Use of care in dementia: overmedication in question. Exploitation of data from the generalist beneficiary sample.

Summary The management of dementia is a challenge for clinicians because these patients constitute a heterogeneous population. In the context of this management, the interest of antidementia drugs (anticholinesterase and memantine) is debated: the clinical effectiveness seems questionable and the adverse effects are not negligible. In 2010, good practice recommendations gave physicians the choice to prescribe or not these drugs. Since then, questions remain unanswered: 1/ what is the evolution of the prescription rates of these drugs since these recommendations, in other words how has the clinical expertise of physicians, one of the pillars of the evidence-based medicine triptych, been expressed? 2/ what are the factors that remain associated today with the fact of prescribing or not prescribing these drugs? and 3/ is there an over-hospitalization linked to their adverse effects? The question of over-medicalization is at the heart of our thesis problem. In this work, we answered these 3 questions which constituted our 3 objectives. We were able to show that physicians seemed to be less and less confident about antidementia drugs with a decrease in their prescription since 2010 and important consequences in terms of avoided costs. When they continued to be prescribed, these treatments were mainly prescribed for younger patients or those in better health. Finally, anticholinesterase drugs, mainly rivastigmine, increased the risk of hospitalization through cardiac and digestive adverse effects. Our results argue against the prescription of antidementia drugs from the point of view of both morbidity and health care costs. The question of the patient's point of view remains.