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42 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S Tableau 11: Indicateurs retenus : Indicator Cf Measurable a priori Measure to ask Comment Depression to vulnerable elders 1. If a person age 75 or older (a vulnerable elder) is started on an antidepressant medication, THEN the following medications should NOT be used as first- or second-line therapy: - tertiary amine tricyclics : amytriptyline – imipramine – doxepin – clomipramine – trimipramine - monoamine oxidase inhibitors (unless atypical depression is present) 35,37 OUI (partiellement) Prescriptions of the following medications as first or second-line therapy for patients aged ≥ 75 years : indicator of poor quality: should not be prescribed Trimipramine : non disponible (compendium 2003) Concernant la prescription d’inhibiteurs des monoamines oxydases, nous n’aurons pas l’information concernant une éventuelle dépression atypique mais on peut se dire que ce même type de contreindication peut se rencontrer dans les 2 groupes de pratiques. Un des IMAO n’est pas remboursé. - benzodiazepines Benzodiazepines: non remboursées - or stimulants (except methylphenidate) 2. If a patient age 75 or older(a vulnerable elder ) has diabetes, then his or her HbA1c level should be measured at least every 12 months Within the total number of patients aged ≥ 75 years for which there is prescription of antidepressants: => Number of patients with the following medication : - tertiary amine tricyclics : amytriptyline – imipramine – doxepin – clomipramine - monoamine oxidase inhibitors Diabetes mellitus to vulnerable elders 35, 37 OUI Follow-up of HbA1c for diabetic patients age ≥ 75 years => Number of diabetic patients aged >= 75 years for which HbA1c was measured at least annually. => Number of times (and dates) that HbA1c is measured for each diabetic patients age ≥ 75 years Stimulants centraux: sur prescription mais pas remboursé Voir indicateurs diabète.
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 43 3. If a diabetic person age 75 or older (vulnerable elder) is not blind, then he or she should receive a dilated eye examination performed by an ophthalmologist, optometrist or diabetes specialist every 2 years (annually) 4. If a patient age 75 or older (a vulnerable elder ) is newly diagnosed with hypertension, then within 4 weeks of the diagnosis an electrocardiogram should be performed 5. If a patient age 75 or older has established CAD and his or her cholesterol level is not known, then he or she should undergo a fasting cholesterol evaluation including total LDL and HDL cholesterol 6. If a person age 75 or older (a vulnerable elder) is prescribed warfarin (for Atrial Fibrillation) then an international normalized ratio (INR) should be determined within 4 days after initiation of therapy. 7. If a person age 75 or older (a vulnerable elder) is prescribed warfarin then an international normalized ratio (INR) should be done at least every 6 weeks 35, 37 OUI Ophthalmologic follow-up for diabetic patients age ≥ 75 years => number of diabetic patients age >= 75 who have had dilated eye examination annually. => Number of times (dates) that each diabetic patients age ≥ 75 years have had an dilated eye examination Care of hypertension to vulnerable elders 35, 37 oui Within patients age 75 or older receiving newly a antihypertensive medication. (not received medications in the last xx months): => Number of patients for which there has been an ECG realised in the xx months preceding or following. Ischemic heart disease to vulnerable elders 35 OUI Measure of fasting cholesterol for patients age ≥ 75 year on nitrate therapy: => Number of patients age ≥ 75 year on nitrate therapy for which there has been measure of fasting cholesterol + LDL cholesterol + HDL cholesterol Medication use to vulnerable elders 35, 37 OUI Checking of INR for patients age 75 or older on warfarin within the 4 days after initiation of therapy (patients not on warfarin in the last 12 months) => Number of patients for which a treatment with warfarin is initiated for which the INR is measured in the xx days following 35, 37 OUI Follow-up of INR for patients age=>75 on warfarin => Number of patients >= 75 under warfarin and with Possibilité de savoir si aveugle ou non? Sinon : prévalence faible ? en Belgique, fond d’œil faits par ophtalmo voir indicateurs diabète. délai de réalisation de l’ecg par rapport au diagnostic voir indicateurs hypertension dans l’analyse tenir compte du fait que nous n’avons pas les données antérieurs à l’étude et que donc il risque d’y avoir des patients pour qui ces mesures ont été effectuées auparavant. Cependant ce phénomène est identique dans les 2 groupes de patients. Voir indicateurs coronary artery disease. Élargi aux traitements par sintrom? Indicateur repris en général pour tous les patients (moins de 65 ans) idem commentaire cidessus
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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