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Parcours de soins des patients atteints de sclérose en plaques à partir des données médico-administratives en France

Abstract : Multiple sclerosis (MS) is a chronic neurological disease starting in young adulthood and affecting about 100,000 persons in France. During the last two decades, therapeutic practices have evolved with the release of new substances, especially oral disease-modifying therapies (DMTs). Care pathways in MS involve both medical (general practitioners, neurologists) and paramedical (physiotherapists and nurses) health care professionals. However, no recommendation on care pathways in MS exists so far in France. Moreover, few data are available on care-seeking of persons with MS (PwMS) and the utilization of DMTs in France. The use of state sequence analysis (SSA) on data issued from the French National Health Data System (SNDS, i.e. databases from the French Health Insurance System) offers the opportunity to study care pathways. The main objective of this PhD thesis was to study the care pathways of PwMS in France using data from SNDS, in order to describe care-seeking and to create a typology of pathways. The secondary objectives were to study MS DMTs utilization in France (frequency and therapeutic sequences), and the feasibility to measure the level of motor disability in SNDS. Over the 2010-2015 study period, 112,745 PwMS were identified. Amongst them, 47.4% had at least one delivery of a MS-specific DMT. A typology was obtained allowing the identification of five clinically distinct groups of patients. In parallel, a parameter quantifying the level of motor disability in SNDS, which could be replicated in other studies, was defined. Thanks to the different analyses and raised methodological questions, key-elements allowing the use of SSA in health field, especially multichannel sequence analysis, were highlighted.
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Submitted on : Monday, November 25, 2019 - 4:44:22 PM
Last modification on : Thursday, January 14, 2021 - 11:21:06 AM
Long-term archiving on: : Wednesday, February 26, 2020 - 9:16:10 PM


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  • HAL Id : tel-02379451, version 1


Jonathan Roux. Parcours de soins des patients atteints de sclérose en plaques à partir des données médico-administratives en France. Médecine humaine et pathologie. Université Rennes 1, 2018. Français. ⟨NNT : 2018REN1B042⟩. ⟨tel-02379451⟩



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