Prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients in general practice: a cross-sectional study based on French and Italian prescribing data

BACKGROUND Asthma is often poorly controlled and guidelines are often inadequately followed in medical practice. In particular, the prescription of non-asthma-specific drugs can affect the quality of care. The goal of this study was to measure the frequency of the prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients and to look for associations between sex or age and the prescription of these drugs. METHODS A cross-sectional study was conducted using computerised medical records from French and Italian general practitioners' networks. Patients were selected according to criteria adapted from the HEDIS (Healthcare Effectiveness Data and Information Set) criteria. The outcome measure was the number of antibiotics or anxiolytics/hypnotics prescriptions per patient in 1 year. Parallel multivariate models were developed. RESULTS The final sample included 3,093 French patients (mean age 27.6 years, 49.7% women) and 3,872 Italian patients (mean age 29.1 years, 48.7% women). In the univariate analysis, the French patients were prescribed fewer antibiotics than the Italian patients (37.1% vs. 42.2%, p < 0.00001) but more anxiolytics/hypnotics (17.8% vs. 6.9%, p < 0.0001). In the multivariate models, the female patients were more likely to receive antibiotics (odds ratio: 1.5 [1.3-1.7]) and anxiolytics/hypnotics (odds ratio: 1.8 [1.5-2.1]). CONCLUSIONS The prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients is frequent, especially in women. Asthma guidelines should address this issue by referring to other guidelines covering the prescription of non-asthma-specific drugs, and alternative non-pharmacological interventions should be considered

Correlates of quality of life of pre-obese and obese patients: a pharmacy-based cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies.</p> <p>Methods</p> <p>A convenience sample of patients with a Body Mass Index ≥ 28 kg/m²were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension.</p> <p>Results</p> <p>QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m²was significantly associated with poorer QOL scores on physical, relational and psychological dimensions.</p> <p>Conclusion</p> <p>Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.</p

Prometheus: the implementation of clinical coding schemes in French routine general practice

Background Clinical data are most useful, both at the individual level and collectively, if they are coded according to a standard classification system. However, clinicians often have little motivation to routinely code their consultation data. The main classification systems available in French primary care are the International Classification of Primary Care (ICPC)and the Dictionary of Consultation Results (DCR). Objective To assess the feasibility of using the ICPC-2 and the DCR for coding health problems managed in routine general practice in France. Methods Between December 2001 and June 2003, 61 volunteer general practitioners (GPs)from the Paris area prospectively recorded the health problems they managed at consultations, using either the ICPC (36 GPs)or the DCR (25 GPs), for a period of six months. They were equipped with one of three proprietary medical software applications specifically adapted for the study, or one open source utility, interfacing with five other, non-adapted, proprietary software programs. They had a two-day training session, were financially compensated, and were provided with electronic feedback. Results The mean reported coding time per consultation was 2.5 minutes, but 28 physicians (46%) judged the coding time excessive and reported a maximum acceptable time of 1.2 minutes. Coding consultation data was considered more useful at the collective level (by 95% of physicians)than at the individual practice level (by 69%). Only 34 physicians (56%)expressed willingness to carry on routine coding after the end of the study. Some results differed depending on the classification system used, especially due to confounding factors, as some physicians could have previously used the given system. Conclusions Coding health problems on a routine basis proved to be feasible. However, this process can be used on a more widespread basis and linked to other management data only if physicians are specially trained and rewarded, and the software incorporates large terminologies mapped with classifications

The Experience of Pregnancy Discovery andAcceptance: A Descriptive Study Based on freeHierarchical Evocation by Associative Networks

Women’s childbearing experiences vary with pregnancy intentional nature and outcome. An Associative Network study targeted 129 women pregnant &gt;1 year ago and their experiences at pregnancy start and post-pregnancy. Word-associations formed 15 themes and 5 metathemes. The main pregnancy discovery themes were “Affect” (39%), “Relationships with others” (11%), and “Logistics” (7%). The main post-pregnancy themes were “Affect” (18%), “Relationship with the child” (13%), and “Personal progress” (12%). The overall polarity index was higher in intended vs. unintended pregnancies. Whatever pregnancy outcome, women expressed impressions of constructive experience. Discovering pregnancy and deciding about it led anyway to personal and social progress

Breast cancer specialists&apos; perspective on their role in their patients&apos; return to work: A qualitative study

OBJECTIVES: This study aimed to explore the views of breast cancer (BC) specialists as to their role in the return-to-work (RTW) process of their BC patients. METHODS: A qualitative study using semi-structured interviews was conducted in a sample of 20 BC specialists selected according to age, gender, medical specialty (medical oncology, radiation oncology, gynecological surgery), and healthcare organization (regional cancer center, university or private hospital). All interviews were audiotaped and transcribed for qualitative thematic content analysis. RESULTS: BC specialists had heterogeneous representations and practices regarding their role in their patients` RTW process, ranging from non-involvement to frequent discussion. Most BC specialists had concerns regarding the ?right time and right way? to address patient`s RTW. They hardly mentioned workplace and job factors as potential barriers but rather stressed motivation. The main reported barriers to involvement in the RTW process were lack of time, lack of knowledge, lack of skills, and a professional attitude exclusively focused on cancer care issues. CONCLUSION: While our study showed varying representations and practices among BC specialists, participants consistently identified barriers in supporting BC survivors` RTW. The results will guide the development of an intervention to facilitate the role of BC specialists in the RTW process as part of a multicomponent intervention to facilitate BC survivors` RTW

Dépister ou ne pas dépister (une revue systématique des recommandations de pratique sur les dépistages de masse)

Contexte: Les guides de pratique sur les dépistages de masse se sont multipliés et couvrent un nombre croissant de problèmes de santé. Les médecins généralistes peuvent avoir des difficultés pour les connaître et les mettre en oeuvre de manière appropriée. Objectifs: Identifier les recommandations sur les dépistages de masse en soins primaires selon leur grade. Méthodologie: Nous avons effectué une revue systématique de la littérature internationale dans les bases de données Medline et Web of Science ainsi que dans six sources majeures de guides de pratiques. Les guides de pratiques sur le dépistage publiés de mars 2002 à août 2012 ont été inclus. Le système de gradation du NICE a été utilisé pour reclasser les grades des recommandations de tous les guides de pratiques inclus. Résultats: Cent quarante-neuf guides de pratiques ont été identifiés, comprenant 228 recommandations couvrant 65 problèmes de santé (80 avec les subdivisions). Ces recommandations étaient prescriptives pour 27 problèmes de santé, proscriptives pour 40, et divergentes pour 13. Douze problèmes de santé étaient couverts par de fortes recommandations (grade A) pour le dépistage de masse et six par de fortes recommandations contre. Les recommandations proscriptives étaient plus fréquemment de plus bas grade (66% avec un grade C ou D), en comparaison avec les recommandations prescriptives (31 %, p<0,001). Nous n'avons trouvé qu'une seule forte recommandation prescriptive (sur l'infection à Chlamydia) chez les adolescents et aucune chez les enfants. L'appareil uro-génital (16 problèmes de santé), la grossesse (14) et le système cardio-vasculaire (10) étaient les principaux appareils corporels concernés par les recommandations de dépistage. Parmi les dépistages recommandés, 17 étaient basés sur des tests biologiques, 13 sur des tests cliniques et 6 sur des imageries. Les recommandations étaient émises par des agences nationales (42%) ou des sociétés de spécialités (58%), principalement en provenance des Etats-Unis (74%), du Royaume Uni (9%) et du Canada (7%). Les recommandations proscriptives étaient plus souvent produites par les agences nationales que par les sociétés de spécialité (51% contre 25%, p=O.OOl). Conclusions: Les médecins devraient mieux suivre les recommandations de haut grade pour protéger leurs patients contre le surdiagnostic et se protéger eux-mêmes contre le risque de poursuite judiciaire. Pour améliorer le respect des recommandations, leurs rédacteurs devraient définir avec attention les problèmes de santé couverts et utiliser un système de gradation standard. Des indicateurs pertinents pour évaluer la balance bénéfices-risques, de même que la limite d'âge supérieure et l'intervalle de dépistage, devraient être fournis pour chaque recommandation.LYON1-BU Santé (693882101) / SudocSudocFranceF

L'intervention brève en soins de santé primaires (une revue systématique de la littérature)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Intérêt des peptides natriurétiques de type B dans l'insuffisance cardiaque en médecine ambulatoire (une revue de la littérature internationale)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Disposition des médecins généralistes à participer à la recherche en soins primaires (l'étude DRIM )

LYON1-BU Santé (693882101) / SudocSudocFranceF