Effectiveness of coordinated care to reduce the risk of prolonged disability among patients suffering from subacute or recurrent acute low back pain in primary care: protocol of the CO.LOMB cluster-randomized, controlled study

BackgroundLow back pain (LBP) is a common musculoskeletal condition and, globally, a leading cause of years lived with disability. It leads to reduced social participation, impaired quality of life, and direct and indirect costs due to work incapacity. A coordinated approach focusing on psychosocial risk factors, active reeducation, and the early use of tools to maintain employment, may be effective for improving prognosis of patients with LBP. Primary care professionals and multidisciplinary teams, who see patients in the early stages of LBP may be in the best position to implement such a coordinated approach. We designed this study to assess a coordinated multi-faceted strategy in primary care for patients with subacute or recurrent acute LBP.MethodsThe CO.LOMB study was designed as a multicentric, cluster-randomized, controlled study. Patients aged 18–60 years, with subacute or recurrent acute LBP are eligible. Patients also need to be employed (but can be on sick leave) with access to occupational health services. The clusters of GPs will be randomized (1:1) to either the Coordinated-care group or the Usual-care group. Patients will be assigned the group allocated to their GP. The healthcare professionals (GPs and associated physiotherapists) allocated to the Coordinated-care group will perform a 2-session study training. The following interventions are planned in the Coordinated-care group: exploration and management of psychosocial factors, active reeducation with a physiotherapist, the implementing of tools to maintain employment, and a reinforced cooperation between primary healthcare professionals. The primary objective is to assess the benefit of coordinated primary care to reduce disability in LBP patients at 12 months after enrollment: measure using the validated French version of the Roland Morris Disability Questionnaire. Secondary objectives include the evaluation of pain, work status, and quality of life at various time points. The study plans to enroll 500 patients in 20 GP clusters. Patients will be followed up for 12months.DiscussionThis study will evaluate the benefit of a coordinated multi-faceted strategy in primary care for patients with LBP. Notably whether this approach will alleviate the associated disability, attenuate pain, and promote the maintenance or return to work.Clinical Trial RegistrationNCT04826757

Quelles sont les méthodes de travail des étudiants en médecine de Lille en DCEM2 et DCEM3 de 2011 à2013, en particulier concernant la lecture critique d'article

Contexte : Dès 2011, les étudiants de deuxième cycle de la faculté de médecine de Lille ont fait part de leurs difficultés concernant le passage des examens en une seule session de fin d année. Parallèlement, les instances facultaires ont révisé les programmes et instauré des examens partiels. C est dans ce contexte qu une réflexion pédagogique globale sur les méthodes de travail des étudiants et le vécu des examens a été initiée et a fait l objet de deux thèses menées conjointement. Objectif : Décrire les méthodes de travail des étudiants en médecine de Lille en DCEM, notamment concernant la LCA afin d aboutir à des pistes de réflexion pédagogiques. Méthode : Étude descriptive qualitative par entretiens semi-structurés et entretien de groupe réalisée auprès d étudiants en DCEM2 et DCEM3 de 2011 à 2013. Analyse informatique par théorisation ancrée approchée avec double codage. Résultats : Les étudiants en médecine ont rapporté une grande variabilité de leurs méthodes de travail. Ils ont dit que les ED rythmaient le travail mais que leur intérêt était variable. Les examens facultaires et les ECN ont été rapportés comme la principale motivation au travail. Ils ont raconté leurs difficultés en lien avec une quantité importante de travail, un manque de méthode, d encadrement et le sentiment d être perdus concernant les sources de travail. Les étudiants ont dit souhaiter que les ED ciblent les notions essentielles et guident leur travail. Ils ont dit vouloir interagir plus facilement avec les enseignants. Concernant la LCA, les étudiants ont jugé cette matière difficile du fait de sa méthodologie particulière, de l utilisation de termes complexes et n en comprennent pas l intérêt. Ils ont confié la travailler uniquement pour les examens. Ils ont dit souhaiter que l enseignement soit mieux organisé et orienté vers les ECN car la LCA compte pour 10% de la note aux ECN. Conclusion : L apprentissage par problème pourrait répondre aux attentes des étudiants en proposant une réflexion en petits groupes sur des cas pratiques et en favorisant l'interaction entre étudiants et enseignants. La clarification des attentes des enseignants envers les étudiants permettrait de les aider dans leur travail. Concernant la LCA, s'ajoute le problème de l'incompréhension de l'intérêt de la matière qui parait éloignée de la pratique. Proposer aux étudiants des clubs de lecture d'articles ou les intégrer, notamment pendant leurs stages, à la rédaction d'articles médicaux pourrait être bénéfiqueLILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

L’accompagnement de thèse de médecine générale avec des patients, nouvelle piste pédagogique de partenariat de soin avec le patient

Un partenariat patient-doctorant en médecine organise la transformation pédagogique de la faculté de médecine, Université Côte d’Azur. Celle-ci entre dans la culture du partenariat avec le patient (Boivin et al, 2017) qui promeut une nouvelle approche relationnelle du système de santé, en prolongement des recommandations de la recherche européenne Interreg APPS (2020). Une piste pédagogique impliquant des patients cochercheurs permise par une faculté de médecine dont le doyen a donné à un département d’enseignement et de recherche de médecine générale (DERMG) la mission d’accueillir une entité dédiée en son sein, le Centre d’Innovation du Partenariat avec les Patients et le Public (CI3P). Méthode : En 2020, dans le prolongement d’un partenariat créé depuis 2015 entre une association citoyenne développant de l‘éducation populaire dans le domaine de la santé, la Maison de la Médecine et de la Culture (MMC) et le DERMG, a été créée successivement une convention proposant des heures complémentaires aux internes en médecine générale qui participent aux événements de l’association, à un diplôme Universitaire primé par le ministère de l’enseignement supérieur et de la recherche (Prix PEPS 2018) et à la mise en oeuvre fin 2019 du CI3P. C’est de cette entité dédiée, le CI3P, qu’émergent de nouvelles formes de partenariat telle la conception méthodologique en troisième cycle, des accompagnements de thèse demédecine générale avec des patients partenaires cochercheurs

Impact of non-drug therapies on asthma control: A systematic review of the literature

International audienceDespite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking.To identify non-drug interventions likely to improve asthma control

Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study

International audienceBackground: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients' care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients' use of mHealth apps that could impact their willingness to recommend the apps to patients.Objective: The aim of this qualitative study is to investigate French GPs' attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs' perceptions and expectations of mHealth technologies.Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis.Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients' compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data).Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs' digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow

French General Practitioners’ Adaptations for Patients with Suspected COVID-19 in May 2020

International audienceIn France, towards the end of the first lockdown, COVID-19 management was largely transferred from hospitals to primary care. Primary care actors adapted their practices to ensure patients’ access to care, while limiting contamination. In this study, we aimed to identify patterns of adaptations implemented by French general practitioners (GPs) in May 2020 for outpatients with confirmed or suspected COVID-19, and factors associated with these adaptions. A French survey concerning care organization adaptations, and individual, organizational, and territorial characteristics, was sent to GPs. Data were analyzed by multiple correspondence analysis followed by agglomerative hierarchical clustering to identify GPs’ adaptation clusters. A multinomial logistic regression model estimated the associations between clusters and individual, organizational, and territorial factors. Finally, 3068 surveys were analyzed (5.8% of French GPs). Four GPs’ adaptation clusters were identified: autonomous medical reorganization (64.2% of responders), interprofessional reorganization (15.9%), use of hospital (5.1%), and collaboration with COVID-19 outpatient centers (14.8%). Age, practice type and size, and territorial features were significantly associated with adaptation clusters. Our results suggest that healthcare systems should consider organizational features of primary care to effectively deal with future challenges, including healthcare crises, such as the COVID-19 pandemic, but also those linked to epidemiologic and societal changes

The challenge for general practitioners to keep in touch with vulnerable patients during the COVID-19 lockdown: an observational study in France

International audienceBackground: In France, the first COVID-19-related lockdown (17th March to 10th May 2020) resulted in a major decrease in healthcare service utilization. This raised concerns about the continuity of care for vulnerable patients.Objectives: To identify individual and organizational factors associated with the initiatives taken by French GPs to contact vulnerable patients during the lockdown.Methods: A national observational survey using an online questionnaire was conducted to document French GPs' adaptations to the COVID-19 situation, their individual and organizational characteristics, including practice type (individual, group, multidisciplinary) and size. Data were collected from 7th to 20th May 2020 using mailing lists of GPs from the study partners and GPs who participated in a previous survey. This paper analysed answers to the question exploring whether and how GPs took initiatives to contact vulnerable patients. Responses were categorized in: no initiative; selection of patients to contact with a criteria-based strategy; initiative of contact without criteria-based strategy. Multivariate multinomial logistic regression identified factors associated with each category. Key components of the reported initiatives were described by inductive analysis of verbatim material.Results: Among the 3012 participant GPs (similar to 5.6% of French GPs), 1419 (47.1%) reported initiatives to contact some patients without criteria-based strategy, and 808 (26.8%) with a strategy using various clinical/psychological/social criteria. Women GPs more often declared initiatives of contacts with a criteria-based strategy (OR = 1.41, 95% CI [1.14-1.75]) as well as GPs with more than two patients who died due to COVID-19 in comparison with those having none (OR = 1.84, 95% CI [1.43-2.36]). Teaching GPs more often used criteria-based strategies than the other GPs (OR = 1.94, 95% CI [1.51-2.48]). Compared with those working in small monodisciplinary practice, GPs working alone were less likely to implement criteria-based initiatives of contacts (OR = 0.70, 95% CI [0.51-0.97]), while GPs working in multidisciplinary practice were more likely (OR = 1.94, 95% CI [1.26-2.98] in practices > 20 professionals).Conclusion: French GPs took various initiatives to keep in touch with vulnerable patients, more frequently when working in group practices. These findings confirm the importance of primary care organization to ensure continuity of care for vulnerable people

Interprofessional clinical decision‐making process in health: A scoping review

International audienceAbstract Aims To describe the key elements of the interprofessional decision‐making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. Design Scoping review of the literature. Data Sources MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. Review Methods References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision‐making process, (iv) were performed in an interprofessional context. ‘ PRISMA ‐scoping review’ guidelines were respected. The eligible studies were analysed and classified by an inductive approach Results We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision‐making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. Conclusion Decision‐making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision‐making in health. Impact The quality of a team decision‐making is critical to the quality of care. Interprofessional decision‐making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. Impact Statement Interprofessional decision‐making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision‐making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change

Une entité dédiée à la mobilisation des patients au coeur d'une faculté de médecine : le Centre d'Innovation du Partenariat avec les Patients et le Public (CI3P), point d'étape

Un partenariat institutionnel issu de l’action d’une association citoyenne oeuvrant dans ledomaine de la santé, la Maison de la Médecine et de la culture (MMC), a participé à la création d’uneentité croisant savoirs des professionnels de santé et savoirs expérientiels des patients au sein même de lafaculté de médecine de l’Université Côte d’Azur (Flora et al, 2020). Ce Centre d’Innovation dupartenariat avec les patients et le public (CI3P), codirigé par un tandem de partenariat médecin-patientDepuis sa création, le CI3P mobilise des patients partenaires sur la base de leurs compétences mobilisantles savoirs expérientiels acquis de la vie avec la maladie, qu’ils soient patients ou proches. Cettemobilisation s’organise selon une approche systémique en pédagogie médicale, dans l’enseignement dessciences de la santé, les milieux de soin et dans la recherche (Boivin et al, 2017). Ce centre présenté dansson organisation et ses missions lors du précédent colloque sur les patients enseignants organisé à lafaculté de médecine de Lyon Claude Bernard propose un nouvel état des lieu

Conception d’une formation interdisciplinaire à la collaboration interprofessionnelle en santé et services sociaux en partenariat patient : contribution d’une approche capacitante renforcée par le design pédagogique

L’éducation interprofessionnelle (EIP) est un domaine de recherche et de pratique d’enseignement essentiel depuis vingt ans tant dans les universités que dans les milieux de pratique en sciences de la santé et psychologie sociale. Les opportunités de formation à l’EIP se présentent lorsque des étudiants et des étudiantes de plusieurs professions de santé apprennent ensemble de manière interactive la collaboration interprofessionnelle et à améliorer les résultats des soins à la communauté citoyenne. Il est prouvé que la conception des soins est de meilleure qualité lorsque les professionnels de santé comprennent les rôles respectifs de chacun, ce qui facilite leur communication et leur travail d'équipe. Cependant, ce type de conception pédagogique d’une formation interdisciplinaire rencontre de nombreux problèmes tels que les obstacles de communication, synchronisation des horaires, de logistique ainsi que celui du cloisonnement des professions engendrant des préjugés malgré les efforts pédagogiques émis. En outre, ces formations accueillent d’importantes cohortes en formation initiale universitaire et leur design pédagogique peut manquer d’ancrages authentiques ce qui diminue la capabilité des personnes à mobiliser la collaboration interprofessionnelle en partenariat de soins. Cet article propose un modèle théorique fondé sur une approche capacitaire renforcée incluant l’usage du design pédagogique pour la réussite étudiante afin de concevoir ce type de formation en dépassant les limites évoquées par la littérature du domaine. Nos résultats rendent compte du processus d’agentivité collective suscité par la démarche d’intervention collaborative et les ressources coproduites dans l’atteinte de cet objet. Quelques illustrations empiriques documentent le processus développemental engagé, mais aussi ses freins initiaux.Interprofessional education (IPE) has been a key area of research and teaching practice for the past twenty years in both university and practice settings in the health sciences and social psychology. IPE training opportunities arise when students from multiple health professions interactively learn together about interprofessional collaboration and how to improve care outcomes for the community at large. It has been proven that the design of care is of higher quality when healthcare professionals understand each other's respective roles, facilitating their communication and teamwork. However, this type of pedagogical approach to interdisciplinary training is fraught with problems, such as communication barriers, synchronization of schedules and logistics, as well as the compartmentalization of professions, which can lead to prejudice despite the educational efforts made. What's more, these courses are attended by large cohorts of initial university trainees, and their pedagogical design may lack authentic anchors, thus diminishing the ability of individuals to mobilize interprofessional collaboration in care partnerships. This article proposes a theoretical model based on an enhanced capability approach, including the use of pedagogical design for student success, to design this type of training by overcoming