ABSTRACT
INTRODUCTION: Hospital-based health technology assessment (HB-HTA) has been introduced to help hospital management in decision making about the adoption of new health technologies (HTs). We reviewed the accuracy of the expected medical impact of HTs assessed at our hospital, as well as the acceptance of this process by clinicians. METHODS: For each HT adopted between 2002 and 2011, a semi-structured interview with the involved clinician was conducted, assessing (i) the perceived utility of the HB-HTA process, (ii) the accuracy of the new HT's expected medical impact as compared with observed patient data from the year 2012, and (iii) the compliance with the indications of the HB-HTA report. RESULTS: Over the 10-year period, forty HB-HTAs were carried out, of which thirty-four led to acceptance. Twenty-seven of the twenty-eight clinicians involved in these thirty-four HTs accepted the interview and 85 percent acknowledged the utility of the HB-HTA process. Five of the thirty-four HTs were no longer in use. For the twenty-nine remaining HTs, observed patients' number was as expected in eight, higher in four, lower in fifteen, and not available in two cases. Available average length of stay was 61 percent longer than expected. Two HTs had a higher complication rate and three a lower success rate. Indications evolved in 55 percent of HTs after a few years (seven restrictions, six broadenings, and three other changes). CONCLUSIONS: A HB-HTA process is useful to improve quality in decision making. Follow-up analysis should routinely be performed to adapt HB-HTA reports' conclusions to practical experience and new scientific evidence.
Subject(s)
Hospitals , Technology Assessment, Biomedical , Interviews as Topic , Qualitative Research , Surveys and QuestionnairesABSTRACT
Leishmaniasis is an infection of the tropical to temperate zone, occasionally imported in our regions by travellers and migrants. Leishmania parasites are transmitted by the sting of a sand fly, Phlebotomus or Lutzomyia, and causes two clinical syndromes with either cutaneous, also mucosal, or disseminated involvement. Clinical suspicion needs a confirmation by the detection of the parasite. The treatment is adapted to the patient, the clinical presentation, the region, the species and the availability. Cutaneous leishmaniasis can be observed only or treated by topical or systemic regimens. Visceral leishmaniasis is a progressive illness, in most cases mortal, particularly in the immunocompromised patient. It requires systemic treatment.
La leishmaniose est une infection parasitaire des ceintures tropicales à tempérées occasionnellement importée dans nos régions par des voyageurs et des migrants. Les parasites du genre Leishmania sont transmis par la piqûre de la mouche des sables, Phlebotomus ou Lutzomyia, et causent deux syndromes cliniques distincts, soit une atteinte cutanée, éventuellement des muqueuses, soit une atteinte disséminée. La confirmation du diagnostic dépend de la mise en évidence du parasite. Le traitement est adapté au patient, à la clinique, à la région, à l'espèce et à sa disponibilité. La forme cutanée peut être observée visuellement et traitée par des soins locaux ou par voie systémique. La forme viscérale est d'évolution progressive et le plus souvent mortelle à terme, notamment chez le patient immunosupprimé. Elle nécessite un traitement systémique.
