Begarin L, Beaujour A, Fainsilber P, Hermil J-L, Lévesque H, Benhamou Y
Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France.
Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France; Département de médecine générale, faculté de médecine pharmacie de Rouen, 1, boulevard Gambetta, 76000 Rouen, France.
J Mal Vasc. 2014 Dec;39(6):382-8. doi: 10.1016/j.jmv.2014.04.010. Epub 2014 Jun 5.
Multi-component compression, inelastic, short stretched or coated strips bandages, and class 4 stockings have been recommended since 2010 by the French Superior Health Authority as first- and second-line treatment for venous leg ulcers.
Assess the prescribing habits and knowledge of general practitioners about compression therapy and determine factors predictive of prescriptions consistent with recommendations.
Evaluation study of professional practices conducted during a six-week period. A questionnaire was sent to 210 general practitioners asking them to report their prescribing practices and the last prescription written for a patient with venous ulcers.
The response rate was 36.2% (76 responses). For the last patient seen, long stretched bands were prescribed by 50.8% of responders, stockings by 40% and multi-component compression by 7.7%. Stockings were class 2 for 87.7% of the prescriptions. Knowledge of short stretched bands and multi-component compression was reported by 45.8% and 38.9% of general practitioners respectively. Guidelines were followed by 10.8% of the physicians. No factor related to the general practitioner (age, sex, modalities of exercise, experience and education), to the patients (age, sex, under-nutrition, autonomy) or to the leg ulcer (size, exudates, course, complexity of care), was associated with compliance or not with the guidelines. General practitioner training enabled a non-significant improvement of prescriptions (14.3% vs 4%, P=0.24).
Compliance with the guidelines for compression therapy is insufficient in general medicine. Better training and knowledge of modalities for compression therapy could be useful to improve prescription practices and encourage use of multi-component compression and short stretched bandages, known to be more effective and better tolerated.
自2010年起，法国最高卫生管理机构推荐使用多成分加压、无弹性、短拉伸或带涂层的条带状绷带以及4级弹力袜作为下肢静脉溃疡的一线和二线治疗方法。
评估全科医生关于加压治疗的处方习惯和知识，并确定与推荐处方一致的预测因素。
在六周内对专业实践进行评估研究。向210名全科医生发送问卷，要求他们报告其处方习惯以及为一名静脉溃疡患者开具的最后一张处方。
回复率为36.2%（76份回复）。对于最后一位就诊患者，50.8%的回复者开具了长拉伸绷带，40%开具了弹力袜，7.7%开具了多成分加压绷带。87.7%的弹力袜处方为2级。分别有45.8%和38.9%的全科医生报告了解短拉伸绷带和多成分加压绷带。10.8%的医生遵循了指南。没有发现与全科医生（年龄、性别、运动方式、经验和教育程度）、患者（年龄、性别、营养不良、自理能力）或腿部溃疡（大小、渗出物、病程、护理复杂性）相关的因素与是否遵循指南有关。全科医生培训使处方有了非显著性改善（14.3%对4%，P = 0.24）。
在普通医学中，对加压治疗指南的遵循情况不足。更好地培训以及对加压治疗方式的了解可能有助于改善处方实践，并鼓励使用已知更有效且耐受性更好的多成分加压绷带和短拉伸绷带。
