{"id":1650,"date":"2020-04-05T21:20:04","date_gmt":"2020-04-06T04:20:04","guid":{"rendered":"http:\/\/monvisitebetter.ca\/evidence\/better-essai-controle-randomise-ecr\/"},"modified":"2020-04-08T21:08:22","modified_gmt":"2020-04-09T04:08:22","slug":"the-better-trial","status":"publish","type":"post","link":"https:\/\/www.better-program.ca\/fr\/evidence\/the-better-trial\/","title":{"rendered":"BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR)"},"content":{"rendered":"<div id=\"page-header-block_5e6ef11e31ead\" class=\"page-header block alignfull\">\n  <div class=\"page-header-content\">\n    <div class=\"page-header-content-wrapper\">\n              <h5 class=\"red\">Completed Initiatives<\/h5>\n            <h1>BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR)<\/h1>\n      \n          <\/div>\n  <\/div>\n  <div class=\"page-header-image\">\n          <div class=\"mask\">\n        <img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1707\" src=\"https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-scaled.jpg\" class=\"attachment-full size-full\" alt=\"\" srcset=\"https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-scaled.jpg 2560w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-300x200.jpg 300w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-1024x683.jpg 1024w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-768x512.jpg 768w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-1536x1024.jpg 1536w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-2048x1365.jpg 2048w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/>      <\/div>\n          <div class=\"swoop image-top-left\">\n  <svg width=\"271\" height=\"232\" viewBox=\"0 0 271 232\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n    <g stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n      <g transform=\"translate(-381.000000, -576.000000)\" class=\"shape yellow\" fill=\"#FED292\">\n        <g transform=\"translate(156.000000, 136.000000)\">\n          <path d=\"M265.557208,487.189506 C315.60114,420.53788 381.576801,439.743631 423.090827,453.878491 C540.604638,493.890678 492.777294,576.144665 440.87301,616.455285 C385.166388,659.723102 289.489434,696.122032 244.274497,649.549258 C221.913179,626.537872 208.331629,563.393447 265.557208,487.189506\"><\/path>\n        <\/g>\n      <\/g>\n    <\/g>\n  <\/svg>\n<\/div>\n<div class=\"swoop image-top-right\">\n  <svg width=\"271\" height=\"232\" viewBox=\"0 0 271 232\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n    <g stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n      <g transform=\"translate(-381.000000, -576.000000)\" class=\"shape red\" fill=\"#FED292\">\n        <g transform=\"translate(156.000000, 136.000000)\">\n          <path d=\"M265.557208,487.189506 C315.60114,420.53788 381.576801,439.743631 423.090827,453.878491 C540.604638,493.890678 492.777294,576.144665 440.87301,616.455285 C385.166388,659.723102 289.489434,696.122032 244.274497,649.549258 C221.913179,626.537872 208.331629,563.393447 265.557208,487.189506\"><\/path>\n        <\/g>\n      <\/g>\n    <\/g>\n  <\/svg>\n<\/div>\n  <\/div>\n\n    <div class=\"grey-bg\"><\/div>\n<\/div>\n\n\n\n<div class=\"text-block block\">\n<a href=\"http:\/\/better-program.ca\/donnees-et-preuves-scientifiques\/?lang=fr\" class=\"link__text back\">Retour a Donn\u00e9es et preuves scientifiques<\/a>\n<\/div>\n\n\n\n<h4 class=\"h4-intro wp-block-heading\">L\u2019objectif du projet BETTER initial \u00e9tait de d\u00e9terminer si la pr\u00e9vention et le d\u00e9pistage du cancer et d\u2019autres maladies chroniques telles que le diab\u00e8te et les maladies cardiovasculaires pouvaient \u00eatre am\u00e9lior\u00e9s dans le contexte de la m\u00e9decine familiale.<\/h4>\n\n\n\n<p>Le projet BETTER consistait en un essai clinique al\u00e9atoire pragmatique par groupes bas\u00e9 sur le cadre de travail sur la pr\u00e9vention et la prise en charge des maladies chroniques du minist\u00e8re de la sant\u00e9 et des soins de longues dur\u00e9es de l\u2019Ontario (<a href=\"http:\/\/www.health.gov.on.ca\/en\/pro\/programs\/cdpm\/#1\">Pr\u00e9vention et gestion des maladies chroniques : Cadre de travail de l\u2019Ontario<\/a>).<\/p>\n\n\n\n<p>Le projet BETTER initial se situait dans le contexte de huit \u00e9quipes de soins primaires (ESP) en milieu urbain dans deux villes canadiennes (Toronto, Ontario et Edmonton, Alberta). Les ESP consistent en un mod\u00e8le int\u00e9gr\u00e9 de prestation de soins primaires qui incluent une \u00e9quipe interprofessionnelle. Elles fonctionnent selon un syst\u00e8me collaboratif pour fournir des soins de sant\u00e9 primaires complets, accessibles et coordonn\u00e9s aux patients inscrits. L\u2019\u00e9quipe comprend g\u00e9n\u00e9ralement un m\u00e9decin de premi\u00e8re ligne, un infirmier praticien sp\u00e9cialis\u00e9, un infirmier, un di\u00e9t\u00e9tiste et un pharmacien, ainsi que d\u2019autres professionnels de la sant\u00e9.<\/p>\n\n\n\n<p>Huit ESP ont pris part au projet BETTER, quatre dans chaque ville. Quatre m\u00e9decins de premi\u00e8re ligne (MPL) au sein de chaque ESP ont \u00e9galement particip\u00e9 , pour un total de trente-deux MPL (seize dans chaque ville). Dans chaque ville, deux des quatre MPL ont \u00e9t\u00e9 assign\u00e9s de fa\u00e7on al\u00e9atoire au groupe d\u2019intervention sur les patients (seize MPL au total pour les deux villes).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"480\" src=\"https:\/\/better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema-1024x480.png\" alt=\"Sch\u00e9ma de l'\u00e9tude\" class=\"wp-image-715\" srcset=\"https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema-1024x480.png 1024w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema-300x141.png 300w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema-768x360.png 768w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema-1536x720.png 1536w, https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/better-design-schema.png 1872w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p>Ce sch\u00e9ma a donc conduit aux groupes suivants :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Huit ESP o\u00f9 les patients recevaient une intervention uniquement au niveau du cabinet m\u00e9dical<\/li><li>Huit ESP o\u00f9 les patients recevaient une intervention uniquement au niveau personnel<\/li><li>Huit ESP o\u00f9 les patients recevaient \u00e0 la fois une intervention au niveau du cabinet m\u00e9dical et au niveau personnel<\/li><li>Huit ESP o\u00f9 les patients et le cabinet m\u00e9dical continuaient \u00e0 suivre les proc\u00e9dures habituelles<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Intervention au niveau du patient \u2013 Facilitation interne<\/h4>\n\n\n\n<p>L\u2019intervention de facilitation au niveau du patient a fait appel \u00e0 huit praticiens de pr\u00e9vention (un par ESP), professionnels de la sant\u00e9 disponibles au sein de chaque ESP et choisis par le cabinet m\u00e9dical pour assumer ce r\u00f4le. Les praticiens de pr\u00e9vention ont re\u00e7u une formation sp\u00e9cialis\u00e9e sur l\u2019approche BETTER d\u2019utilisation de m\u00e9thodes de pr\u00e9vention et de d\u00e9pistage bas\u00e9es sur des donn\u00e9es probantes. Ces praticiens rencontraient les patients en priv\u00e9 (\u00ab visite de pr\u00e9vention \u00bb) pour \u00e9valuer leur risque de maladies chroniques et pour les aider \u00e0 \u00e9tablir des objectifs pour la pr\u00e9vention et le d\u00e9pistage des maladies chroniques (PDMC). En prenant les d\u00e9cisions ensemble, le praticien de pr\u00e9vention et le patient d\u00e9veloppaient une \u00ab ordonnance de pr\u00e9vention \u00bb personnalis\u00e9e et bas\u00e9e sur les ant\u00e9c\u00e9dents familiaux et m\u00e9dicaux et les risques de maladies chroniques du patient. Cette ordonnance de pr\u00e9vention personnalis\u00e9e pouvait aussi comporter des recommandations pour passer des tests de d\u00e9pistage et\/ou, si n\u00e9cessaire, pour des programmes de modification du mode de vie.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Intervention au niveau du cabinet m\u00e9dical \u2013 Facilitation externe<\/h4>\n\n\n\n<p>L\u2019intervention de facilitation au niveau du cabinet m\u00e9dical impliquait deux facilitateurs de pr\u00e9vention (un par ville). Ces personnes \u00e9taient ext\u00e9rieures au cabinet m\u00e9dical et avaient suivi une formation sur l\u2019approche BETTER pour les ESP. Chaque facilitateur avait re\u00e7u une formation au Centre for Effective Practice (CEP) (Centre pour des pratiques efficaces) et en Quality Improvement and Innovation Partnership (QIIP) (Partenariat pour l\u2019am\u00e9lioration de la qualit\u00e9 et l\u2019innovation) pour travailler avec des repr\u00e9sentants de chaque ESP afin de d\u00e9velopper des continuums de PDMC pour chaque technique utilis\u00e9e dans l\u2019approche BETTER. Chaque facilitateur \u00e9valuait l\u2019utilisation par les cabinets m\u00e9dicaux de leurs dossiers m\u00e9dicaux informatis\u00e9s (DMI) et pr\u00e9parait une \u00ab ordonnance de pr\u00e9vention \u00bb destin\u00e9e \u00e0 adapter les DMI \u00e0 la PDMC (p. ex. lettres d\u2019invitation pour les patients, contr\u00f4le et commentaires, aide \u00e0 la d\u00e9cision) et personnalis\u00e9e aux besoins de chaque ESP. Cette ordonnance visait \u00e0 optimiser l\u2019utilisation des outils et des ressources disponibles pour les cabinets m\u00e9dicaux.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">R\u00e9sultats de l\u2019\u00e9tude BETTER<\/h4>\n\n\n\n<p>Le recrutement pour l\u2019\u00e9tude BETTER a commenc\u00e9 en ao\u00fbt 2010 et s\u2019est termin\u00e9 en mars 2011. Au total 789 patients \u00e2g\u00e9s de quarante \u00e0 soixante-cinq ans ont \u00e9t\u00e9 enr\u00f4l\u00e9s. L\u2019analyse des donn\u00e9es a d\u00e9montr\u00e9 un effet positif tr\u00e8s prononc\u00e9 de l\u2019intervention de facilitation au niveau du patient et un faible effet de l\u2019intervention de facilitation au niveau du cabinet m\u00e9dical.<\/p>\n\n\n\n<p>Plusieurs instruments sont \u00e9galement n\u00e9s du projet BETTER initial :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Des continuums de soins bas\u00e9s sur des donn\u00e9es probantes pour chaque technique de pr\u00e9vention et de d\u00e9pistage des maladies chroniques, dont des outils et \u00ab une bo\u00eete \u00e0 outils \u00bb adapt\u00e9e \u00e0 un contexte de soins primaires<\/li><li>L\u2019algorithme BETTER, un outil \u00e0 l\u2019usage des cliniciens sur la strat\u00e9gie \u00e0 utiliser pour parler de la pr\u00e9vention et du d\u00e9pistage des maladies chroniques<\/li><li>Des outils \u00e9ducatifs et d\u2019entretiens motivationnels offrant de l\u2019aide aux cliniciens lors de l\u2019\u00e9valuation pour chaque patient des risques individuels de maladies chroniques et de son d\u00e9sir de changement.<\/li><\/ul>\n\n\n\n<p>Pour plus de renseignements sur les prochaines \u00e9tapes du projet BETTER, veuillez cliquer <a href=\"https:\/\/better-program.ca\/evidence#publications\">ici<\/a>.<\/p>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<p>The BETTER trial was made possible through a financial contribution from Health Canada, through the Canadian Partnership Against Cancer&rsquo;s Coalitions Linking Action &amp; Science for Prevention (CLASP) initiative, and from the Heart and Stroke Foundation of Canada.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/images.squarespace-cdn.com\/content\/v1\/546d05b0e4b08897ae0800fb\/1441057208566-9QVLFFZREQXNDRUM30KA\/ke17ZwdGBToddI8pDm48kEG2o0sJwfratzFaubdiHcUUqsxRUqqbr1mOJYKfIPR7LoDQ9mXPOjoJoqy81S2I8N_N4V1vUb5AoIIIbLZhVYy7Mythp_T-mtop-vrsUOmeInPi9iDjx9w8K4ZfjXt2djog16IwOZxL61TEwYrPw43jekfboNPfvkkbq6J4khuFm4bjm9DAHF2kOsIZRJKXnA\/image-asset.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">\u00c9quipe de l\u2019essai BETTER (2009 &#8211; 2012)<\/h2>\n\n\n\n<p class=\"footnote\"><strong>Chercheuses principales<\/strong>: Dre Eva Grunfeld et Dre Donna Manca<br><strong>Groupe de travail sur la m\u00e9thodologie<\/strong> : E. Grunfeld (Pr\u00e9sidente), D. Manca, R. Moineddin, K. Thorpe, M. Mamdani, P. Krueger.<br><strong>Groupe de travail clinique :<\/strong>: D. Campbell-Scherer (Chair), R. Barrett, S. Bell, S. Bible, S. Buchman, J. Carroll, M. Dhaliwal, S. Dunn, M. Griever, E. Grunfeld, C. Harrison, L. Hosford, M. Kahan, D. Klein, C. Korownyk, K. Lang-Robertson, D. Manca, J. Meuser, V. Mozgala, J. Pencharz, L. Radmanovich, J. Rogers, G. Salvalaggio, L. Schaar, R. Stoller, D.L. Vesik, R. Wymer, M. Yan.<br><strong>Analyse statistique<\/strong>: R. Moineddin, K. Thorpe, C. Meaney.<br><strong>Coordination de l\u2019essai<\/strong>: Applied Health Research Centre, L. Patterson, C. Fernandes.<br><strong>Analyse \u00e9conomique<\/strong>: J. Hoch, J. Beca.<br><strong>Assistants de recherche<\/strong> : T.K. Dallman, K. Kam, M. Leyland, P. Patel, D. Sanderson, C. Wright.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>L\u2019objectif du projet BETTER initial \u00e9tait de d\u00e9terminer si la pr\u00e9vention et le d\u00e9pistage du cancer et d\u2019autres maladies chroniques telles que le diab\u00e8te et les maladies cardiovasculaires pouvaient \u00eatre am\u00e9lior\u00e9s dans le contexte de la m\u00e9decine familiale.<\/p>\n","protected":false},"author":1,"featured_media":1035,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,67],"tags":[],"class_list":["post-1650","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-completed","category-realisees"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR) - The Better Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.better-program.ca\/fr\/evidence\/the-better-trial\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR) - The Better Program\" \/>\n<meta property=\"og:description\" content=\"L\u2019objectif du projet BETTER initial \u00e9tait de d\u00e9terminer si la pr\u00e9vention et le d\u00e9pistage du cancer et d\u2019autres maladies chroniques telles que le diab\u00e8te et les maladies cardiovasculaires pouvaient \u00eatre am\u00e9lior\u00e9s dans le contexte de la m\u00e9decine familiale.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.better-program.ca\/fr\/evidence\/the-better-trial\/\" \/>\n<meta property=\"og:site_name\" content=\"The Better Program\" \/>\n<meta property=\"article:published_time\" content=\"2020-04-06T04:20:04+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-04-09T04:08:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.better-program.ca\/wp-content\/uploads\/2019\/12\/shutterstock_317585807-scaled.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1707\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/\"},\"author\":{\"name\":\"admin\",\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/#\\\/schema\\\/person\\\/ad144c4c65766c5af84788af12f07d41\"},\"headline\":\"BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR)\",\"datePublished\":\"2020-04-06T04:20:04+00:00\",\"dateModified\":\"2020-04-09T04:08:22+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/\"},\"wordCount\":1124,\"publisher\":{\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.better-program.ca\\\/wp-content\\\/uploads\\\/2019\\\/12\\\/shutterstock_317585807-scaled.jpg\",\"articleSection\":[\"Completed\",\"Termin\u00e9\"],\"inLanguage\":\"fr-FR\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/\",\"url\":\"https:\\\/\\\/www.better-program.ca\\\/fr\\\/evidence\\\/the-better-trial\\\/\",\"name\":\"BETTER Essai Contr\u00f4l\u00e9 Randomis\u00e9 (ECR) - 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