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  1. Article: Perception of barriers and facilitators in the continuity of care for precarious migrants in general practice

    Romey, Adélie / Vaysse, Marianne / Jouault, Clémence / Letrilliart, Laurent

    Sante publique (Vandoeuvre-les-Nancy, France)

    2023  Volume 35, Issue 2, Page(s) 171–181

    Abstract: Introduction: Continuity of care is essential for the diagnosis and treatment of somatic and mental conditions in precarious migrants. This study explored the barriers and facilitators in the continuity of care provided to precarious migrants in general ...

    Title translation Perception des freins et facilitateurs de la continuité des soins délivrés aux migrants précaires en médecine générale
    Abstract Introduction: Continuity of care is essential for the diagnosis and treatment of somatic and mental conditions in precarious migrants. This study explored the barriers and facilitators in the continuity of care provided to precarious migrants in general practice.
    Methods: A qualitative study was carried out based on semi-directed interviews with twenty precarious migrants. The term “medical follow-up” was used in the interview grid to represent the concept of continuity of care. The verbatims were analyzed using the grounded theory approach, with data analysis triangulation.
    Results: Precarious migrants described the medical follow-up as repeated access to the same doctor for all their health problems. This follow-up was limited by difficulties in accessing health insurance and guidance in the health system, and by language and cultural barriers. Conversely, the physician’s clinical and interpersonal skills, the presence of a translator, the support from the migrants’ family circle and associations, and some organizations of the care structure facilitated their medical follow-up.
    Conclusions: Relational, managerial, and informational continuities of care provided to precarious migrants should be optimized in a synergistic manner. To achieve this, it is necessary to improve doctors’ training in communication with migrants, medical information sharing and migrants’ education to the appropriate use of the healthcare system, in order to encourage their gradual empowerment in their care pathway.
    MeSH term(s) Humans ; Transients and Migrants ; Health Services Accessibility ; Qualitative Research ; General Practice ; Continuity of Patient Care ; Perception
    Language French
    Publishing date 2023-07-16
    Publishing country France
    Document type English Abstract ; Journal Article
    ZDB-ID 1465524-x
    ISSN 2104-3841 ; 0995-3914
    ISSN (online) 2104-3841
    ISSN 0995-3914
    DOI 10.3917/spub.232.0171
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Frequency and determinants of technical procedures in French general practice: a cross-sectional study.

    Pointis, Victor / Panjo, Henri / Schott, Anne-Marie / Letrilliart, Laurent

    Rural and remote health

    2023  Volume 23, Issue 2, Page(s) 7359

    Abstract: Introduction: Technical skills have many areas of application in general practice and are a dimension of medical competence. Several studies have attempted to describe the technical procedures performed in general practice but most had limitations in ... ...

    Abstract Introduction: Technical skills have many areas of application in general practice and are a dimension of medical competence. Several studies have attempted to describe the technical procedures performed in general practice but most had limitations in the data collection process, the scope of the procedures addressed, or the healthcare actors involved. No French comparable data have been published. The aim of the present study was therefore to describe the frequency and type of technical procedures in French general practice, and to assess their determinants, in particular rurality.
    Methods: The present study was ancillary to the ECOGEN (Eléments de la COnsultation en médecine GENérale) study, which was an observational cross-sectional, multicentre, nationwide study conducted in 128 French general practices. Data were collected on 20 613 patient-GP encounters, including the characteristics of GPs and encounters, as well as the health problems managed during the encounter and their associated processes of care; the latter two variables were coded according to the International Classification of Primary Care classification. The GPs' practice location was first classified as rural area, urban cluster, or urban area; the former two categories were combined for analysis. The various technical procedures were classified according to the framework of the International Classification of Process in Primary Care. The frequency of each technical procedure was compared according to GP practice location. The dependent variable analysed was the performance of at least one technical procedure per each health problem managed. Bivariate analysis was performed for all independent variables followed by multivariate analysis for key variables, using a hierarchical model including three levels: the physician, the encounter, the health problem managed.
    Results: The data included 2202 technical procedures performed. At least one technical procedure was performed in 9.9% of encounters and for 4.6% of health problems managed. The two most frequent groups of technical procedures performed were injections (44.2% of all procedures) and clinical laboratory procedures (17.0%). The following procedures were more often performed by GPs practicing in a rural area or an urban cluster than those practicing in an urban area: injection of joints, bursae, tendons and tendon sheaths (4.1% v 1.2% of all procedures), manipulation and osteopathy (10.3% v 0.4%), excision/biopsy of superficial lesions (1.7% v 0.5%), and cryotherapy (1.7% v 0.3%). Conversely, the following procedures were more often performed by GPs practicing in urban areas: vaccine injection (46.6% v 32.1%), point-of-care testing for group A streptococci (11.8% v 7.6%), and ECG (7.6% v 4.3%). GPs practicing in a rural area or an urban cluster performed more often technical procedures than those practising in an urban area (odds ratio=1.31, 95% confidence interval 1.04-1.65), according to the multivariate model.
    Conclusion: Technical procedures were more frequently performed and more complex when they were performed in French rural and urban cluster areas. More studies are required to assess patients' needs regarding technical procedures.
    MeSH term(s) Humans ; Cross-Sectional Studies ; Family Practice ; General Practice ; Data Collection ; Physicians
    Language English
    Publishing date 2023-05-25
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2105620-1
    ISSN 1445-6354 ; 1445-6354
    ISSN (online) 1445-6354
    ISSN 1445-6354
    DOI 10.22605/RRH7359
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: General practice and associated health conditions in patients aged 65 years or over.

    Vandroz, Elodie / Subtil, Fabien / Bonneroy, Marc / Letrilliart, Laurent

    Geriatrie et psychologie neuropsychiatrie du vieillissement

    2022  

    Abstract: We aimed at identifying associations of health conditions addressed during general practice consultations involving patients aged 65 years or over, according to sex. This is an ancillary study of the ECOGEN study on the consultation practices of French ... ...

    Abstract We aimed at identifying associations of health conditions addressed during general practice consultations involving patients aged 65 years or over, according to sex. This is an ancillary study of the ECOGEN study on the consultation practices of French general practitioners. We studied the 15 most frequent health issues addressed in patients aged 65 years or over and identified the pairs most frequently and strongly associated. The sample included 5,782 consultations corresponding to 17,182 health issues addressed. Each consultation involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with a lipid disorder. Some associations were specific to the patient's sex. Significant associations identified may improve the management of elderly patients with multiple morbidities by encouraging synergic treatments.
    Language English
    Publishing date 2022-02-14
    Publishing country France
    Document type Journal Article
    ISSN 2115-7863
    ISSN (online) 2115-7863
    DOI 10.1684/pnv.2022.1015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Comparison of rural and urban French GPs' activity: a cross-sectional study.

    Lurquin, Bénédicte / Kellou, Nadir / Colin, Cyrille / Letrilliart, Laurent

    Rural and remote health

    2021  Volume 21, Issue 3, Page(s) 5865

    Abstract: Introduction: In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities ... ...

    Abstract Introduction: In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities according to their location. The aim of this study was to analyse French GP activities according to their rural or urban practice location.
    Methods: This study was ancillary to the Eléments de la COnsultation en médecine GENérale (ECOGEN) study, which was a cross-sectional, multicentre, national study conducted in 128 French general practices in 2012. Data were collected by 54 interns in training during a period of 20 working days from December 2011 to April 2012. GP practice location was classified as rural area, urban cluster or urban area. The International Classification of Primary Care (ICPC-2) was used to classify reasons for encounter, health problem assessments, and processes of care. Univariate analyses were performed for all dependent variables, then multivariable analyses for key variables, using hierarchical mixed-effect models.
    Results: The database included 20 613 consultations. The mean yearly number of consultations per GP was higher in rural areas (p<0.0001), with a shorter consultation length (p<0.0001). No difference was found for GP sex (p=0.41), age (p=0.87), type of fees agreement (p=0.43), and type of practice (p=0.19) according to their practice location. Urban patients were younger, and there was a lower percentage of patients over 75 years (p<0.001). GPs more frequently consulted at patients' homes in rural areas (p<0.0001). The mean number of chronic conditions managed was higher in rural areas and urban clusters than in urban areas (p<0001). Hypertension (p<0.0001), type 2 diabetes (p=0.003), and acute bronchitis/bronchiolitis (p=0.01) were more frequently managed in rural areas than in urban clusters and areas. Health maintenance/prevention (p<0.0001) and no disease situations (p<0.0001) were less frequent in rural areas. Drug prescription was more frequent in rural areas than in urban clusters and areas (p<0.0001). Multivariable analysis confirmed the influence of a GP's rural practice location on the consultation length (p<0.0001), the number of chronic conditions per consultation (p<0.0001) and the number of health maintenance/prevention situations (p<0.0001), and a trend towards a higher yearly number of consultations per GP (p=0.09).
    Conclusion: French rural GPs tend to have a higher workload than urban GPs. Rural patients have more chronic conditions to be managed but are offered fewer preventive services during consultations. It is necessary to increase the GP workforce and develop cooperation with allied health professionals in rural areas.
    Language English
    Publishing date 2021-09-01
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2105620-1
    ISSN 1445-6354 ; 1445-6354
    ISSN (online) 1445-6354
    ISSN 1445-6354
    DOI 10.22605/RRH5865
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: [No title information]

    Plaete, Justine / Schlienger, Isabelle / Rabilloud, Muriel / Letrilliart, Laurent

    Sante publique (Vandoeuvre-les-Nancy, France)

    2021  Volume 33, Issue 3, Page(s) 369–377

    Abstract: Objective: To describe the unaccompanied minors' reasons for consulting and their health problems managed in a permanence of access to health care (PASS) at the Hospices civils de Lyon.: Methods: Consultation data of the unaccompanied minors cared ... ...

    Title translation Motifs et résultats de consultations de mineurs non accompagnés dans une permanence d’accès aux soins.
    Abstract Objective: To describe the unaccompanied minors' reasons for consulting and their health problems managed in a permanence of access to health care (PASS) at the Hospices civils de Lyon.
    Methods: Consultation data of the unaccompanied minors cared for in 2016 and 2017 at the Edouard Herriot Hospital PASS, Lyon, were collected and coded according to the International Classification of Primary Care (CISP-2).
    Results: The majority of unaccompanied minors were male adolescents from French-speaking sub-Saharan African countries. Each consultation included an average of 1.6 reason for encounter (95%CI: 1.5-1.8) and 2.0 health problems diagnosed (95%CI: 1.9-2.1). Apart from the discussion of test results, the most frequent reasons for consultation were physical symptoms, particularly generalized abdominal pain (8.7%), headache (6.6%) or pruritus (6.5%). Health problems diagnosed were mainly digestive (11.4%), cutaneous (11.0%) and osteoarticular (7.0%) problems, psychic diagnoses being rare.
    Conclusions: Unaccompanied minors seems to be apparently in good health, which probably results from under-diagnosing infectious diseases and psychic disorders. We recommend the implementation in the PASS of a common protocol for screening infectious conditions and detecting psychic disorders.
    MeSH term(s) Adolescent ; Female ; Health Services Accessibility ; Humans ; Male ; Mental Disorders ; Minors ; Referral and Consultation ; Refugees
    Language French
    Publishing date 2021-07-11
    Publishing country France
    Document type Journal Article
    ZDB-ID 1465524-x
    ISSN 2104-3841 ; 0995-3914
    ISSN (online) 2104-3841
    ISSN 0995-3914
    DOI 10.3917/spub.213.0369
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Barriers and Facilitators to the Use of Clinical Decision Support Systems in Primary Care: A Mixed-Methods Systematic Review.

    Meunier, Pierre-Yves / Raynaud, Camille / Guimaraes, Emmanuelle / Gueyffier, François / Letrilliart, Laurent

    Annals of family medicine

    2023  Volume 21, Issue 1, Page(s) 57–69

    Abstract: Purpose: To identify and quantify the barriers and facilitators to the use of clinical decision support systems (CDSSs) by primary care professionals (PCPs).: Methods: A mixed-methods systematic review was conducted using a sequential synthesis ... ...

    Abstract Purpose: To identify and quantify the barriers and facilitators to the use of clinical decision support systems (CDSSs) by primary care professionals (PCPs).
    Methods: A mixed-methods systematic review was conducted using a sequential synthesis design. PubMed/MEDLINE, PsycInfo, Embase, CINAHL, and the Cochrane library were searched in July 2021. Studies that evaluated CDSSs providing recommendations to PCPs and intended for use during a consultation were included. We excluded CDSSs used only by patients, described as concepts or prototypes, used with simulated cases, and decision supports not considered as CDSSs. A framework synthesis was performed according to the HOT-fit framework (Human, Organizational, Technology, Net Benefits), then a quantitative synthesis evaluated the impact of the HOT-fit categories on CDSS use.
    Results: A total of 48 studies evaluating 45 CDSSs were included, and 186 main barriers or facilitators were identified. Qualitatively, barriers and facilitators were classified as human (eg, perceived usefulness), organizational (eg, disruption of usual workflow), and technological (eg, CDSS user-friendliness), with explanatory elements. The greatest barrier to using CDSSs was an increased workload. Quantitatively, the human and organizational factors had negative impacts on CDSS use, whereas the technological factor had a neutral impact and the net benefits dimension a positive impact.
    Conclusions: Our findings emphasize the need for CDSS developers to better address human and organizational issues, in addition to technological challenges. We inferred core CDSS features covering these 3 factors, expected to improve their usability in primary care.
    MeSH term(s) Humans ; Decision Support Systems, Clinical ; Health Personnel ; Technology ; Primary Health Care
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171425-3
    ISSN 1544-1717 ; 1544-1709
    ISSN (online) 1544-1717
    ISSN 1544-1709
    DOI 10.1370/afm.2908
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  7. Article ; Online: Résultats de consultation des patients âgés de 65 ans et plus pris en charge en médecine générale : quelles sont les associations remarquables ?

    Vandroz, Elodie / Subtil, Fabien / Bonnefoy, Marc / Letrilliart, Laurent

    Geriatrie et psychologie neuropsychiatrie du vieillissement

    2021  Volume 19, Issue 4, Page(s) 366–374

    Abstract: Introduction: We aimed at identifying the associations of health issues managed in general practice encounters with patients aged 65 years or over, according to their sex.: Methods: Ancillary study of the ECOGEN study on the consultation practice of ... ...

    Title translation Health issues of patients aged 65 years or over managed in general practice: which associations are remarkable?
    Abstract Introduction: We aimed at identifying the associations of health issues managed in general practice encounters with patients aged 65 years or over, according to their sex.
    Methods: Ancillary study of the ECOGEN study on the consultation practice of French general practitioners. We have studied the 15 most frequent health issues managed in patients aged 65 years or over and identified the pairs most frequently and strongly associated.
    Results: The sample included 5,782 encounters corresponding to 17,182 health issues managed. Each encounter involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with lipid disorder. Some associations were specific to patient sex.
    Conclusion: The remarkable associations identified may enable to improve the management of elderly patients with multimorbidity by favouring synergic treatments.
    MeSH term(s) Aged ; General Practice ; General Practitioners ; Humans ; Multimorbidity ; Referral and Consultation
    Language French
    Publishing date 2021-11-28
    Publishing country France
    Document type Journal Article
    ISSN 2115-7863
    ISSN (online) 2115-7863
    DOI 10.1684/pnv.2021.0970
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Drug prescription goals in primary care: a cross-sectional study.

    Bernard, Louis / Ecochard, René / Gueyffier, François / Letrilliart, Laurent

    BMC health services research

    2020  Volume 20, Issue 1, Page(s) 6

    Abstract: Background: Care goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement ... ...

    Abstract Background: Care goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement between physicians and patients.
    Methods: This was a cross-sectional study conducted by 11 resident trainees acting as observers in 23 general practices. The residents recorded the indication and main physician's goal for all drugs prescribed during five consultation days in each practice in December 2015, and the main patient's goal for a sub-sample of consultations. We used an eight-category generic classification of prescription goals, including three specific (mortality, morbidity and cure), three non-specific (symptoms, quality of life, functioning) and two non-specified (other goal, no goal) categories. Analyses were based on a multivariable, multilevel model and on the kappa statistic applied to the sub-sample of consultations.
    Results: The sample encompassed 2141 consultations and 5036 drugs. The main physicians' goal of drug prescriptions was to relieve symptoms (43.3%). The other goals were to decrease the risk of morbidity (22.4%), to cure disease (11.7%), to improve quality of life (10.6%), to decrease the risk of mortality (8.5%) and to improve functioning (1.8%). The choice of a specific goal was more frequent in patients with the following characteristics: over 50 (OR [1.09;1.15]), of male gender (OR [1.09;1.39]), with full financial coverage for a long-term condition (OR [1.47;1.97]), known by the physician (OR [1.19;2.23]), or with a somatic health problem (OR [2.56;4.17]). Cohen's kappa for drug prescription goals between the patients and the physicians was 0.26 (0.23-0.30).
    Conclusions: Physicians' goals are poorly shared with patients. It remains to be assessed whether it is possible to collect and discuss information on prescription goals on a daily basis.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Drug Prescriptions ; Female ; France ; General Practice ; General Practitioners/psychology ; General Practitioners/statistics & numerical data ; Goals ; Humans ; Male ; Middle Aged ; Physician-Patient Relations ; Practice Patterns, Physicians' ; Primary Health Care ; Young Adult
    Language English
    Publishing date 2020-01-02
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study
    ISSN 1472-6963
    ISSN (online) 1472-6963
    DOI 10.1186/s12913-019-4870-y
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  9. Article ; Online: Evaluation of a guidelines website capitalizing on Finnish content and Belgium interface: A pilot study in French general practice.

    Rambaud, Claire / Fauquert, Benjamin / Charbonnel, Pascal / Falcoff, Hector / Letrilliart, Laurent

    Health informatics journal

    2021  Volume 27, Issue 2, Page(s) 14604582211024702

    Abstract: No reference point-of-care, web-based medical compendium is available in general practice in France. We have then conducted the experimentation ... ...

    Abstract No reference point-of-care, web-based medical compendium is available in general practice in France. We have then conducted the experimentation of
    MeSH term(s) Belgium ; Family Practice ; Finland ; General Practice ; Humans ; Pilot Projects
    Language English
    Publishing date 2021-07-20
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2213115-2
    ISSN 1741-2811 ; 1460-4582
    ISSN (online) 1741-2811
    ISSN 1460-4582
    DOI 10.1177/14604582211024702
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  10. Article ; Online: General practitioner gender and use of diagnostic procedures: a French cross-sectional study in training practices.

    Bouissiere, Amandine / Laperrouse, Marine / Panjo, Henri / Ringa, Virginie / Rigal, Laurent / Letrilliart, Laurent

    BMJ open

    2022  Volume 12, Issue 5, Page(s) e054486

    Abstract: Objectives: The acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the influence of general practitioner (GP) gender on the use of the three ... ...

    Abstract Objectives: The acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the influence of general practitioner (GP) gender on the use of the three main categories of diagnostic procedures-clinical examinations, laboratory tests and imaging investigations.
    Design: Cross-sectional nationwide multicentre study.
    Setting: French training general practices.
    Participants: The patient sample included all the voluntary patients over a cumulative period of 5 days per office between November 2011 and April 2012. The GP sample included 85 males and 43 females.
    Methods: 54 interns in general practice, observing their GP supervisors, collected data about the characteristics of GPs and consultations, as well as the health problems managed during the visit and the processes of care associated with them. Using hierarchical multilevel mixed-effect logistic regression models, we performed multivariable analyses to assess differences in each of the three main categories of diagnostic procedures, and two specific multivariable analyses for each category, distinguishing screening from diagnostic or follow-up procedures. We searched for interactions between GP gender and patient gender or type of health problem managed.
    Results: This analysis of 45 582 health problems managed in 20 613 consultations showed that female GPs performed more clinical examinations than male GPs, both for screening (OR 1.75; 95% CI 1.19 to 2.58) and for diagnostic or follow-up purposes (OR 1.41; 95% CI 1.08 to 1.84). Female GPs also ordered laboratory tests for diagnostic or follow-up purposes more frequently (OR 1.21; 95% CI 1.03 to 1.43). Female GPs performed even more clinical examinations than male GPs to diagnose or follow-up injuries (OR 1.69; 95% CI 1.19 to 2.40).
    Conclusion: Further research on the appropriateness of diagnostic procedures is required to determine to what extent these differences are related to underuse or overuse.
    MeSH term(s) Cross-Sectional Studies ; Female ; General Practice ; General Practitioners ; Humans ; Male ; Practice Patterns, Physicians' ; Referral and Consultation
    Language English
    Publishing date 2022-05-06
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-054486
    Database MEDical Literature Analysis and Retrieval System OnLINE

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