Prévention et promotion de la santé

Transcription

1 Fribourg e congrès suisse du cancer Prévention et promotion de la santé Pr Jacques Cornuz, Lausanne

2 Burden of disease and risk factors: ranking Top 5 Smoking Physical inactivity High BMI High BP Nutrition Lancet 2012

3 Avoiding disability: greatest impact through physician advice Lancet

4 Efficacy of physicians training: Swiss trial Training course assessed in a randomized trial: Cornuz J et al. Ann Intern Med. 2002

5 Comparison of two types of training

6 Results Medical counselling quality 10 Mean score (SD) (range: 0-14) (0.3) 2.7 (0.2) Training Control P=0.002 Cornuz J et al. Ann Intern Med. 2002

7 Results 1-year smoking abstinence among patients % 1-year smoking cessation Training Control P=0.005 Cornuz J et al. Ann Intern Med. 2002

8 First-line therapy in health care settings Nicotine replacement therapy Gum Transdermal patch Inhaler Double the likelihood of quitting one year later Tablets Higher efficacy when combined with counseling Choice based on smoker s preference. Highly cost-effective interventions: $/yr saved 8

9 So proud to be an ex-smoker COPD patient nail 1 month after stopping!

10 A smoker s device (inhaler) 2 months after the quit date 10

11 Physical activity promotion Scientific literature: effective approaches to physical activity promotion (Heath et al, 2012). 7 best investments for physical activity (GAPA 2011) school programmes transport urban planning public education community-wide programmes sport for all integration of physical activity promotion into primary health care systems 11

12 Physical activity promotion Scientific literature: effective approaches to physical activity promotion (Heath et al, 2012). 7 best investments for physical activity (GAPA 2011) school programmes transport urban planning public education community-wide programmes sport for all integration of physical activity promotion into primary health care systems 12

13 Résultat méta-analyse 13

14 Physical activity promotion in HC system Health care system: specific role because (Martin et al. 2014) it provides access to individuals who might be difficult to reach for physical activity promotion it can make use of established structures and procedures. Patients appreciate if their family physician addressed their physical activity behaviour (Bize et al., 2008). Several systematic reviews showed the effectiveness of physical activity counselling in primary care (Orrow et al, 2012, Campbell et al, 2012, Garrett et al., 2011, Anokye et al, 2014). 14

15 PAPRICA Physical activity promotion in primary care 15

16 PAPRICA - Physical Activity Promotion in PRImary CAre Developed in a multi-partner process including Swiss College for Primary Care Medicine, Policlinique Médicale Universitaire in Lausanne, Institute of Social and Preventive Medicine, University of Zurich. Based on evidence as well as on established approaches and tools Based on specific demands of primary care physicians 16

17 PAPRICA Development after focus group Handbook for physicians Tested Booklets for patients 25 physicians Improvement Handbook light 1 Booklet for patients Training Multidisciplinary team Tested with residents Optimised + standardised Training : French-speaking area of Switzerland (7/ year) Training 2014: German-speaking area Echanges internationaux - ICPAPH 17

18 PAPRICA Training session Module 1 Social representations of PA Summary of links between PA and health Module 2 Two video sequences: motivational and non motivational interviewing Practicing motivational interviewing with a simulated patient Modules 3 et 4 de la formation 18

19 PAPRICA Training session (ctd) Module 3 Experimentation of moderate PA Experimentation of postural stabilization Module 4 Presentation of handbook, booklet, website, evaluation Nombre de formations réalisées 19

20 External evaluation Before and after assessment Méthodes préférées pour conseil 20

21 I thank you for your attention