General Practitioners In France Research Articles

Chronic disease medication management at home. A quantitative survey among 180 patients.

In France, 40% of people aged over 16 (20 million) report having at least one chronic disease requiring long-term treatment. Compliance is estimated to be 50% on average. To study the practical management of oral treatments at home by people living with one or more chronic diseases. Thirty general practitioners in France were invited by e-mail to enrol ten consecutive patients with chronic diseases. A quantitative, descriptive, observational, cross-sectional study was carried out using standardised questionnaires to assess the socio-demographic profile of doctors and patients and the management of oral medication at home. Twenty general practitioners collected 180 questionnaires: 69.4% said they did not find taking their medication a problem; 42.8% used a pillbox; 79.4% said they knew 'all' their medications. 61% reported forgetting to take their medication. More than half of patients are non-adherent. Personalised reminders could reduce unintentional medication non-adherence.

Antibiotic prescriptions associated with a diagnosis of acute nasopharyngitis by general practitioners in France.

Rhinopharyngitis is a common viral infection that has led to an overuse of prescription drugs. Antibiotics, which are not indicated for this infection, are frequently misused. The purpose of this study was to describe drug prescriptions for acute rhinopharyngitis diagnoses in the French general practices. Retrospective study of 1,067,403 prescriptions issued by 2,637 physicians to 754,476 patients residing in metropolitan France for a diagnosis of nasopharyngitis. The data were sourced from the prescription software, Cegedim, for a period spanning from first January 2018 to 31st December 2021 and analysed according to patients and physicians ages. A total of 2,591,584 medications were prescribed by GPs with a median of 3 medications per patient. A total of 171,540 antibiotics were prescribed (16% prescription rates) with amoxicillin being the most frequently prescribed (102,089 prescriptions and 59.5% of antibiotic prescriptions). Amoxicillin prescription increases in extreme age groups (patients less than 9-year-old were prescribed amoxicillin in 18.2% of their visits, those over 80 years-old 10% of the visits, while patients aged 20-29-year-old were prescribed amoxicillin in just 2.9% of their visits), and more prescriptions are issued by older doctors (GPs older than 70 years prescribed antibiotics in 26.4% of the visits vs 3.2% of the visits by GPs aged less than 29 years). Nasopharyngitis is frequently a cause of therapeutical over-prescriptions including antibiotics with an antibiotic prescription rate of 16%. Additional research is required to enhance our understanding of the factors linked to drug prescriptions.

Gender awareness among general practitioners in France: a cross sectional study using the Nijmegen Gender Awareness in Medicine Scale (N-GAMS)

Gender is a key determinant of health and healthcare use. The question of whether physicians are aware of gender issues is important to avoid gender bias in medical practice. This study aimed to validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) in a representative population of French general practitioners (GPs) and to analyze their gender sensitivity and the presence of gender stereotypes among them. The N-GAMS, already validated in medical students, measures gender awareness through 3 subscores: gender sensitivity (GS) and gender-role ideology towards patients (GRIP) and doctors (GRID) (gender stereotypes). After translation into French, it was distributed to 900 GPs. The scale was validated through exploratory factor analysis (EFA). Psychometric properties were tested. Multivariate linear regressions were conducted to explore the associations between GPs’ characteristics and N-GAMS subscores. EFA identified 3 meaningful factors consistent with prior theory. Subscores exhibited good internal consistency. The main findings were that GRIP was significantly higher in older physicians, in male physicians, among those who less involved their patients in decisions, and those who were not training supervisors. For GRID, results were quite similar to those of GRIP. GS was significantly higher for physicians working in health centres or medical homes and for those with gynecological practices but lower when they less involved patients in medical decisions. This study suggests that it is necessary to teach gender issues not only in medical schools but also as part of continuing medical education.

Physician Awareness of the Safe Use of Cyproterone Acetate in Europe: A Survey on the Effectiveness of Additional Risk Minimization Measures.

Cyproterone acetate (CPA) is a synthetic progesterone derivative introduced in the 1970s and prescribed as antiandrogenic therapy for inoperable prostate cancer, sexual deviations in men, and signs of androgenization in women. In 2020, the CPA summary of product characteristics (SmPC)was revised to include an updated special warning and precaution about (1) the risk of meningioma with increasing cumulative dose and (2) contraindication in patients with meningioma or history of meningioma. A Direct Healthcare Professional Communication(DHPC) was distributed. The European Medicine Agency's Pharmacovigilance Risk Assessment Committee requested that marketing authorization holders in Europe conduct a survey to assess physicians' knowledge of the updated key safety information. The primary objective of this study was to measure physicians' awareness (i.e., did they receive and review the revised SmPC and DHPC) and level of knowledge and understanding of the key safety information pertaining to the restricted use of CPA monotherapy because of the risk of meningioma. This cross-sectional web-based survey was administered to dermatologists, endocrinologists, gynecologists, urologists, oncologists, psychiatrists, and general practitioners in France, Germany, Poland, Spain, and the Netherlands who had prescribed CPA monotherapy in the previous 12 months to assess awareness of the risk of meningioma associated with CPA monotherapy. Of the 613 physicians who participated, 85% correctly indicated that CPA monotherapy should be prescribed with the lowest effective dose, 75% correctly indicated that the risk of meningioma increases with increasing cumulative CPA monotherapy doses, and 73% correctly indicated that treatment with CPA-containing products must be stopped permanently if a patient is diagnosed with meningioma. Overall, 40% of physicians reported having received the DHPC, and 42% reported having received the revised SmPC. Despite low recall of receipt of the updated SmPC and DHPC, most physicians surveyed are aware of the meningioma risk and actions to mitigate the risk.

Antibiotic prescription in ambulatory care for COVID-19 patients: a cohort analysis in four European countries.

To analyse antibiotic prescription rates in ambulatory care for COVID-19 patients by general practitioners (GPs) in four European countries. A total of 4,513,955 anonymised electronic prescribing records of 3656 GPs in four European countries were analysed. Diagnosis and prescriptions were retrieved. Antibiotic prescription rates during COVID-19 consultations were analysed and compared between France, the UK, Belgium and Romania. Overall prescription rate was in France and Belgium (6.66 and 7.46%). However, analysing median GP prescribing rates, we found that 33.9% of the GPs in Belgium prescribed antibiotics with a median of 16 prescriptions per 100 COVID-19 consultations, while 55.21% of the GPs in France prescribed a median of 8 antibiotic prescriptions per 100 COVID-19 consultations. Overall antibiotic prescription rates were less in Romania than in the UK (22% vs 32%); however, 73% of the Romanian GPs vs 57% of the British GPs prescribed antibiotics. Depending on the country, the proportion of each type of antibiotic was statistically different, with the proportion of azithromycin being more than 50% of all antibiotics in each country except for the UK where it was less than 1%. Both individual GPs prescribing patterns in addition to overall consumption patterns should be analysed in order to implement a tailored antimicrobial stewardship programme. Furthermore, antibiotic prescribing rates in COVID-19 are lower than other respiratory tract infections.

Impact of deintensifying hypoglycaemic drugs in older adults with type 2 diabetes: protocol for an emulation of a target trial

IntroductionIn older adults with type 2 diabetes (T2D), overtreatment with hypoglycaemic drugs (HDs: sulfonylureas, glinides and/or insulins) is frequent and associated with increased 1-year mortality. Deintensification of HD is thus...

Screening for alcohol use in primary care: assessing French general practitioner practices.

Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.

A national media mass campaign improves beliefs and behaviours about low back pain in the general population and in general practitioners.

Previous international mass-media campaigns for low back pain (LBP) have had conflicting impacts on the general population. The objective was to evaluate the impact of a national back pain campaign conducted between 2017 and 2019 on beliefs and behaviours of general practitioners and the general population in France. Between 2017 and 2019, a mass-media campaign was used to disseminate positive messages about LBP using several media, along with a parallel campaign addressed to general practitioners. An email survey before the campaign and 6 and 18 months after the campaign started evaluated beliefs and behaviours among a representative sample of the 2 target populations (3500 people from the general population and 700 general practitioners before the campaign, and 2000 people and 300 general practitioners 6 and 18 months after). Overall, 56% of the general population respondents before the campaign and 74% and 75% at 6 and 18 months after adhered to the statement "One should maintain physical activity" when dealing with LBP. Conversely, the percentage adhering to the statement "The best treatment is resting" decreased significantly from 68% before the campaign to 45% at 6 and 18 months after. Physicians reported delivering more reassurance and giving more documentation to patients after the campaign. They prescribed less sick leave during the first consultation (65% before the campaign, 46% and 30% at 6 and 18 months after). A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP.

Perceptions and attitudes about antibiotic resistance in the general public and general practitioners in France

BackgroundDuring the last 20 years, France has taken important steps to tackle antibiotic resistance. These include national awareness campaigns for the general public, and supporting changes in terms of antibiotic prescription for healthcare practitioners. To prepare the upcoming 2022/2023 campaign, we conducted two surveys to assess (1) the general public’s knowledge, attitudes and behaviours regarding antibiotics and (2) the perceptions and practices of general practitioners (GPs).MethodsTwo quantitative telephone surveys were conducted using the same methodology as that used in 2010 by the National Health Insurance Authority. The first was conducted in 2019 in a national representative quota sample of 1204 persons aged over 15 years living in metropolitan France, including an over-sample of 332 parents of children aged six years or under. The second was conducted in 2020 in a national representative sample of 388 GPs.ResultsTwenty-seven percent of respondents reported taking antibiotics during the previous year. Sixty-five percent of GPs declared prescribing fewer antibiotics during the previous five years. However, 33% of GPs reported they often had patients who put high pressure to get antibiotics. The pressure from elderly patients, especially those with comorbidities was notable. Three percent of respondent patients reported putting often pressure on their GP. All respondents expressed total trust in their GP irrespective of whether s/he had prescribed them antibiotics. Half knew that antibiotics act only on bacteria, and 38% said they understood precisely what antibiotic resistance is.ConclusionAlthough antibiotic use is decreasing in France, patient pressure on GPs to prescribe antibiotics is very high. GPs are key ambassadors in reducing antibiotic use. Awareness campaigns must target elderly patients in particular.

Location dynamics of general practitioners in France

BackgroundFor several years now, the socio-political context in France has widened the territorial divide between metropolitan France and peripheral France. Access to healthcare is part of this divide, which harms small and medium-sized towns as well as rural fringes. This article focuses on these geographic dynamics in access to healthcare, with a focus on self-employed general practitioners (GPs), who are essential links in the care pathway as referring physicians. MethodsThis paper uses data from French public statistics from 2007 to 2017 to build spatial panels and to highlight the territorial factors that explain the dynamics of the locations of GPs. ResultsOver the period under review, the density of GPs has decreased and territorial disparity has increased. There is no trend towards a worsening of this isolation of either the periphery or deprived cantons with regard to the density of GPs in these areas. However, we note a clear trend towards the grouping together of different types of care within cantons, leading to a tendency towards the polarization of the healthcare supply in the territories of mainland France, which implies another type of geographical difficulty. ConclusionThe increase in territorial disparities in accessibility to GPs does not really seem to correspond to the classical divides in France, but rather raises the issue of intra-metropolis and intra-periphery disparities.

EVALUATION OF A DIGITAL THERAPY FOR UNCONTROLLED HYPERTENSIVE PATIENTS FOLLOWED BY GENERAL PRACTITIONERS IN FRANCE

Objective: The digital therapy was designed by hypertension specialists and included - a touch-sensitive tablet (Vodafon smart tab 3G) and an automatic blood pressure, connected via Bluetooth to the tablet (ihealth, BKN-550BT), a web portal developed specifically for the study with access reserved for health professionals involved in the follow-up of hypertensive patients. The health data were hosted on an accredited server. Design and method: The digital therapy was designed by hypertension specialists and included - a touch-sensitive tablet (Vodafon smart tab 3G) and an automatic blood pressure, connected via Bluetooth to the tablet (ihealth, BKN-550BT), a web portal developed specifically for the study with access reserved for health professionals involved in the follow-up of hypertensive patients. The health data were hosted on an accredited server. - as software for the patient, several applications specifically developed to 1) perform home blood pressure monitoring over 3 days 2) monitor treatment compliance (GIRERD questionnaire) 3) detect excessive salt consumption (ExSel questionnaire) for the physician a web interface specifically developed to 1) know the results of the remote monitoring of each patient 2) help to follow the recommendations of the ESH for the associations of antihypertensive drugs 3) obtain if necessary the opinion of a Hypertension specialist after a request written by e-mail. 77 patients treated for uncontrolled primary hypertension at office visit despite the prescription of bi-therapy were randomized into 2 groups: a group in which the physician had access to functions 2 and 3 of the website, and a control group in which the physician did not have access to functions 2 and 3 of the website. All patients were instructed to use the 1 2 3 applications once every 3 weeks for a total of 3 months. Results: The patients included were 63 ± 7 years old. 32.5% of patients used the entire program and completed 4 HBPM and visited the physician again at the final visit. The table shows the main results by randomization group: Conclusions: A digital therapy developed by hypertension specialists is effective in improving hypertension control in patients followed by general practitioners in France.

Evaluation of the contribution of a multimedia tool in the monitoring of low-risk pregnancy: Qualitative study carried out with general practitioners in France.

ObjectiveWe aimed to evaluate the usefulness of a new multimedia tool, a video on pregnancy and a video on physiological labor, for the initial and continuous training of general practitioners and the education of pregnant women. MethodThis is a qualitative study for which we conducted semi-structured individual interviews with general practitioners in France practicing pregnancy monitoring. The interviews were recorded and then transcribed verbatim. Data triangulation and thematic analysis were carried out. ResultsTwelve interviews were carried out between November 2018 and September 2019. Physicians agreed on the complexity of obstetrics and the need for continuous training. From this perspective, the video tool was found to be useful for initial training and continuing medical education. Our video was regarded as useful for reassuring doctors regarding their knowledge and practice. Women's knowledge of pregnancy has been found to be insufficient, and this tool has real potential to overcome this lack of knowledge. Areas for improvement and the method of dissemination were also discussed. ConclusionIn the multimedia era, our tool has real potential for the initial and continuing training of doctors and the education of patients. It would be useful in the future to evaluate our multimedia tool with patients.

Collaboration entre médecins généralistes et psychologues en libéral

Psychologists and general practitioners (GPs) are the stakeholders most consulted by patients with psychological difficulties. They each have their own professional identity, their own working framework, references, and language. In France, interactions between them seem limited in private practice. The importance of developing collaboration between GPs and psychologists is supported by data from collaborative mental health practices developed in various countries. Such practices have shown significant improvement in health care, and benefits for patients’ health, as well as for GPs’ and psychologists’practices, and for the community. In 2018, the French National Authority for Health published an overview of the situation and recommendations to improve the coordination between GPs and other healthcare actors concerning adult patients with mental health disorders. The review invites healthcare actors to work with better conviction, involvement, and shared culture, as well as to recognize each other's roles and competences. The professionals interviewed in this article, three psychologists and three GPs, outline the current state of collaboration between psychologists and GPs in France and in Belgium, reviewing professional identities, barriers to interactions and organizations. Interprofessional collaboration in mental health involving these actors is formalized and developed in several countries, unlike in France where work and experimentation are rare. The role of each is not well known, and few opportunities are offered for interprofessional practice and education. The authors report on their experience in the field, and on initiatives that have been implemented in a Southern France region. Several actions are reported: joint professional training evenings, “public cross-consultations” and “joint case studies” (with patients’ agreement), working group between faculties leading to a joint Study Day, programming paired cross-consultations in the practice of each, as well as exchanging medical and psychology students. This experience allowed for constructive meetings, exchanges within “professional couples” on common patients, and opportunities to expose medical and psychological views. It also enabled the authors to observe their different professional language and tools used, to break the isolation of mental health care actors, to accelerate the understanding of patients’ situations, and to mutually enrich professional knowledge and practices. This feedback from field experience, which is not representative or generalizable, shows that it is possible to take advantage of interprofessionality in the field. When the actors know each other, working together in the interest of the professionals and of the patients shows better results. Finally, the authors question what desirable directions should be adopted–particularly concerning the institutional frameworks recently implemented in France, and the need for shared professional training–and interrogate the definition of “collaboration” itself.

Perceptions of homeopathy in supportive cancer care among oncologists and general practitioners in France

ObjectivesIn France, homeopathy is the most frequently used complementary therapy in supportive care in oncology (SCO); its use is steadily increasing. However, data is limited about the perception and relevance of homeopathy by oncologists and general practitioners (GPs) both with and without homeopathic training (HGPs and NHGPs, respectively). Our aim was to evaluate French physicians’ perceptions of homeopathy to clarify its place in SCO through two original observation survey-based studies.Materials and methodsTwo cross-sectional surveys of French physicians were conducted involving (1) 150 specialist oncologists; (2) 97 HGPs and 100 NHGPs. Questions evaluated physician attitudes to homeopathy and patterns of use of homeopathic therapies in patients requiring SCO. Survey responses were described and analyzed on the basis of physician status.ResultsTen percent of oncologists stated they prescribe homeopathy; 36% recommend it; 54% think that homeopathy is potentially helpful in SCO. Two-thirds of the NHGPs sometimes prescribe homeopathy in the context of SCO and 58% regularly refer their patients to homeopathic doctors. HGPs have a positive perception of homeopathy in SCO.ConclusionsHomeopathy is viewed favorably as an integrated SCO therapy by the majority of French physicians involved with cancer patients—oncologists and GPs. Symptoms of particular relevance include fatigue, anxiety, peripheral neuropathy, sleep disturbance, and hot flashes. In such clinical situations, response to conventional therapies may be suboptimal and homeopathy is considered a reliable therapeutic option. These two studies highlight the fact that homeopathy has gained legitimacy as the first complementary therapy in SCO in France.

Pre-return to work consultation and therapeutic part-time work: Cross-sectional study on level of knowledge and use by general practitioners in France

Background In France, general practitioners (GPs) may use two tools specifically designed to help employees who experience difficulties in returning to work after sick leave: the pre-return-to-work (PRW) medical consultation and therapeutic part-time (TPT) work. Objectives The objective was to investigate the level of knowledge and use of these two tools by GPs in Maine-et-Loire, France. Methods This cross-sectional study was performed using a telephone questionnaire to evaluate the level of knowledge of GPs and the use of these two tools in patients having difficulties returning to work. Results Among the 200 randomly selected GPs, 122 responded (response rate: 61%). More than half of the interviewed GPs declared they ‘often’ (46%) or ‘always’ (14%) contacted the occupational physician in these situations. Moreover, 62.2% and 32.7% believed that they had a ‘vague’ or ‘very good’ level of knowledge, and 41% and 51% declared either ‘frequent’ or ‘regular’ level of use of the PRW medical consultation, respectively. Regarding TPT work, 47% and 53% reported a ‘very good’ or ‘vague’ level of knowledge, and 41% and 51% a ‘frequent’ or ‘regular’ level of use, respectively. GPs who had a better level of knowledge of this tool reported a higher level of use (p < 0.001). Conclusion This study shows that while the level of knowledge and use of the PRW medical consultation and TPT work is good, it is not optimal. This could be improved by organising training courses for GPs. Obstacles to their wider use could be investigated further in a qualitative study.

Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France

BackgroundMost French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care.MethodsTwenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis.ResultsThe resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation.ConclusionThis study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016

BackgroundGuidelines that detail preventive measures against Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b, and influenza are published annually in France to decrease the risk of severe infections in immunocompromised patients. We aimed at describing adherence to these guidelines by GPs in the management of their asplenic patients in France between 2013 and 2016.MethodWe conducted a multicenter retrospective study between January 2013 and December 2016 in three French hospitals: asplenic adults were identified and their GPs were questioned. A descriptive analysis was performed to identify the immunization coverage, type and length of antibiotic prophylaxis, number of infectious episodes, and education of patients.Results103 patients were finally included in this study: only 57% were adequately vaccinated against Streptococcus pneumoniae or Neisseria meningitidis, 74% against Haemophilus influenzae type b, and 59% against influenza. Only 24% of patients received a combination of all four vaccinations. Two-thirds of patients received prophylactic antibiotics for at least 2 years. Overall, this study found that 50% of splenectomized patients experienced at least one pulmonary or otorhinolaryngological infection, or contracted influenza.ConclusionsThese data match those reported in other countries, including Australia and the United Kingdom, meaning a still insufficient coverage of preventive measures in asplenic patients. Improved medical data sharing strategies between healthcare professionals, along with educational measures to keep patients and physicians up to date in the prevention of infections after splenectomy would improve health outcomes of asplenic patients.

Completeness of pharmacovigilance reporting in general medicine in France.

Spontaneous reporting remains one of the cornerstones of post-marketing drug safety surveillance. One of its main limitations is a lack of completeness.The main aim of this study was to assess the completeness of pharmacovigilance reports sent by general practitioners (GPs) to regional pharmacovigilance centers (RPC) reported in the French pharmacovigilance database (FPVD). Secondary aim was to identify factors associated with complete reports. All adverse drugs reactions (ADRs) sent by GPs in France in 2015 were analyzed. According to information provided in ADR reports (ADR, date of occurrence, clinical description, drugs suspected, etc.), completeness was analyzed from &#8220;mandatory&#8221; criteria (age, gender, ADR&#160;and suspected drug(s)) and &#8220;non-mandatory&#8221; criteria (medical history, concomitant drugs, symptoms evolution and complementary exams) and classified&#160;as&#160;&#8220;well-documented&#8221;, &#8220;slightly-documented&#8221; or &#8220;poorly-documented&#8221;. In 2015, the FPVD contained 3,020 ADR reports realized by GPs. Only 16.4% of these reports were classified as &#8220;well-documented&#8221;, in accordance with study criteria. The most poorly documented items were concomitant drugs (41.4%) and complementary exams (37.4%). An association between a &#8220;well-documented&#8221; ADR report and its &#8220;seriousness&#8221; (OR = 3,02 [95%&#160;CI&#160;2,44; 3,23], P&#160;&lt;&#160;10&#8211;3) and elderly compared to adults (OR&#160;=&#160;1,76 [95% CI 1,42; 2,18], P&#160;&lt;&#160;10&#8211;3) or children (OR = 4,59 [95% CI 2,51; 8,39], P&#160;&lt;&#160;10&#8211;3). Our study shows that only one out of six ADR reports was &#8220;well-documented&#8221;. It appears to be important to promote pharmacovigilance to improve completeness of ADR reports.

Pay for performance scheme for general practitioners in France: results in 2018

Abstract Methods A pay-for-performance scheme, known as Remuneration on public health objectives (ROSP) and based on meeting targets on quality and efficiency indicators, was introduced for general practitioners in France in 2012. Since 2017, following the 2016 medical agreement between Health Insurance and doctors’ unions, ROSP has consisted of 29 indicators: 8 about chronic disease management, 12 about prevention and 9 about appropriate and efficient prescriptions. The aim of this work was to describe the 2018 results and the overall evolution of the indicators for office-based practitioners. Data are from the French national health system database. Results Follow-up of diabetic patients is steady: diabetic retinopathy screening and regular HbA1c measurement have been performed in 63% and 79% of them since 2016, respectively. Screening for chronic kidney disease improved for diabetic patients (29% in 2015 to 39% in 2018) and hypertensive patients (6% to 11%) but remain low. Influenza vaccination among people over 65 years increased in 2018 (55%) while a downward trend has been observed since 2011 (58% in 2011, 53% in 2016). The number of antibiotic treatments has decreased since 2011, from 46 out of 100 adults without long-term disease to 36 in 2018. In contrast, breast cancer and cervical cancer screening indicators have stagnated for several years around 66% and 56%, respectively. In terms of efficiency, all the indicators improved, most of them consisting in biosimilar and generic drugs prescription. By 2018, ROSP represents 3% of doctors’ revenue (including fee-for-service and lump sum payments). Conclusions By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations. Key messages By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations.

General practitioners, pregnancy and addictions in France in 2015

Abstract Background Tobacco smoking and alcohol drinking during pregnancy result in serious health hazard for both the baby and the mother. In France, about 17% of pregnant women smoke and 20% consume alcohol. General practitioners (GPs) can have an active role in preventing those behaviors as they often interact with pregnant patients: one quarter of French pregnant women have had at least one antenatal visit with a GP. The aim of our study is to describe French GPs’ practices (screening and counseling) toward pregnant patients regarding tobacco smoking and alcohol drinking. Methods In 2015, a telephone survey was set based on a stratified random sampling of metropolitan France GPs. A representative sample of 1,414 French GPs completed the study. Results Screening for alcohol consumption at least once for every patient was done by 61% of GPs and for smoking by 82% of GPs. Counselling to quit alcohol consumption was done by 77% of GPs while counselling to quit smoking was done by about 90% of them. GPs’ practices were significantly better among those who had more recent ongoing training. Regular drinkers GPs were less likely to systematically screen for alcohol use and GPs’ alcohol use frequency was adversely related to recommending quitting. Current and former smokers GPs were less likely to recommend quitting to pregnant patients smoking over 5 cigarettes per day. Conclusions Screening for alcohol use and smoking during pregnancy is not yet systematic among GPs in France. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation. Besides, as regular alcohol use and smoking are related to unwanted practices, prevention for the benefit of GPs could be even more fruitful. Key messages Screening for alcohol use and smoking during pregnancy is not systematically done by French GPs. GPs’ prevention role with pregnant patients could be emphasized, potentially through initial and ongoing trainings adaptation.