Oral Communication

Survey on the treatment of spasticity by botulinum toxin A injections in Midi-Pyrenees Area

Prof Philippe MARQUEa, Prof Xavier DE BOISSEZONa


Introduction. In Toulouse hospital, the waiting time between two botulinum toxin A injections has increased from 6 to 11 months between 2008 and 2012. In this inefficient context we wanted to conduct a survey to draw up an inventory of the use of botulinum toxin A in the area, mapping practices, to identify barriers to use of this treatment.

Methodology. 45 centers that could accommodate patients with spasticity of upper or lower limbs were targeted. They received a survey by mail, and without response a raise to 15 days, 1 month and 6 months.

Results. More than half of the targeted institutions (n = 23/43) in the Midi-Pyrenees area (excluding CHU) responded to the survey. Of all the institutions, only a minority practices botulinum toxin injections to treat patients with muscle hyperactivity (n = 8, 34.8%). These are, for half, public institutions (n = 4, 50%). Meanwhile, the CHU generates 89% of injections of Midi-Pyrénées.

The main reason for the lack of botulinum toxin injections for patients with spasticity is related in 60% of cases to funding problems. Organizational problems within the institution (7/15 = 47%) are cited second. The majority of these institutions (n = 11/15, 73%) believe that yet needs exist: between 5 and 45 patients should be able to benefit from this treatment annually in their institution. Almost all of these institutions (n = 13/15, 87%) have transferred an average of 19 patients in 2012 to another facility for treatment.

Discussion. This centripetal organization appears very inefficient and costly, both in terms of time between injections, accessibility, transport costs. A new organization of the sector, more distributed and involving tele-expertise is being developed.

Keywords : Botulinum toxin type A, spasticity, nursing organisation, medico-economy