Julien Gelly1, Josselin Le Bel2, Isabelle Aubin-Auger3, Alain Mercier4, Elodie Youssef3, France Mentre5, Michel Nougairede3, Laurent Letrilliart6, Xavier Duval7. 1. Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, julien.gelly@univ-paris-diderot.fr. 2. Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris. 3. Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris. 4. Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Department of General Practice, University Rouen, F-76000 Rouen. 5. Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris. 6. Department of General Practice, University Claude Bernard, Lyon 1, F-69000 Lyon and. 7. Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, AP-HP, Hôpital Bichat, INSERM, Centre d'Investigation Clinique (CIC) 007, F-75018 Paris, France.
Abstract
BACKGROUND: Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation. OBJECTIVE: To assess with passive observers, the degree to which French GPs opportunistically perform primary preventive care during routine consultation. METHODS: Observational cross-sectional multicentre ancillary study of the French ECOGEN study. The study period extended from 28 November 2011 to 30 April 2012. The inclusion criteria were patients seen by GPs at surgery and home consultations in non-randomized pre-determined half-day blocks per week. The non-inclusion criteria were patient's refusal and consultations initially focused on primary prevention in response to patient's request (ancillary study's specific criterion). Using passive observers, data were collected based on the second version of International Classification of Primary Care. Preventive consultations were defined if at least one problem/diagnosis was considered by consensus as definitely related to primary prevention. For each one of the 128 participating GPs, aggregation of data was performed from all his/her consultations. Determinants of the proportion of preventive consultations per GP were assessed by multivariate linear regression. RESULTS: Considering 19003 consultations, the median proportion of preventive consultations per GP was 14.9% (range: 0-78.3%). It decreased with increased proportion of patients aged 18 or less (P = 0.006), with increased proportion of home visits (P = 0.008) and with increased proportion of consultations lasting under 10 minutes (P = 0.02). None of the GPs' personal characteristics were significantly associated. CONCLUSION: Primary preventive care activity was related to the characteristics of GPs' patients and practice organizational markers and not to GPs' personal characteristics.
BACKGROUND: Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation. OBJECTIVE: To assess with passive observers, the degree to which French GPs opportunistically perform primary preventive care during routine consultation. METHODS: Observational cross-sectional multicentre ancillary study of the French ECOGEN study. The study period extended from 28 November 2011 to 30 April 2012. The inclusion criteria were patients seen by GPs at surgery and home consultations in non-randomized pre-determined half-day blocks per week. The non-inclusion criteria were patient's refusal and consultations initially focused on primary prevention in response to patient's request (ancillary study's specific criterion). Using passive observers, data were collected based on the second version of International Classification of Primary Care. Preventive consultations were defined if at least one problem/diagnosis was considered by consensus as definitely related to primary prevention. For each one of the 128 participating GPs, aggregation of data was performed from all his/her consultations. Determinants of the proportion of preventive consultations per GP were assessed by multivariate linear regression. RESULTS: Considering 19003 consultations, the median proportion of preventive consultations per GP was 14.9% (range: 0-78.3%). It decreased with increased proportion of patients aged 18 or less (P = 0.006), with increased proportion of home visits (P = 0.008) and with increased proportion of consultations lasting under 10 minutes (P = 0.02). None of the GPs' personal characteristics were significantly associated. CONCLUSION: Primary preventive care activity was related to the characteristics of GPs' patients and practice organizational markers and not to GPs' personal characteristics.
Keywords:
General practitioners; organizational efficiency; physician’s practice patterns; preventive medicine; professional practice; quality of health care.
Authors: Paul Sebo; Hubert Maisonneuve; Bernard Cerutti; Jean-Pascal Fournier; Nicolas Senn; Cédric Rat; Dagmar M Haller Journal: PLoS One Date: 2017-09-05 Impact factor: 3.240