提供机会性初级预防保健的法国全科医生概况——一项观察性横断面多中心研究

Profile of French general practitioners providing opportunistic primary preventive care--an observational cross-sectional multicentre study.

作者信息

Gelly Julien, Le Bel Josselin, Aubin-Auger Isabelle, Mercier Alain, Youssef Elodie, Mentre France, Nougairede Michel, Letrilliart Laurent, Duval Xavier

机构信息

Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobials, Modelling, Evolution (IAME), Unité mixte de recherche (UMR) 1137, F-75018 Paris, University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris,

出版信息

Fam Pract. 2014 Aug;31(4):445-52. doi: 10.1093/fampra/cmu032. Epub 2014 Jun 12.

DOI:10.1093/fampra/cmu032

PMID:24925928

Abstract

BACKGROUND

Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation.

OBJECTIVE

To assess with passive observers, the degree to which French GPs opportunistically perform primary preventive care during routine consultation.

METHODS

Observational cross-sectional multicentre ancillary study of the French ECOGEN study. The study period extended from 28 November 2011 to 30 April 2012. The inclusion criteria were patients seen by GPs at surgery and home consultations in non-randomized pre-determined half-day blocks per week. The non-inclusion criteria were patient's refusal and consultations initially focused on primary prevention in response to patient's request (ancillary study's specific criterion). Using passive observers, data were collected based on the second version of International Classification of Primary Care. Preventive consultations were defined if at least one problem/diagnosis was considered by consensus as definitely related to primary prevention. For each one of the 128 participating GPs, aggregation of data was performed from all his/her consultations. Determinants of the proportion of preventive consultations per GP were assessed by multivariate linear regression.

RESULTS

Considering 19003 consultations, the median proportion of preventive consultations per GP was 14.9% (range: 0-78.3%). It decreased with increased proportion of patients aged 18 or less (P = 0.006), with increased proportion of home visits (P = 0.008) and with increased proportion of consultations lasting under 10 minutes (P = 0.02). None of the GPs' personal characteristics were significantly associated.

CONCLUSION

Primary preventive care activity was related to the characteristics of GPs' patients and practice organizational markers and not to GPs' personal characteristics.

摘要

背景

全科医生（GP）机会性提供的预防服务不足。原因大多是通过全科医生的自我报告收集，而非通过独立观察。

目的

通过被动观察者评估法国全科医生在常规诊疗期间机会性开展初级预防保健的程度。

方法

法国ECOGEN研究的观察性横断面多中心辅助研究。研究期从2011年11月28日至2012年4月30日。纳入标准为全科医生在手术诊疗及每周预先确定的非随机半天时间段内进行家访时接待的患者。排除标准为患者拒绝以及最初因患者要求而专注于初级预防的诊疗（辅助研究的特定标准）。使用被动观察者，依据国际初级保健分类第二版收集数据。若至少有一个问题/诊断经共识确定与初级预防明确相关，则定义为预防性诊疗。对于128名参与研究的全科医生中的每一位，汇总其所有诊疗的数据。通过多变量线性回归评估每位全科医生预防性诊疗比例的决定因素。