Attitudes toward preventive services and lifestyle : the views of primary care patients in Europe. The EUROPREVIEW patient study

Background: For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective: To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods: Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results: Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years. Conclusions: A high proportion of patients attending primary care with unhealthy lifestyles (especially risky drinkers) do not perceive the need to change their habits, and about half the patients reported not having had any discussion on healthy lifestyles with their GPs. Patients overestimate their need to be screened for cardiovascular risk factors and for cancer.peer-reviewe

Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

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

Indicateurs de qualité dans la prise en charge de l'hyperglycémie du patient diabétique de type 2 en soins primaires (revue de la littérature internationale)

Introduction : La prévalence du diabète de type 2 est en augmentation constante à l échelle mondiale, responsable une morbi-mortalité importante et de coûts élevés. Optimiser l équilibre glycémique permettrait de diminuer l impact de ses complications. Un moyen d améliorer la prise en charge est la création d indicateurs de qualité permettant de mesurer la performance de la pratique quotidienne au sein des programmes de paiements à la performance (P4P). L objectif de cette étude est de recenser les indicateurs de qualité des soins et traitements relatifs à l hyperglycémie dans le diabète de type 2 en soins primaires dans le monde.Méthode : Nous avons réalisé une revue non systématique de la littérature internationale sur les articles publiés entre 2002 et 2012 dans la littérature indexée (PubMed et Embase) et la littérature grise. Nous avons recensé l ensemble des indicateurs relatifs à l hyperglycémie utilisés à l étranger, puis nous les avons regroupés selon leur thème et leur type (procédure, résultat, structure). Résultats : Nous avons identifié 42 articles comprenant 104 indicateurs sources qui utilisent l HbA1c, la glycémie, le métabolisme et la thérapeutique. Après regroupement, nous avons obtenu 14 indicateurs définitifs : 50% utilisent la thérapeutique, 28,6% l HbA1c, 14,3% la glycémie et 7,1% le métabolisme. 92,9% sont des indicateurs de procédure, et 7,1% sont des indicateurs de résultat. Dans 78,6% des cas, ils sont utilisés en routine (dans un programme de P4P ou ayant un impact en pratique courante). Conclusion : Nous avons identifié un nombre élevé d indicateurs qui présentent une grande diversité et hétérogénéité, reflétant les possibilités multiples de mesurer la qualité des soins. Des études complémentaires permettraient d évaluer leur pertinence et leur faisabilité pour élargir leur mise en pratique, notamment en France où seuls deux de ces indicateurs sont actuellement utilisésIntroduction : Prevalence of type 2 diabetes in increasing worldwide and reponsible for high morbidity and mortality, and high costs as well. Optimization of glycemic rates may decrease complications. One way to improve care is to create quality indicators measuring performance of daily manners, among pay for performance programs (P4P). The aim of this study is to identity quality indicators of care and treatments related to hyperglycemia in type 2 diabetes, in worldwide primary cares. Method : We made a non systematic review of international literature on articles published between 2002 and 2012 in indexed literature (PubMed and Embase) and non indexed literature. We have collected al the indicators related to hyperglycemia used abroad, and then we have regrouped them according to their theme and type (procedure, result, structure). Results : We have identitfied 42 articles containing 104 "source indicators" as HbA1c, glycemia, metabolism and therapy. After regroupment, we obtained 14 "definite indicators" : 50% using therapy, 28,6% using HbA1c, 14,3% using glycemy and 7,1% using metabolism. Most of them (92,9%) were procedure indicators, and 7,1% were result indicators. In 78,6% of cases, they were routinely used (in P4P or having an impact on daily exercise). Conclusion : We identified a high rate of indicators wich ppresent a big diversity and heterogenicity. It shows the numerous ways to measure quality of care. Further studies may help to evaluate their accuracy And feasibility to enlarge their use, in particular in France where only two of there indicators are commonly usedST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF

Angine et prescription d'antibiotiques (impact de l'utilisation systématique du score de Mac Isaac)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Fréquence de diagnostic et traitement des infections cutanées bactériennes superficielles à staphylocoque doré en médecine générale

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Evolution de la prescription d'antibiotiques en cas de rhinopharyngite en médecine générale

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Plaidoyer pour l’intégration des patients formateurs dans l’enseignement des futurs médecins généralistes à partir de l’expérience de l’université Sorbonne Paris Nord et de la littérature internationale

International audienc

Scoring and psychometric validation of the ‘Determinants of Intentions to Vaccinate’ (DIVA©) questionnaire

International audienceBackground: Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the ‘Determinants of Intentions to Vaccinate’ (DIVA©) questionnaire that aims to assess PCPs’ attitudes and beliefs toward vaccination.Methods: The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD.Results: The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The ‘Commitment of the PCP to the vaccination approach’ score showed very good internal consistency reliability (Cronbach’s alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed.Conclusions: The DIVA questionnaire is a valid and reliable measure of PCPs’ attitudes and beliefs toward vaccination