{"id":8329,"date":"2019-05-28T17:05:35","date_gmt":"2019-05-28T15:05:35","guid":{"rendered":"https:\/\/francelyme.fr\/?p=8329"},"modified":"2023-02-20T08:37:10","modified_gmt":"2023-02-20T07:37:10","slug":"rapport-sur-les-tables-rondes-du-senat","status":"publish","type":"post","link":"https:\/\/francelyme.fr\/site\/rapport-sur-les-tables-rondes-du-senat\/","title":{"rendered":"Rapport d’information sur les tables rondes du S\u00e9nat"},"content":{"rendered":"
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Ce rapport d’information de Mme \u00c9lisabeth DOINEAU est fait au nom de la commission des affaires sociales : n\u00b0 453 (2018-2019) – 10 avril 2019<\/a> <\/p>\n\n\n\n

r18-4531<\/a>T\u00e9l\u00e9charger<\/a><\/div>\n\n\n\n

Les quatre tables rondes organis\u00e9es par la commission des affaires sociales du S\u00e9nat ont permis aux s\u00e9natrices et s\u00e9nateurs, ainsi qu\u2019\u00e0 tous ceux qui ont pu suivre ces auditions sur internet, de mesurer la complexit\u00e9 de la probl\u00e9matique de la maladie de Lyme et des maladies vectorielles \u00e0 tiques (MVT). L\u2019objectif de ces tables rondes n\u2019\u00e9tait pas de trancher la controverse qui divise les acteurs en pr\u00e9sence mais d\u2019identifier des leviers permettant de surmonter les clivages afin d\u2019avancer vers des solutions concr\u00e8tes, dans l\u2019int\u00e9r\u00eat des malades.<\/p>\n\n\n\n

http:\/\/www.senat.fr\/espace_presse\/actualites\/201903\/maladie_de_lyme.html<\/a><\/p>\n\n\n\n

Voici les 3 exigences majeures soulign\u00e9es par la commission<\/h4>\n\n\n\n

1) Renforcer la recherche et la surveillance \u00e9pid\u00e9miologique sur la borr\u00e9liose de Lyme.\n\n<\/h4>\n\n\n\n

\n La commission s’\u00e9tonne que l’axe strat\u00e9gique 5 du plan national de \nlutte contre la maladie de Lyme ne mentionne pas le montant des cr\u00e9dits\n consentis par les pouvoirs publics \u00e0 l’effort de recherche et se \ncontente de faire r\u00e9f\u00e9rence au soutien de diverses institutions (…) La\n mise en place d’un fonds de financement de la recherche sur la maladie\n de Lyme, le cas \u00e9ch\u00e9ant aliment\u00e9 par des cr\u00e9dits fl\u00e9ch\u00e9s du PIA ou des\n missions d’enseignement, de recherche, de r\u00e9f\u00e9rence et d’innovation \n(MERRI), dont la responsabilit\u00e9 pourrait \u00eatre confi\u00e9e \u00e0 l’ANR, \npermettrait de disposer d’une vision globale de l’effort public dans ce \n domaine.\n\n<\/p>\n\n\n\n

2) Replacer le patient au centre de la r\u00e9flexion sur la prise en charge de la maladie de Lyme et des autres maladies vectorielles \u00e0 tiques. <\/h4>\n\n\n\n

Plut\u00f4t que de s’opposer sur (…) la fiabilit\u00e9 syst\u00e9matique des tests s\u00e9rologiques (…) il revient aux professionnels de sant\u00e9 de replacer le patient au centre d’une d\u00e9marche <\/strong>diagnostique et th\u00e9rapeutique pragmatique qui privil\u00e9gie l’analyse de son tableau clinique et un bilan \u00e9tiologique complet.<\/p>\n\n\n\n

La commission recommande la diffusion la plus large<\/strong> de la recommandation de bonne pratique de la HAS aupr\u00e8s des professionnels de sant\u00e9, en particulier des m\u00e9decins g\u00e9n\u00e9ralistes, et des \u00e9tablissements de sant\u00e9, le cas \u00e9ch\u00e9ant par une circulaire conjointe de la direction g\u00e9n\u00e9rale de la sant\u00e9 et de la direction g\u00e9n\u00e9rale de l’offre de soins.<\/p>\n\n\n\n

La sensibilisation des m\u00e9decins traitants doit demeurer une priorit\u00e9<\/strong> : l’inscription du d\u00e9pistage et de la prise en charge de la borr\u00e9liose de Lyme dans la formation initiale et le d\u00e9veloppement professionnel continu des m\u00e9decins g\u00e9n\u00e9ralistes constitue, selon la commission, un des leviers d’une am\u00e9lioration de la prise en charge de cette maladie. <\/p>\n\n\n\n

3) Rassembler la communaut\u00e9 m\u00e9dicale autour d’un seul r\u00e9f\u00e9rentiel de bonne pratique : <\/h4>\n\n\n\n

Malgr\u00e9 un processus rigoureux d’\u00e9laboration, reconnu au plan international, la recommandation [de la HAS] n’a pas emport\u00e9 le consensus attendu. D\u00e8s sa publication, sa validit\u00e9 a \u00e9t\u00e9 attaqu\u00e9e de front par plusieurs soci\u00e9t\u00e9s savantes, au premier rang desquelles la Spilf et l’Acad\u00e9mie nationale de m\u00e9decine. (…) Le travail conduit par la HAS, qui a respect\u00e9 une d\u00e9marche extr\u00eamement codifi\u00e9e et rigoureuse, ne saurait \u00eatre remis en cause. (…) La commission s’interroge donc sur l’initiative du directeur g\u00e9n\u00e9ral de la sant\u00e9 tendant \u00e0 confier \u00e0 la Spilf \u00ab la coordination de l’\u00e9laboration de nouvelles recommandations pratiques concernant la pr\u00e9vention, le diagnostic, et le traitement de la borr\u00e9liose de Lyme et des autres maladies vectorielles \u00e0 tiques \u00bb. Il est inenvisageable que des recommandations, potentiellement concurrentes, coexistent<\/strong> dans la prise en charge de la borr\u00e9liose de Lyme. Selon votre commission, le travail conduit par la Spilf ne saurait se substituer \u00e0 la recommandation de bonne pratique de la HAS qui doit rester le r\u00e9f\u00e9rentiel \u00e0 diffuser aupr\u00e8s des patients, des professionnels de sant\u00e9 et des \u00e9tablissements de sant\u00e9.<\/strong>

La commission appelle le minist\u00e8re de la sant\u00e9 \u00e0 respecter cette d\u00e9marche de co-construction. Aucun protocole de soins ne saurait \u00eatre reconnu par les autorit\u00e9s publiques sans avoir tenu compte de l’avis et des attentes des patients et usagers. <\/p>\n

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