Practitioners In France Research Articles

How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering

BackgroundGeneral practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages. ObjectivesTo investigate how GPs cope with doctor shortage issues. Materials and methodsTwo cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics. Results87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas. ConclusionThese results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

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.

Supply chain strategies in response to a black-swan event: a comparison of USA, French and Polish firms

PurposeThis research aims to analyse the perceptions of practitioners in three regions regarding the challenges faced by their firms during the pandemic, considered a black-swan event. It examines the strategies implemented to mitigate and recover from risks, evaluates the effectiveness of these strategies and assesses the difficulties encountered in their implementation.Design/methodology/approachIn the summer of 2022, an online survey was conducted among supply chain (SC) practitioners in France, Poland and the St. Louis, Missouri region of the USA. The survey aimed to understand the impact of COVID-19 on their firms and the SC strategies employed to sustain operations. These regions were selected due to their varying levels of SC development, including infrastructure, economic resources and expertise. Moreover, they exhibited different responses in safeguarding the well-being of their citizens during the pandemic.FindingsThe study reveals consistent perceptions among practitioners from the three regions regarding the impact of COVID-19 on SCs. Their actions to enhance SC resilience primarily relied on strengthening collaborative efforts within their firms and SCs, thus validating the tenets of the relational view.Originality/valueCOVID-19 is (hopefully) our black-swan pandemic occurrence during our lifetime. Nevertheless, the lessons learned from it can inform future SC risk management practices, particularly in dealing with rare crises. During times of crisis, leveraging existing SC structures may prove more effective and efficient than developing new ones. These findings underscore the significance of relationships in ensuring SC resilience.

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.

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...

The profile of French osteopaths: A cross-sectional survey

BackgroundOsteopathy is not a health profession in France but it was regulated in 2007. However, the profession is very popular, and the number of osteopaths is the largest in Europe. Since there is limited published data on the profile and characteristics of osteopaths practising in France, this study aimed to survey the current situation of osteopathic practitioners in France. MethodsA voluntary online-based survey was distributed to French osteopaths between March and July 2022. This survey consisted of 52 questions adapted from the original French version of the validated Benelux Osteosurvey. ResultsA total of 1461 osteopaths responded to the study, of which 785 (53.73%) were female. The majority of respondents were aged between 30 and 39 years (50.65%), had full-time training (89.73%), during 5 years (67.15%), were self-employed (99.59%), advertised themselves exclusively as osteopaths (90.35%) and showed a solid professional identity. The median number of consultations per week was 21–25, and nearly one-third of respondents (31.42%) reported having other professional activities outside their clinical practice as an osteopath. Osteopaths in France manage acute and chronic complaints in all body areas but mainly in the spine. ConclusionsThis study provides a first overview of the current profile of osteopathic practitioners in France since 2012. At present, it constitutes a new informative report of their characteristics and provides several perspectives on the profession's development in terms of status and training. Implications for practice●The majority of respondents were aged between 30 and 39 years, had undergone a full-time five-year training, advertised themselves exclusively as osteopaths and manifested a strong osteopathic identity.●Most reported being self-employed, and managing acute and chronic complaints located in all body areas, but mainly the spine.●Respondents expressed a strong desire for a greater integration of osteopathy into the French health system, especially through better collaboration with other healthcare professionals.

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.

Customizing Health Recommendations About Physical Activity During Pregnancy: A Qualitative Study Among Practitioners in France.

While studies have long shown the beneficial health effects of physical activity during pregnancy, such recommendations have been rarely analyzed in terms of how practitioners adapt such health messages to patients' social profiles. The present study sought to apprehend the logics underlying practitioner (non)recommendations of physical activity and exercise during pregnancy, and how these were associated with social distinctions made between patients. Semi-directive interviews were conducted with 20 midwives and 17 gynaecologists and obstetricians in south-eastern France. Based on thematic analyses, the results show how recommendations draw from both medical and social knowledge, mobilizing social representations regarding physical activity, (non)normative bodies and othered social categories of class, ethnicity or obesity. The othering processes reiterate gendered social hierarchies as well as moral orders surrounding normative bodies and health-enhancing behaviours. The findings demonstrate how social hierarchies and beliefs intertwine with public health discourses about the body and health-enhancing practices, suggesting directions for reducing their impact in contexts of medicine and health.

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.

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.

Gender Inequality Among Hospital and University Practitioners in France in 2020: Where Have We Been and Where are We Now?

Backgrounds: Women are under-represented in senior academic and hospital positions in many countries. We aim to assess the place and the evolution of tenured female and male health practitioners’ working in French public Hospitals. Methods: Data of this observational study were collected from the National Management Centre (Centre National de Gestion) up to January 1, 2020. First, we describe demographic characteristics and specialties of all tenured medicine, pharmacy, and dentistry doctors’ working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, we report the annual incidence of new entrance according to gender and professional status from 1999 to 2019. Findings: In 2020, 51 401 health practitioners (49·7% of female) are in activity in French public hospitals. Women represent 52·5% of the Hospital Practitioners, 48·6% of the Associate Professors, and 22·0% of the Full Professors. There are disparities between the rates of female Full Professors in medicine (20·6%), pharmacy (36·1%), and dentistry (44·3%). Women are nominated Hospital Practitioners earlier than men (37·1 versus 38·8 years), at a similar age among Associate Professors (36·1 versus 36·5 years), and at a later age among Full Professors (43·7 versus 41·9 years). Compared to men, the annual rates of appointed women varied between 1999 and 2019 from 47·6% to 60·4% for Hospital Practitioners, from 50·0% to 44·6% for Associate Professors, and from 11·2% to 33·3% for Full Professors. Interpretation: Although hospitals are becoming more and more feminised, there is still a gender gap to access the Full Professors status in medicine and pharmacy, but not in Dentistry. Despite a trend towards, gender equality has not yet been achieved regarding access to the highest positions. Funding Statement: None. Declaration of Interests: ALB, NA, CV, BH, FL, BL, MBM, AB, and JSA declare no competing interests.

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.

Azithromycin and Hydroxychloroquine Accelerate Recovery of Outpatients with Mild/Moderate COVID-19

Aims: The challenge regarding COVID-19 is to prevent complications and fatal evolution. Azithromycin (AZM) and hydroxychloroquine (HCQ) have proven their antiviral effect in vitro. We aimed to assess the efficacy and safety of AZM alone or combined to HCQ, prescribed, at an early stage, in patients with Covid-19, in a primary care setting.&#x0D; Study Design: Retrospective observational study.&#x0D; Place and Duration of Study: Patients have been followed by private practitioners in France, between March and April 2020.&#x0D; Methodology: Eighty-eight patients received either no or a symptomatic treatment (NST) (n=34) or AZM alone (n=34) or AZM+HCQ (n=20). The efficacy end point was the time to clinical recovery and the safety end point was the occurrence of cardiovascular events. To improve the evidence level, a case-control analysis was performed on a sample of 57 patients (19/group) matched for age, sex and BMI.&#x0D; Results: The mean (SD) times to achieve clinical recovery were respectively 25.8 days (11.1), 12.9 days (13.4) and 9.2 days (9.3), showing a statistically significant difference between NST and AZM alone (p&lt;0.0001) or AZM+HCQ (p&lt;0.0001). The statistical difference between NST and AZM was confirmed (p=0.0149) as well as the difference with AZM+HCQ (p=0.0002). No cardiac toxicity was recorded in any patient. No statistical difference was shown between AZM and AZM+HCQ groups, although the dual therapy tended to be more effective in patients over 50 years, based on an analysis using the cox model.&#x0D; Conclusion: AZM and AZM+HCQ favourably impacted the course of the disease. We need trials, ideally prospective/double blind, to show if a statistical difference can be evidenced with a broader group, and clarify the indications of each treatment depending on initial clinical presentation.

Développement, validation et fiabilité d’un questionnaire pour l’évaluation du recours aux thérapeutes alternatifs : QuERTA

The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items. Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.

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.

Epileptic psychoses are underrecognized by French neurologists and psychiatrists

This study evaluates the knowledge about psychotic disorders associated with epilepsy among medical practitioners in France. A self-report questionnaire was sent, and responses of 486 participants were collected. Results showed the rate of correct responses being higher among neurologists compared to psychiatrists, respectively 70.6% and 58.3% (p < 10−11). The highest rate of correct responses was found for the participants trained in epileptology (71%), and a regression analysis confirmed that epilepsy-training was the most influential variable. However, we found that knowledge about epileptic psychosis was imprecise among all participants: current classification was not known to most participants (77%), there were false beliefs concerning postictal confusion and psychosis (41%), and both prevalence and duration of postictal psychosis were not well-known. There is the first survey to highlight such gaps of knowledge, and hopefully lead to measures to remedy this, especially specialists such as psychiatrists, neurologists, and epileptologists who may be called upon to treat such patients.