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Stratégies D'optimisation De La Pertinence Des Requêtes Relatives À L'irm Et À La TDM

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Stratégies D'optimisation De La Pertinence Des Requêtes Relatives À L'irm Et À La TDM JANVIER 2018 ÉTAT DES CONNAISSANCES Stratégies d’optimisation de la pertinence des requêtes concernant l'IRM et la TDM Stratégies et outils favorisant une utilisation optimale Une production de l’Institut national d’excellence en santé et en services sociaux (INESSS) Stratégies d’optimisation de la pertinence des requêtes concernant l'IRM et la TDM Stratégies et outils favorisant une utilisation optimale Rédigé par Yannick Auclair Avec la collaboration de Brigitte Coté Sous la direction de Michèle de Guise Le contenu de cette publication a été rédigé et édité par l’INESSS. Ce document et ses annexes sont accessibles en ligne dans la section Publications de notre site Web. Équipe de projet Équipe de l’édition Auteur Patricia Labelle Yannick Auclair, Ph. D. Denis Santerre Hélène St-Hilaire Collaboratrice Brigitte Côté, M.D., FRCPC, M. Sc. Sous la coordination de Renée Latulippe, M. A. Coordination scientifique Yannick Auclair, Ph. D. Avec la collaboration de Littera Plus, révision linguistique Direction scientifique Denys Melnychenko, trad.a. (OTTIAQ), Michèle de Guise, M.D., FRCPc, M.M. traduction Repérage d’information scientifique Lysane St-Amour, M.B.S.I. Soutien documentaire Flavie Jouandon Dépôt légal Bibliothèque et Archives nationales du Québec, 2018 Bibliothèque et Archives Canada, 2018 ISSN 1915-3104 INESSS (PDF) ISBN 978-2-550- 80109-2 (PDF) © Gouvernement du Québec, 2018 La reproduction totale ou partielle de ce document est autorisée à condition que la source soit mentionnée. Pour citer ce document : Institut national d’excellence en santé et en services sociaux (INESSS). Stratégies d’optimisation de la pertinence des requêtes concernant l'IRM et la TDM – Stratégies et outils favorisant une utilisation optimale. Rapport rédigé par Yannick Auclair avec la collaboration de Brigitte Côté. Québec, Qc : INESSS; 2018. 86 p. L’Institut remercie les membres de son personnel qui ont contribué à l’élaboration du présent document. Lecteurs externes La lecture externe est un des mécanismes employés par l’INESSS pour assurer la qualité de ses travaux. Les lecteurs externes valident les aspects méthodologiques de l’évaluation, de même que l’exactitude du contenu, en fonction de leur domaine d’expertise propre. Pour le présent rapport, les lecteurs externes sont : M. Luigi Lepanto, M.D., M. Sc., F.R.C.P.C., directeur des services professionnels, CHUM; professeur titulaire de clinique, Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal; adjoint au directeur, responsable de l'Unité d’évaluation des technologies et des modes d’intervention en santé, CHUM. M. Benoit Gallix, M.D., Ph. D., professeur, Département de radiologie diagnostique, Université McGill. M. Alexandre Messier, M.D., CCMF (MU), médecin-conseil, DGSSMU, MSSS; professeur adjoint de clinique, Département de médecine familiale et de médecine d’urgence, Université de Montréal. M. Cédric Carbonneil, Ph. D., chef du service Évaluation des actes professionnels, Haute Autorité de Santé (HAS), France. Mme Stéphanie Schramm, médecin, adjointe au chef du service Évaluation de la pertinence des soins et amélioration des pratiques et des parcours (SA3P), Haute Autorité de Santé (HAS), France. Autres contributions L’Institut tient aussi à remercier les personnes suivantes qui ont contribué à la préparation du présent rapport en fournissant soutien, information et conseils clés : Mme Alicia Framarin, M. Sc., scientifique principale, technologies et modes d’intervention, INESSS M. Michel Rossignol, M.D., M.Sc., médecin-conseil, INESSS Déclaration de conflits d’intérêts Aucun conflit déclaré. Responsabilité L’Institut assume l’entière responsabilité de la forme et du contenu définitifs du présent document. Les conclusions et recommandations ne reflètent pas forcément les opinions des lecteurs externes ou celles des autres personnes consultées aux fins du présent dossier. TABLE DES MATIÈRES RÉSUMÉ ...................................................................................................................................................... II SUMMARY .................................................................................................................................................. V SIGLES ET ACRONYMES ........................................................................................................................... VIII 1 INTRODUCTION ............................................................................................................................ 1 1.1 Problématique ............................................................................................................................. 1 1.2 Contexte de la demande .............................................................................................................. 1 1.3 Objectif et livrable ........................................................................................................................ 1 2 MÉTHODE ..................................................................................................................................... 3 2.1 Questions d’évaluation ................................................................................................................ 3 2.2 Type de revue de la littérature .................................................................................................... 3 2.3 Stratégies de recherche et sélection des études ......................................................................... 3 2.4 Évaluation de la qualité méthodologique des études ................................................................. 3 2.5 Extraction, synthèse des données et appréciation de la preuve ................................................. 4 3 RÉSULTATS ET DISCUSSION .......................................................................................................... 5 3.1 Interventions auprès des professionnels (p. ex. la diffusion de lignes directrices, l’éducation médicale continue, les rappels et l'audit et rétroaction) .......................................... 5 3.2 Accès aux services et champs de pratique des cliniciens référents........................................... 13 3.3 Triage des requêtes et mécanismes de préautorisation ou de prénotification ........................ 21 3.4 Systèmes de soutien à la décision clinique (SSDC) .................................................................... 25 3.5 Structures organisationnelles, mesures financières et rôles professionnels du spécialiste en imagerie médicale ................................................................................................................. 32 Limites du rapport ............................................................................................................................. 38 4 CONCLUSION ET PISTES D’ACTION............................................................................................. 39 RÉFÉRENCES ............................................................................................................................................. 41 ANNEXE A Sources d’information et critères d'inclusion .................................................................. 53 ANNEXE B Stratégies de recherche de l’information scientifique ..................................................... 54 ANNEXE C Sélection des études......................................................................................................... 57 ANNEXE D Définition des niveaux de preuve .................................................................................... 58 ANNEXE E Tableaux des preuves ....................................................................................................... 59 ANNEXE F Barrières et facilitateurs à l’implantation d'un SSDC couplé à l’OE .................................. 81 ANNEXE G Indicateurs de pertinence ................................................................................................ 82 LISTE DES TABLEAUX ET FIGURES Tableau 1 Types de stratégies d'intervention auprès des professionnels et leur effet sur la pratique .................................................................................................................................. 5 Figure 1 Distribution de la littérature repérée en fonction du lieu (A) et des modalités d’imagerie (B) ....................................................................................................................... 15 Tableau 2 Effet et niveau de preuve de l'accès direct des médecins de famille à la TDM et à l'IRM ..................................................................................................................................... 16 Figure 2 Distribution de la littérature repérée en fonction du lieu (A) et des modalités d’imagerie (B) ....................................................................................................................... 22 Tableau 3 Effet et niveau de preuve des mécanismes de préautorisation ou de prénotification ....... 23 Figure 3 Distribution de la littérature repérée en fonction du lieu de l’étude .................................. 26 Tableau 4 Effet et niveau de preuve des systèmes de soutien à la décision clinique .......................... 28 Tableau 5 Exemples d’indicateurs associés à l'imagerie utilisés dans le cadre du programme PQRS ..................................................................................................................................... 34 Tableau A-1 Sources d’information pour l’ensemble
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