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Introduction: General practitioners are the first prescribers of speech therapy in France, a country in which speech therapists can practice only on medical prescription. The objective of this study was to measure general practioner's knowledge on means of prescribing speech therapy., Method: Cross-sectional study by self-questionnaires for general practitioners and residents in general practice in France. The test assessed five types of knowledge conducive to correct prescription of speech therapy: requirements for prescription, indications, prescription wording, ages of treatment eligibility, and reimbursement. The questionnaires were tested on an expert population, whose median score was used as a cut-off to separate doctors who knew the modalities of speech therapy prescription from those whose knowledge was insufficient. The characteristics differentiating the two groups were compared by multiple logistic regression., Results: Five hundred and three general practitioners and five hundred and two residents in general medicine were included; 82.3% of the physicians having written a thesis and 86.2% of the residents had insufficient knowledge of the modalities of speech therapy prescription. Age, number of years since acquisition of a medical diploma and urban practice all had a negative impact on general practitioners' knowledge of speech therapy., Conclusion: French general practitioners' knowledge of speech therapy prescription seems insufficient. It is consequently necessary to improve the initial and continuing training of doctors. Collaborative work between general practitioners and speech therapists should be carried on, developed and strengthened., Competing Interests: Declaration of Competing Interest Les auteurs déclarent ne pas avoir de liens d'intérêts., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.) more...

Background: The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature., Objective: To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care., Method: A retrospective cohort study using Observatory of General Medicine Datalink from 1995 to 2010. All patients consulting a GP from the Datalink network for pharyngitis have been included. The occurrence of a PTA in the 15 days following the consultation for pharyngitis was matched. The association between PTA and prescriptions of NSAIDs was studied via an adjusted logistic regression model., Results: During the study period, 105 802 cases of pharyngitis and 48 cases of PTA following a pharyngitis were reported, concerning respectively 67 765 and 47 patients. In the multivariate analysis, the risk of PTA was associated positively with a NSAIDs prescription (OR = 2.9, 95% CI = 1.6-5.2). Other factors associated with PTA occurrence were the prescription of corticosteroids (OR = 3.1, 95% CI = 1.3-7.6) and an age between 20 and 40 years (OR = 5.7, 95% CI = 2.5-13.0). The prescription of antibiotics was not significantly associated with PTA (P = 0.7)., Conclusion: Prescription of NSAIDs in pharyngitis may increase the risk of PTA. This study encourages considering cautiously the balance between benefits and harms before prescription of NSAIDs for pharyngitis., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...

Background: At cancer diagnosis, it is unclear whether continuity of care (COC) between the patient and GP is safeguarded., Aim: To identify patient-GP loss of COC around the time of, and in the year after, a cancer diagnosis, together with its determinants., Design and Setting: A post-hoc analysis of data from a prospective cohort of GPs in France, taken from a survey by the Observatoire de la Médecine Générale., Method: A prospective GP cohort ( n = 96) filed data on patients who were diagnosed with incident cancer between 1 January 2000 and 31 December 2010. COC was assessed by ascertaining the frequency of consultations and the maximal interval between them. (In France, patients see their referring/named GP in most cases.) A loss of COC was measured during the trimester before and the year after the cancer diagnosis, and the results compared with those from a 1-year baseline period before cancer had been diagnosed. A loss of COC was defined as a longer interval (that is, the maximum number of days) between consultations in the measurement periods than at baseline. Determinants of the loss in COC were assessed with univariate and multivariate logistic regression models., Results: In total, 2853 patients were included; the mean age was 66.1 years. Of these, 1440 (50.5%) were women, 389 (13.6%) had metastatic cancer, and 769 (27.0%) had a comorbidity. The mean number of consultations increased up to, and including, the first trimester after diagnosis. Overall, 26.9% (95% confidence interval [CI] = 25.3 to 28.6) of patients had a loss of COC in the trimester before the diagnosis, and 22.3% (95% CI = 20.7 to 23.9) in the year after. Increasing comorbidity score was independently associated with a reduction in the loss of COC during the year after diagnosis (adjusted odds ratio [OR] comorbidity versus no comorbidity 0.61, 95% CI = 0.48 to 0.79); the same was true for metastatic status (adjusted OR metastasis versus no metastasis 0.49, 95% CI = 0.35 to 0.70)., Conclusion: As COC is a core value for GPs and for most patients, special care should be taken to prevent a loss of COC around the time of a cancer diagnosis, and in the year after., (© British Journal of General Practice 2019.) more...

Objectives: Public Health actors in France are striving to improve the use of national databases for public health and research. The main objective of this project was to develop a research tool in ambulatory care by matching medical data and reimbursement data., Methods: Data sources were the health insurance database (SNIIRAM) and the General Practice Observatory (OMG) database. The SNIIRAM is a national medical and administrative database comprising data used in healthcare reimbursement. The OMG is a medical database on ambulatory care recording presenting complaints called "Results of Consultation" (RC). Based on data for patients who consulted one of the 30 general practitioners selected in 2008, we performed a probabilistic matching of the two databases., Results: The linkage procedure allowed matching of 89,211 consultations or doctor visits and 29,088 patients. Comparison of long-term diseases (ALD) and RC showed that 94% of patients with diabetes as ALD had at least one RC coded as diabetes during the year, but only 65% of patients with one RC coded as diabetes were reported as ALD for this disease. Matching of the databases identified 12% of diabetic patients without antidiabetic treatment and without ALD for this affection; these patients were therefore not identifiable in the SNIIRAM database., Conclusion: This study describes an innovative database matching methodology. It also illustrates the contribution of this model of matched data in terms of targeting populations at risk. Other approaches to analysis of comorbidities, medical practices and care pathways could be proposed. more...

Context: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators., Methods: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated., Results: We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria., Conclusion: The two approaches yield very "similar" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes. more...

Background: France is in Europe, the country in which the mortality due to potentially preventable causes is the highest. At the same time, French doctors receive no incentives to undertake prevention activities. This article examined the general practitioners' (GPs) determinants (characteristics, patient list and contextual factors) of cardiovascular prevention and vaccination carried out by GPs in their offices., Methods: Data were collected from 105,726 patients followed by 86 GPs (observational study). A multilevel analysis with two levels: GP and patient (HLM) was performed., Results: A high between-GP variability of the prevention activity is underlined in both domains. After controlling for patient characteristics, we observed a positive effect of the GP's workload (ORa=1.03) and of an elderly GP's patient list (ORa=1.04) on cardiovascular prevention, a positive effect of a patient list with a high level of health care consumption on vaccination activity (ORa=1.04). The significant influence of contextual factors is ever more demonstrative: the ORa is 1.3 times lower in cardiovascular prevention and 1.6 in vaccination when the density of GPs in the local community of the doctor's practice grows of one-point (1/1000); the ORa is two times lower in both cardiovascular prevention and vaccination for GPs having an urban practice., Conclusion: These results emphasize the need for taking into account contextual factors to implement prevention policies in primary care. But further studies of this type should be conducted by taking other variables into account in order to improve the proportion of variance explained in our models. more...

Objective: The purpose of this study was to determine the respective importance of herpes labialis and genitalis in patients consulting general practitioners and ascertain their knowledge and opinions concerning herpes labialis and genitalis in order to analyze patient behavior in case of flare-ups., Patients and Method: A questionnaire was proposed to a representative sample of patients aged 15 years and older seen at consultation by 49 general practitioners participating in the General Medicine Observatory of the French Society of General Practitioners., Results: Among the 4,403 patients who responded, a known history of herpes labialis was reported by 39. 9 p.100 and of herpes genitalis by 2.5 p.100. Their answers to the questions demonstrated insufficient knowledge of avoidable risks of herpes as a sexually transmitted disease, with very significant misunderstanding by men. Among the 1,711 patients who had experienced herpes labialis, 62.9 p.100 initiated self-medication, 29 p.100 preferred to wait and see and 7.5 p.100 sought medical assistance. Among the 108 patients who had experienced herpes genitalis, at the last flare-up 40 p.100 initiated self-medication, 7.5 p.100 preferred to wait and see and 52 p.100 sought medical assistance. The general practitioner was the first physician consulted for both types of herpes., Discussion: This study illustrates the importance of herpes infections in the general medicine patients. It also confirms that new interventional strategies are needed both for health care and for health education. more...