How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study

BACKGROUND: Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners’ (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. METHODS: This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs’ age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. RESULTS: The high prescribers were middle-aged (40–59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs’ workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. CONCLUSIONS: Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP’s practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12991-015-0041-7) contains supplementary material, which is available to authorized users

Patients’ high acceptability of a future therapeutic HIV vaccine in France: a French paradox?

International audienc

Primary care practitioners’ diagnostic action when the patient may have cancer : an exploratory vignette study in 20 European countries

Availability of data To avoid the risk of identification of individual participants, the datasets generated and analysed during the current study are not publicly available. However, they are available (with any possible identifying information redacted) from the corresponding author on reasonable request. Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. ALN’s time is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with her infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Acknowledgements We would like to thank all the PCPs who piloted the questionnaire and those who completed the survey. We would also like to thank the European GP Research Network for its support. We are grateful to Prof. Barbara Silverman and Prof. Lital Keinan for the data on cancer survival rates in Israel, and to Dr Yochai Schonmann for his work on those data. Two of the vignettes were used by kind permission of the ICBP; we also thank Dr Peter Murchie and Dr Rhona Auckland, who generously provided the other two vignettes. Prof. Antonius Schneider kindly organised the Technical University of Munich’s data collection.Peer reviewedPublisher PD

Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion : a European cross-sectional survey

ALN is supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translation Research Centre, with infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http://dx.doi.org/10.1136/bmjopen-2018-022904).Peer reviewedPublisher PD

Understanding the prescription of antidepressants: a Qualitative study among French GPs

<p>Abstract</p> <p>Background</p> <p>One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them.</p> <p>Method</p> <p>Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers.</p> <p>Results</p> <p>Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found.</p> <p>Conclusions</p> <p>The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.</p

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Prévention de la listériose maternofoetale en médecine générale

La listériose maternofoetale est une maladie rare, peu connue des femmes enceintes et grave pendant la grossesse. La présence d'analogies entre cette maladie et la toxoplasmose congénitale, nous a amenés à envisager la mise en place d'une politique de prévention de la listériose à partir de la listériose à partir de celle de la toxoplasmose, bien établie en France depuis 1978 afin de concevoir une politique pratique à l'échelle des médecins et une politique publique à l'échelle du gouvernement. Pour évaluer les connaissances des médecins généralistes du Val-d'Oise sur la listériose et leur pratique de la prévention de la toxoplasmose congénitale, nous avons réalisé une enquête auprès de 250 d'entre eux, choisis par tirage au sort. Le taux de réponse fut de 33 %. On a pu mettre en évidence un manque de connaissances sur la listériose maternofoetale mais également sur la prévention de la toxoplasmose congénitale. Promouvoir une politique de prévention de la listériose maternofoetale semble possible. Pour cela, une meilleure formation des étudiants en médecine et davantage d'information aux médecins installés, sur les risques infectieux pendant la grossesse, seraient indispensablesPARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comment les internes de médecine générale de Paris Diderot sont ils formés à la psychothérapie de soutien ?

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Vécu de la maladie arthrosique et sa prise en charge en médecine générale

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Freins à l arrêt du traitement hormonal de la ménopause chez les femmes l utilisant au-delà de la durée préconisée

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF