefited from an individual information feedback) and 126 control physicians (who only received the HAS guide), having at least five diabetic patients covered by the agricultural health insurance scheme (Régime agricole) were included. A Chi2 test and a t-test were performed to compare both groups and both periods, respectively. RESULTS: In the control group, the most significant variations between both periods involved the annual follow-up performed by a specialist (cardiologist, ophtalmologist), whereas the differences in therapeutic treatment remained stable or almost stable, statins and aspirin being still underused in patients at increased risk of cardiovascular disease. Finally, the progression in laboratory follow-up remained slow: approximately 1-2% per year according to parameters. The additional information feedback (active group) only led to a significantly different change in cardiac follow-up and the use of aspirin as a platelet suppressive agent, as compared to the mere sending of the HAS guide (control group). CONCLUSION: The impact of HAS guides was limited and uneven in the management of diabetic patients, and was not conclusively strengthened by the additional information feedback. The form and diffusion of good practice recommendations and feedback should be reviewed to allow for a better appropriation.
Subject(s)
Diabetes Mellitus/therapy , Family Practice , Practice Guidelines as Topic , France , Humans , Program EvaluationABSTRACT
The Mutualité Sociale Agricole (MSA) is the French social security agency for all agricultural wage earners and non-wage earners. It is the second French social security scheme after the general scheme, providing coverage for wage earners in commerce and industry. The MSA covers the whole spectrum of benefits (recovery, illness, family, retirement, occupational injury and disease) within a unique business window. The management of the MSA is overseen by elected representatives, thus creating a unique social democracy in the world of social security. Among the services managed by the MSA, occupational health and safety hold an original position: the MSA is indeed the only social security agency dealing with occupational health. 350 occupational physicians and 250 prevention consultants work in a multidisciplinary environment for the benefit of agricultural wage earners, as well as farmers, since the MSA implemented in 2002 an occupational risk prevention scheme for farmers.
Subject(s)
Agriculture , Occupational Health , Social Security , France , HumansABSTRACT
Since 1958, the French National institute for agricultural medicine (INMA) has been studying the determinant health factors (non-exclusively medical) in the agricultural and rural environment. To reach this objective, the INMA organizes various types of training (degree in agricultural medicine, training for the physicians from the Mutualité Sociale Agricole--a French social security agency--, continuing education, seminars and symposiums etc.) designed for various health and safety professionals (occupational physicians, consultant physicians, general practitioners, especially from rural areas, members of safety committees etc.). This agricultural and rural specificity of the INMA is also one of the characteristics of its oldest training (2,500 physicians trained to date): the degree in agricultural medicine, which, following one or two years of courses, allows trainees to carry on occupational medicine in the agricultural sector. Through its holdings, the INMA website (www.inma.fr) provides physicians with a lot of answers to their questions regarding the health issue in agriculture.
