BACKGROUND Human papillomaviruses (HPV) are responsible for the most common sexually transmitted ... more BACKGROUND Human papillomaviruses (HPV) are responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context. OBJECTIVE The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations. The construction of the shared decision aid is a part of the PrevHPV experimental study, an evaluation of a multicomponent intervention aiming to improve HPV vaccination coverage. METHODS In order to develop the decision support tool, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defini...
Introduction En France, 23,7 % de la population cible avait eu le schema vaccinal complet contre ... more Introduction En France, 23,7 % de la population cible avait eu le schema vaccinal complet contre le papillomavirus humain (HPV) a 16 ans en 2018. Les obstacles a la proposition vaccinale par les medecins generalistes sont relativement bien connus. Toutefois, l’abord de cette vaccination et la facon de discuter autour des potentielles resistances de leurs patients ont ete moins etudies. Quelles attitudes adoptent-ils concernant la vaccination anti-HPV et comment font-ils face aux reticences des patients et de leurs familles ? Materiels et methodes Etude qualitative avec analyse inductive generale, realisee entre decembre 2019 et decembre 2020 aupres de medecins generalistes (MG) issus de 4 regions francaises et recrutes par echantillonnage dirige et boule de neige. Les entretiens semi-diriges ont ete menes jusqu’a saturation des donnees et l’analyse a ete triangule par deux autres chercheurs. Resultats Vingt-six MG âges de 29 a 66 ans ont ete interviewe pendant 40 minutes a 1 h 15. L...
IntroductionVaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) i... more IntroductionVaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) infection and related harms. Despite various efforts by French authorities to improve HPV vaccine coverage (VC) these past few years, VC has remained far lower than in most other high-income countries. To improve it, we have coconstructed with stakeholders a school-based and primary care-based multicomponent intervention, and plan to evaluate its effectiveness, efficiency and implementation through a cluster randomised controlled trial (cRCT).Methods and analysisThis pragmatic cRCT uses an incomplete factorial design to evaluate three components applied alone or in combination: (1) adolescents and parents’ education and motivation at school, using eHealth tools and participatory learning; (2) general practitioners’ training on HPV using motivational interviewing techniques and provision of a decision aid tool; (3) free-of-charge access to vaccination at school. Eligible municipalities (cl...
BACKGROUND Estimating the economic burden of community acquired pneumonia (CAP) managed in ambula... more BACKGROUND Estimating the economic burden of community acquired pneumonia (CAP) managed in ambulatory setting is needed in France since no data are available. METHOD A retrospective study (CAPECO) was conducted based on a prospective French study describing patients with suspected CAP managed in primary care (CAPA). The aim of the CAPECO study was to estimate and explain medical costs of a disease episode in CAP patients only followed in ambulatory care and in hospitalised patients. Primary endpoints were the direct medical costs, impact on productivity and costs of incident CAP over one year. Secondary endpoint was to describe predictive factors of costs, hospital admission and stay length. RESULTS In this cohort of 886 patients, resulting in an incidence of CAP of 400 per 100,000 inhabitants per year, the mean direct medical cost of a disease episode of CAP was € 118.8 for strictly ambulatory patients with an equal weight for medical time, drugs, diagnostic procedures and tests. This direct cost was € 102.1 before admission for patients who were finally hospitalised. The mean cost of hospital admissions was € 3522.9. Main predictive factors of hospital admission and stay length were respectively a history of chronic respiratory disease and older age. Factors of direct medical cost were prescribing X-ray examination and having a positive X-ray. The impact of a disease episode on productivity was € 1980 (sd 1400) per ambulatory episode and € 5425 (sd 4760) per episode leading to hospital admission. CONCLUSION Costs per ambulatory episode were modest but increased substantially in hospitalised patients, who were more numerous when chronic respiratory disorders were present and in the elderly. Indirect costs were significant. Deciders should thus consider both direct and indirect costs when assessing preventive interventions in the context of this disease.
To describe the potential workload for patients with multimorbidity when applying existing clinic... more To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines. Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. National Guideline Clearinghouse index of US clinical practice guidelines. We identified the most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (ie hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression). From the guidelines, we extracted all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45-64 years with moderate severity of conditions. For each HRA identified, we performed a literature review to determine the potential workload in terms of time spent on this HRA. Then, we used a simulation modelling approach to estimate ...
community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational ... more community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational cohort study in general practice
physicians manage with a future change in the primary vaccination of infants against diphtheria, ... more physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups
BACKGROUND Human papillomaviruses (HPV) are responsible for the most common sexually transmitted ... more BACKGROUND Human papillomaviruses (HPV) are responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context. OBJECTIVE The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations. The construction of the shared decision aid is a part of the PrevHPV experimental study, an evaluation of a multicomponent intervention aiming to improve HPV vaccination coverage. METHODS In order to develop the decision support tool, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defini...
Introduction En France, 23,7 % de la population cible avait eu le schema vaccinal complet contre ... more Introduction En France, 23,7 % de la population cible avait eu le schema vaccinal complet contre le papillomavirus humain (HPV) a 16 ans en 2018. Les obstacles a la proposition vaccinale par les medecins generalistes sont relativement bien connus. Toutefois, l’abord de cette vaccination et la facon de discuter autour des potentielles resistances de leurs patients ont ete moins etudies. Quelles attitudes adoptent-ils concernant la vaccination anti-HPV et comment font-ils face aux reticences des patients et de leurs familles ? Materiels et methodes Etude qualitative avec analyse inductive generale, realisee entre decembre 2019 et decembre 2020 aupres de medecins generalistes (MG) issus de 4 regions francaises et recrutes par echantillonnage dirige et boule de neige. Les entretiens semi-diriges ont ete menes jusqu’a saturation des donnees et l’analyse a ete triangule par deux autres chercheurs. Resultats Vingt-six MG âges de 29 a 66 ans ont ete interviewe pendant 40 minutes a 1 h 15. L...
IntroductionVaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) i... more IntroductionVaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) infection and related harms. Despite various efforts by French authorities to improve HPV vaccine coverage (VC) these past few years, VC has remained far lower than in most other high-income countries. To improve it, we have coconstructed with stakeholders a school-based and primary care-based multicomponent intervention, and plan to evaluate its effectiveness, efficiency and implementation through a cluster randomised controlled trial (cRCT).Methods and analysisThis pragmatic cRCT uses an incomplete factorial design to evaluate three components applied alone or in combination: (1) adolescents and parents’ education and motivation at school, using eHealth tools and participatory learning; (2) general practitioners’ training on HPV using motivational interviewing techniques and provision of a decision aid tool; (3) free-of-charge access to vaccination at school. Eligible municipalities (cl...
BACKGROUND Estimating the economic burden of community acquired pneumonia (CAP) managed in ambula... more BACKGROUND Estimating the economic burden of community acquired pneumonia (CAP) managed in ambulatory setting is needed in France since no data are available. METHOD A retrospective study (CAPECO) was conducted based on a prospective French study describing patients with suspected CAP managed in primary care (CAPA). The aim of the CAPECO study was to estimate and explain medical costs of a disease episode in CAP patients only followed in ambulatory care and in hospitalised patients. Primary endpoints were the direct medical costs, impact on productivity and costs of incident CAP over one year. Secondary endpoint was to describe predictive factors of costs, hospital admission and stay length. RESULTS In this cohort of 886 patients, resulting in an incidence of CAP of 400 per 100,000 inhabitants per year, the mean direct medical cost of a disease episode of CAP was € 118.8 for strictly ambulatory patients with an equal weight for medical time, drugs, diagnostic procedures and tests. This direct cost was € 102.1 before admission for patients who were finally hospitalised. The mean cost of hospital admissions was € 3522.9. Main predictive factors of hospital admission and stay length were respectively a history of chronic respiratory disease and older age. Factors of direct medical cost were prescribing X-ray examination and having a positive X-ray. The impact of a disease episode on productivity was € 1980 (sd 1400) per ambulatory episode and € 5425 (sd 4760) per episode leading to hospital admission. CONCLUSION Costs per ambulatory episode were modest but increased substantially in hospitalised patients, who were more numerous when chronic respiratory disorders were present and in the elderly. Indirect costs were significant. Deciders should thus consider both direct and indirect costs when assessing preventive interventions in the context of this disease.
To describe the potential workload for patients with multimorbidity when applying existing clinic... more To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines. Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. National Guideline Clearinghouse index of US clinical practice guidelines. We identified the most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (ie hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression). From the guidelines, we extracted all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45-64 years with moderate severity of conditions. For each HRA identified, we performed a literature review to determine the potential workload in terms of time spent on this HRA. Then, we used a simulation modelling approach to estimate ...
community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational ... more community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational cohort study in general practice
physicians manage with a future change in the primary vaccination of infants against diphtheria, ... more physicians manage with a future change in the primary vaccination of infants against diphtheria, tetanus, pertussis and poliomyelitis? A qualitative study with focus groups
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Papers by Serge Gilberg