Question 16738 — pharmacy and medicines

Summary

Mr. Julien Rancoule draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the conditions of administration of subcutaneous infusions of Xylocaine (lidocaine) prescribed to patients suffering from persistent chronic pain. If this treatment remains covered by health insurance, the possibility of benefiting from it at home, with the assistance of health providers and caregivers trained, has been deleted. The patients concerned are now forced to go to a hospital for a single monthly infusion, where the previous protocol was based on several weekly sessions close to their place of living. This change in framework had significant consequences for patients whose condition had until then been stabilized. Also, the reduction in the frequency of administration and the Difficulties in accessing hospital slots, which are frequently saturated, result in an increase in disabling pain, emergency interventions at home and increased use of hospital services for substitution treatments. A petition carried by a group of patients, currently relayed in several hospital establishments, underlines the effectiveness of the previous protocol on the medical, social and economic. Patients testify to a regained autonomy which has enabled, for some, the maintenance or resumption of a professional activity, in the absence of adverse effects. The coordination role played by the providers between the prescribing doctor, the attending physician, the private nurses, the pharmacy and the families appeared to be a determining factor in the success of the protocol. This situation raises several questions: firstly, an issue of public health and continuity of care, since stabilized patients see their care degraded without an equivalent alternative. Secondly, an issue of territorial equity, since monthly access to hospitals is particularly restrictive for patients residing in rural areas or far from specialized structures. Thirdly, an issue of financial sustainability for health insurance, additional hospitalizations and substitution treatments induced by the elimination of home care generating additional costs. Consequently, he wishes to know the measures that the Government intends to take in order, on the one hand, to establish a medico-economic assessment of the removal of home administration from this protocol, and on the other hand, to initiate a independent expertise on the conditions under which this treatment could be authorized again at home, in order to guarantee patients suffering from chronic intractable pain a therapeutic response adapted to their condition and their living environment.

Machine translation from French. The official text remains authoritative.

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