Proposition 53K0907

Proposition de résolution visant à l'amélioration de l'observance thérapeutique des patients.

General information ¶

Authors

N-VA Manu Beuselinck
Open Vld Maggie De Block, Ine Somers
Vooruit Maya Detiège

Submission date

Dec. 21, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

medicine medicinal product health risk health policy health costs resolution of parliament public health disease prevention

Voting ¶

Voted to adopt

Vooruit LE PS | SP Open Vld N-VA MR

Abstained from voting

Groen CD&V Ecolo LDD VB

Party dissidents ¶

• Bernard Clerfayt (MR) abstained from voting.
• Olivier Maingain (MR) abstained from voting.
• Damien Thiéry (MR) abstained from voting.

Contact form ¶

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Discussion ¶

March 28, 2013 | Plenary session (Chamber of representatives)

Full source

The concept of therapeutic observance is the ability of a patient to respect the advice given to him in health matters, in particular with regard to medical prescriptions.

If the patient's adherence to his therapeutic treatment is a determining element for his healing, his non-adherence can have serious consequences for his health, in particular by causing the aggravation of the pathology.

In addition to its health objective, which is to work towards better therapeutic observance, this proposal for a resolution has an economic purpose of reducing costs for the health system. In fact, therapeutic non-observance can have no negligible consequences for the community: epidemiological risks, emergence of drug resistance, additional expenses through the taking of new drugs, through the prescription of auxiliary examinations, the need to hospitalize the patient when this could have been avoided.

For the PS group, it is primary to question the reasons that lead the patient not to comply with the prescriptions given to him. Does he not understand them? Are the prescribed treatments scary? Is the impact of these treatments on their quality of life too significant? Are the side effects hard to tolerate? Is the financial accessibility of these treatments a problem? A multitude of reasons can cause the patient, sometimes unconsciously, to give up these treatments. That is why it seems essential for us to explore in depth the reasons for this non-observance.

The proposed resolution as amended should allow such reflection. It must involve all actors and, first of all, patients through their associations, through mutual associations, through the Observatory of Chronic Diseases. It is with the participation of patients that therapeutic education programs can be developed and that their capacity to take care of themselves can be increased.

Healthcare providers, whether they are doctors, pharmacists or nurses, must of course also participate in this reflection. It is their responsibility to ⁇ their patient’s adherence to the prescribed treatment. It is not enough to announce the disease, to dictate or to give treatment so that the patient follows it blindly. A dialogue must be established. The prescriber must therefore verify that the medical information transmitted is well understood. He must define with his patient the therapeutic goals he intends to ⁇ , he must negotiate the treatment by evaluating the impact it may have on his patient’s daily life. This requires time but also specific training that should be provided to healthcare providers.

Furthermore, regardless of the case, our group would like to recall that it cannot be possible to penalize financially a person who renounces, consciously or unconsciously, his therapeutic treatment. For the patient, the non-acceptance of a treatment is almost immediately transformed into a therapeutic penalty. The double punishment is not acceptable in this matter and will only result in the worsening of the health problems of the person concerned.

The answers to therapeutic non-compliance are ⁇ as complex and multiple as the reasons for this non-compliance. There is no miracle measure. Also, the will expressed in this text to put all the competent actors around the table fully endorses us. Only by bringing together patients, prescribers and care providers can progress be made.

For the PS Group, this proposal for a resolution could constitute the basis for a national policy of therapeutic patient education, in which all health care actors would be involved. We will therefore support this text and be attentive to its impact on the ground.

First of all, I would like to thank colleagues Detiège and Somers for the initiative they took in 2010. If we were offered the resolution, we would have signed it, but unfortunately we did not get that opportunity.

The starting point of the resolution is correct. We need to make the therapeutic faithful much better. We know that this constitutes a problem and that there are various causes behind it, both in the patient and in the healthcare provider.

We discussed this in a constructive way. Several amendments were submitted. We would like to see two points that come more out of the paint in the resolution. Initially, we wanted to involve the patients and the patient associations in particular, more in the screening, and in the whole story. This was addressed by involving both the Observatory for Chronic Diseases and the patient associations. That is positive.

A second aspect was the question of including eHealth. This was not just a question from us, but from different parties. I even remember that the Minister’s collaborator also cited during the debate. Unfortunately, we had to conclude that the amendment we had proposed for that, to know, to measure, to monitor, was rejected. If today one wants to see the extent to which therapeutic faithfulness is observed — the resolution also asks to collect statistical data on it — then one needs an instrument. The only tool available today is eHealth. That is important.

The colleagues were concerned about, among other things, privacy, but I think that the contours of eHealth are so fixed, also in terms of privacy objectives, so that privacy is covered. We believe that when certain therapies are not followed, healthcare providers should be able to indicate them, in discussion with the patient, in a global medical record. Unfortunately, this amendment was not adopted. My colleagues were apparently afraid to include eHealth in the resolution, but for CD&V that really remains a fundamental, essential point. If one submits a resolution here today about therapeutic faithfulness, then one must also be able to monitor and measure. Today eHealth is the only tool for this.

I know that the arguments of the colleagues were that everyone should take responsibility, but for us this is not far enough. We abstained because we think this is an empty box. We also believe that monitoring should be carried out.

We ⁇ do not want to stand in the way of the colleagues’ initiative, but CD&V will, based on the eHealth story and the fact that this unfortunately did not get the text, abstain from voting on this resolution.

Mr. Speaker, colleagues, a number of findings about therapeutic loyalty required us to propose something politically.

In the United States, for example, the lack of therapeutic loyalty leads to the deaths of 125 patients annually. That is an enormously high figure. In addition, 11% of the hospitalizations of elderly persons appear to be the result of improper or improper use of medicines. These are striking figures.

In Belgium, which is important for our patients, it turns out that the actors in healthcare – both doctors and pharmacists and the patients themselves – are insufficiently aware of both the extent and the consequences of the lack of loyalty to the therapist. For these reasons, we have pushed a number of things forward. As already cited by Mr. Seminara and Mrs. Muylle, we in the committee have also considered an update of the proposal. We try to work quickly in Parliament, but it can always be faster. We have optimized a number of things.

Specifically, we ask, for example, the Federal Knowledge Centre for an evaluation in terms of the number of ordinary quality years, and to formulate proposals to improve therapeutic loyalty.

We also request that the Observatory for Chronic Diseases conduct a survey of the patients, asking about the causes of the lack of therapeutic faithfulness and – very importantly – asking the patients themselves about possible solutions.

There would also be a forum where the various stakeholders, such as patient associations, pharmacists, doctors and the pharmaceutical industry, could engage in consultations on the subject.

It is also important that communication between patients and healthcare providers and between healthcare providers improves.

Finally, we also ask the government to consult with the pharmaceutical industry to simplify the intake of medicines. We discussed this in detail in the committee on Wednesday. I then cited figures from the EMA. This shows, for example, that anxiety is one of the major problems among geriatric patients. In children under 12 years of age, the problem is that they are unable to take tablets. Breast pills could provide a solution. In practice, the majority of medicinal products placed on the market are not adapted to the target groups for which they are intended.

Colleagues, I would like to conclude by emphasizing that the results of the studies and the consultation should not be aimed at sanctioning the patient, but to stimulate him. I think there were some misunderstandings and concerns about this in the committee. Own guilt, thick bull is a thought track that at first glance may sound logical to some people. However, when it comes to health, it is a dangerous thought track. Individualization would mean a direct attack on the weakest in our society.

Our health, colleagues, is unevenly distributed in Belgium. Health attitudes are strongly socially determined and can not only be reduced to personal responsibility. Access to good habits is not evenly distributed. So let us make everyone aware and even encourage to make the best choices, but the consequences of smaller choices we really need to continue to bear together.

I would like to briefly read something from the practice. I doubted if I would do it, but it only takes two minutes. It is a story purely out of practice; it is something else in the plenary session. It is intended to make it clear to people that they should be careful and not make the policy too strict for the patient. It’s a piece from a book I once wrote about the pink neighborhood in Antwerp. I’m not going to start with the prostitutes, it’s going to be about the patients themselves.

“Ah, the classes at the university... They are so far away from everyday life, and ⁇ here in Klapdorp. No course can prepare you for what you get in front of your nose. You think you are full of knowledge when you start, but you only know some facts. I hear Professor Laekeman still say: “Students of pharmacy, always inform your customers very clearly and in human language about the instructions for use. The leaflet is printed too small for most people and is incomprehensible.” Professor Laekeman was a little upset when you didn’t know how many milliliters went into a cup of coffee, but it was still pumped into it. A coffee tablespoon is five milliliters, a dessert tablespoon is ten and a tablespoon is fifteen. But, and I lived in a special neighborhood, but yet, who in this neighborhood used dessert tablespoons? They eat fries with their hands and drink from boxes. Why could that professor not even warn us of people who just drink from the bottle – here they call it a teut?”

I thank you for your attention.

Most of our resolutions have already been explained.

Therapeutic loyalty, on the one hand, is important for the health of the patients themselves. On the other hand, however, it also has a significant cost effect.

We know figures from different countries. We know, among other figures, figures from the United States. In Belgium, however, today there is a lack of numerical data and the effective mapping of the scale of the therapeutic vaccine in Belgium.

Therapeutic trouble can be defined in several ways. It can range from one day without taking medication to voluntary discontinuation of treatment.

In the patient survey, it is extremely important not only to detect who does not fully follow his treatment, but also to determine which aspects of a treatment are not followed properly and why they are not followed. For this we need statistical data and surveys are necessary.

The eHealth story will effectively help us with data collection. The medical record and communication between doctors will also be essential in this regard.

On the other hand, awareness is extremely important. It is about raising awareness of both the patient and all healthcare actors. After all, it is only when everyone is aware of the consequences that some things have on the health of the patient, but also the consequences that some things have on the cost of health care, that we will effectively also attach an enormous importance and an enormous added value to therapeutic faithfulness.

In addition, if we map all the data, we can effectively reach an optimization of a treatment, to the optimum prescription of medication and to the optimum use or – as Ms. Detiège has noted – an optimum form of medication for certain target groups.

On the one hand, measurement and knowledge are therefore essential, and on the basis thereof the correct conclusions can be drawn. On the other hand, it is also important to raise awareness, communicate and involve the sectors and all actors within the healthcare sector in the file, in order to ⁇ optimal use and optimal treatment.

Mr. Speaker, I was not registered as speaker, but I would like to briefly justify our abstention on behalf of the Ecolo-Groen group.

If we are in favour of improving therapeutic compliance, because it is a matter of effectiveness for both individuals and for the care system, and we consider the intentions of the resolution to be good, we nevertheless consider that the means put forward neglect the essential, i.e. the role of first-line professionals and the generalist.

It is surprising to observe the removal, between the first text that had been submitted to us and the new one, of the most important point that mentioned a long and comprehensive communication between the patient and the doctor. However, we would have preferred a long-term consultation for a question of consistency.

Furthermore, we believe that the resolution neglects the issue of the relevance of certain prescriptions, the questioning of certain medicines, the overconsumption of medicines, all factors which may be contrary to good therapeutic observance. Therefore, we regret that the analysis was too narrow.

Finally, it is a pity that we have not been associated with this resolution from the beginning. We will abstain.