PhD defense of Mélanie Sustersic on 11/14/2017
PhD thesis of Mélanie Sustersic on 11/14/17 at 3 pm :
“ Patient Information Leaflets (PILs), a tool for improving Doctor Patient Communication : Proposition and validation of methods for construction and clinical evaluation ”
Direction : M. Jean-Luc Bosson, Professeur des Universités - Praticien Hospitalier à l’UGA, laboratoire TIMC-IMAG, Grenoble
Mme Johanna Sommer, Professeur à l’Université de Genève (Suisse), Rapporteur
M. Olivier Desrichard, Professeur à l’Université de Genève (Suisse), Rapporteur
M. Robert Juvin, Professeur à l’UGA, Grenoble, Examinateur
Mme Aurélie Gauchet, Maître de Conférences à l’UGA, Grenoble, Examinateur
M. Pierre-Marie Roy, Professeur des Universités - Praticien Hospitalier au CHU d’Angers, Examinateur
Place : Amphi Boucherle, 109, Bâtiment Boucherle, Faculté de Médecine et de Pharmacie, 38700 La Tronche
Key-words : Patient Information Leaflet (PIL), Doctor-Patient Communication, Adherence, Satisfaction, Generic scores, Primary Care
Patient information has become a public health issue and an essential component of Doctor-Patient communication (DPC). Many authors agree that written information is an indispensable complement to the obligatory oral information, since it improves the quality of care and the patient adherence. Despite the existence of numerous Patient Information Leaflets (PILs), physicians have difficulty appropriating them ; they are often not validated, hard to read, difficult to store, without references, sources and dates of writing. The first step in our work was to propose a methodology for developing PILs and from there, design 125 PILs for the most common reasons for consultation in primary care. An observational study carried out in 26 general practice offices with 350 patients showed that patients appreciate PILs. On the other hand, the understanding of Acute Conditions (AC) is more limited than that of chronic diseases or prescription situations, particularly patients with a low school level. A cluster randomized interventional study performed in 24 general practice offices with 400 patients showed that PILs allowed patients to improve their knowledge about pathologies and modify their health behaviors positively, independently of their level of education. Nevertheless, the heterogeneity of the research protocols made it impossible to compare our results with those of the literature.
To overcome this scientific hurdle and continue our work on the assessment of PILs, we performed a review of the literature on the subject, constructed a theoretical model describing the various effects of PILs and created three generic scales usable for evaluating the impact of PILs on any type of condition (scales of Doctor-Patient Communication, satisfaction and overall adherence). An observational study carried out in 2 Emergency Departments (ED) allowed us to validate the 3 scores, assess the psychometric properties and elucidate their determinants. In the context of AC, the only determinant of the DPC was the quality of the information received (both information "what to do" and "when to reconsult" have an adjusted Odds Ratio 11.9. Characteristics of the patient did not influence the DPC score. The overall adhesion is determined by the type of pathology (inflexible parameter) and by the quality of the DPC. Finally, although satisfaction was strongly associated with the hospital infrastructure and the attitude of the paramedical and medical staff, a high DPC score multiplied the probability of having a good satisfaction score. In a context of emergency consultations, the DPC is paramount and has an impact on the usual health indicators : satisfaction and adherence.
Finally, a before-after intervention study conducted in two ED showed that PILs improve DPC, satisfaction with healthcare professionals, and adherence to medication regimens. PILs decrease the number of reconsultations for the same pathology, in particular return to the ED. They reduce the number of drug prescriptions given by the doctor in favor of complementary examinations and specialized advice. In a context of AC, a PIL given by the doctor improves DPC, the patient’s satisfaction with healthcare professionals and improves both the doctor’s and the patient’s behaviors.
The DPC is a fundamental outcome that will need to be measured more frequently in the future, including in acute situations.