France
France-HiT
France-HiT
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Health systems in transition <strong>France</strong> 187<br />
programmes: first, one focusing on patients with diabetes and, since late 2014,<br />
one focusing on patients with asthma. Moreover, indicators of good follow-up<br />
of chronic diseases have been introduced in ROSP (see section 3.7.2).<br />
The HAS has also developed guidance for pathways for patients with<br />
the following chronic conditions: chronic obstructive pulmonary disease,<br />
Parkinson’s disease, chronic kidney disease, congestive heart failure,<br />
bronchopulmonary cancer and malignant pleural mesothelioma, Hodgkin’s<br />
lymphoma (adult), type 2 diabetes (adult) and atrial fibrillation. These guides<br />
aim to help physicians better deal with acute episodes and to retard the<br />
progression of the disease to the extent possible by improving care practice<br />
and coordination as well as by fostering patient involvement and participation<br />
in care, particularly through therapeutic patient education. Moreover, tools for<br />
patients and health professionals are provided.<br />
However, one of the limitations of such programmes is that while doctors<br />
have a high level of awareness of practice guidelines published by HAS, the<br />
recommendations may not be assimilated because they are too long and<br />
sometimes confusing. For example, a 2013 report of the National Academy of<br />
Medicine (Académie nationale de médecine) identified a number of areas of<br />
overprovision of care, including excessive biological testing and high-technology<br />
imaging and overprescription of drugs (Mornex, 2013). For cancer screening,<br />
a large number of mammographies are undertaken over age 75, despite the<br />
recommended age cut-off, resulting in overdiagnosis of small lesions of limited<br />
medical interest that do not change the life expectancy of the patient and may<br />
expose her to needless anxiety, additional testing and even surgery.<br />
Moreover, the management of acute episodes and disease-related<br />
complications is a key element in ensuring high quality care for patients with<br />
chronic conditions and avoiding unnecessary hospitalizations. For avoidable<br />
hospital admissions for adults with asthma and chronic obstructive pulmonary<br />
disease, <strong>France</strong> has much lower rates than the OECD26 averages (OECD, 2013).<br />
Nonetheless, regional variations in the rate of hospitalizations for exacerbations<br />
of chronic obstructive pulmonary disease, ranging from 0.1 to 2.0 per 1000 in<br />
2010, have led the Ministry in charge of Health and the largest SHI fund to<br />
request a study by the HAS regarding the appropriateness of hospitalizations<br />
during such acute episodes (HAS, 2012). Better data are needed for certain<br />
conditions. For example, avoidable hospital admission rates are not available<br />
for diabetes because it is not necessarily included as secondary diagnosis in the<br />
PMSI database, which also does not include the patient’s ALD status.