Iatrogénèse

It is said that a disease, a state, an side effect, etc… are iatrogenic when they are caused by the medical Traitement , that there is or not error of treatment. In Greek, the word means " literally; caused by the médecin" ( iatros means Médecin, but other health professionals, for example of the pharmacists, can also be about it in the beginning).

The iatrogénèse (in particular medicamentous) in questions

What the iatrogénèse (ex iatrogénie) medicamentous?

All Médicament has beneficial effects, but also undesirable effects. They can come from the drug itself, of its association with another drug, its incompatibility with the patient or an error of catch. It is what is called the iatrogénèse (named before iatrogénie) medicamentous.

Is the situation in France different from other European countries?

The French consume, by anybody, 6 times more Médicament S that the Netherlands: in the Netherlands, on 10 outgoing of a consultation, 6 people do not have an ordinance with Prescription of drugs, whereas the rate is of 0.25 out of 10 in France

For Bernard Kouchner, Secretary of State to Health in 1998, the iatrogènèse induced by the drugs constitutes a serious problem of public health. (...) France is a country where medicamentous overconsumption is obvious and unjustified: we consume 19 times more vasodilators than in the United Kingdom; 3 times more the psychotropic ones than in Germany or in the United Kingdom.

Importance of the risk

The reduction of the iatrogenic risk was defined like a priority by the National conference of health of 1996.

And a first study, undertaken in France in 1997 by the Network of the Regional centres of pharmacovigilance, among in-patients a day given, in services of medicine, surgery and long stay, showed that the prevalence of the medicamentous undesirable effects was of 10,3%. 33% corresponded to serious undesirable effects.

These undesirable effects are the cause of 128.000 hospitalizations each year in France.

There would be, according to Philippe Douste Blazy, 8.000 deaths annual of the only fact of the medicamentous interactions which represent only part of the medicamentous iatrogénèse

Always in France, according to Mrs. Anne-Marie Payet, the figures most usually advanced give a report on 140.000 hospitalizations caused by medicamentous accidents and 13.000 deaths proven .

Risks of the total iatrogénèse

The total iatrogénèse is more general than the medicamentous iatrogénèse.

The CCECQA Bordeaux studied the iatrogénèse in hospital medium in France. This iatrogenic evaluation of the risk low register in the health care institutions reveals a risk of 15%, of which 6.2% would be avoidable.

The total iatrogénèse (by adding immediate and associated causes) was estimated by the INSERM (1997) at 10.000 /an deaths, except infections nosocomiales (which they are estimated to cause 4.200 deaths per annum in France). But this approach most probably underestimates reality according to document DGS/GTNDO only mortality by cancers related to the medical irradiation with diagnostic aiming is estimated at 3.000-5 000 /an, of which an avoidable part . And the 13.000 deaths proven (and perhaps up to 32.000) following a medicamentous accident only (other) did not leave one the deaths except infections nosocomiales.

On the whole, événénements iatrogenic and infections nosocomiales would represent more than 20.000 décès/an. Complementary estimates reveal figures much higher: 34.200 annual deaths, even more , or much more.

(Only) the iatrogénèse medicamentous was studied in hospital medium, for example with the 2nd Forum AAQTE, 1998: " to fight against the médicamenteuse" error; and with the 4emes days of the AAQTE, 2002.

Why the elderly are touched by the medicamentous iatrogénie?

The people of more than 65 years are 2 times more often touched:

with the age, the number of diseases increases, and the consumption of drugs also
the organization eliminates the drugs less better
the risk to be mistaken in the various catches is increased
as well as the risk of medicamentous interactions.

Extracted from a letter of the Director of the French Agency of public health of the health products (AFSSaPS) at the health professionals, June 29th, 2005:

the elderly are particularly exposed with the risk of undesirable effects related to the catch of drugs: the medicamentous undesirable events are 2 times more frequent on average after 65 years and 10 to 20% of them lead to a hospitalization. However close 2/3 could be to them avoided.

the undesirable effects which could be avoided are generally the consequence:

of a therapeutic error (bad indication, not respect of the counter-indications, excessive posology or too prolonged treatment)

of a bad observance of the treatment

or of an inappropriate self medication among these old and fragile patients, treated for several pathologies .

Which are the risks (symptoms)?

The risks differ according to the drugs in question. It can be a question of Hémorragie (taken of an anticoagulant), of Vomissement S, dermatological reactions, of Malaise or falls (Antihypertenseur S, Somnifère S, etc), of impaired renal function, etc

How to avoid it?

For the level of the private individual, it is necessary to respect the ordinance with the letter (schedules of catch, proportioning, duration of the treatment) and to inform all the consulted doctors of the drugs which one takes.

But this approach is often insufficient, because for example the doctor at the origin of the regulation is not always informed of the other drugs taken by the patient, nor of the many interactions between the drugs.

Pharmacist which knows his patient and his practices as regards drugs, or which notes that drugs on one or more ordinances are incompatible between them, can play a considerable part to avoid such harmful interactions between drugs. To fight against the iatrogénèse, the Pharmaceutical File of the patient will be soon consultable in all the dispensaries. It will allow visualization by the pharmacist of the whole of the regulations of a patient over the last 4 months, which they were delivered by him or other dispensaries.

A necessary systemic approach

In a more general way, it is necessary to apprehend the question under the systemic angle, because one charges, at the hospital, more than 80% of the fundamental causes of the undesirable events to the organization (of the hospital, of the care).

With regard to France, the iatrogénèse remains mainly avoidable and the control of the risk fits at the same time in the field of the quality of the care and in that of the public health. . Starting from 5 retrospective epidemiological investigations carried out in France on review of medical file, the avoidable share of iatrogénèse total would be between 30% and more than 50% (most probably 30% for the infection nosocomiale).

Objectives of the Ministry for French Health

Was the Ministry for French Health given, for which date? , of the objectives:

Réduire by 1/3 the frequency of the serious iatrogenic events (EIG) avoidable at the time of the hospital stays
- Réduire of 20% the incidence of the secondary infections nosocomiales to invasive acts
- Réduire of 1/3 the prevalence of the medicamentous hospital low register and avoidable iatrogénie
- Réduire of 1/3 the annual number of hospitalizations due for an avoidable undesirable medicamentous purpose
- Réduire of 30% the annual amounts per capita secondaries to a medical irradiation with aiming diagnoses
- Réduire of 20% the number of deaths having the iatrogénie like main cause

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