全科医生如何将预防性护理建议付诸实践？瑞士和法国的一项横断面研究。
How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France.
作者信息
Sebo Paul, Cerutti Bernard, Fournier Jean-Pascal, Rat Cédric, Rougerie Fabien, Senn Nicolas, Haller Dagmar M, Maisonneuve Hubert
机构信息
Primary Care Unit, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
Unit of Research and Development in Medical Education, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
出版信息
BMJ Open. 2017 Oct 6;7(10):e017958. doi: 10.1136/bmjopen-2017-017958.
OBJECTIVES
We previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs' reports of how they put different preventive recommendations into practice.
DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France).
MAIN OUTCOME MEASURES
We investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use.
RESULTS
A large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ≥21 drinks/week (24%) and ≥4 drinks/occasion for binge drinking (20%), and for women, ≥14 drinks/week (28%) and ≥3 drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2 years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75-80 years (32%-34%).
CONCLUSIONS
The large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.
目的
我们之前发现，欧洲法语区的全科医生（GP）对常见预防性建议的采纳情况各不相同。在本研究中，我们描述了全科医生关于他们如何将不同预防性建议付诸实践的报告。
设计、背景和参与者：2015年在瑞士和法国进行的横断面研究。随机选取3400名全科医生，要求他们完成邮寄问卷（n = 1100）或在线问卷（n = 2300）。仅从事补充和替代医学的全科医生不符合该研究条件。764名全科医生（回复率：邮寄问卷47%，在线问卷11%）返回了问卷（瑞士428名，法国336名）。
主要观察指标
我们调查了全科医生如何开展五项预防措施（血脂异常、结直肠癌和前列腺癌筛查、识别有害饮酒及简短干预），考察他们选择的年龄组、筛查频率、使用的检测方法、是否倾向于共同决策前列腺癌筛查以及他们对有害饮酒的定义。
结果
观察到全科医生提供这些措施的方式存在很大差异。41%的人报告每年进行胆固醇筛查，开始和停止筛查的年龄各不相同。82%的人未使用任何检测方法来识别有害饮酒。对于有害饮酒的定义，最常见的回答是，男性为每周≥21杯（24%），狂饮时每次≥4杯（20%）；女性为每周≥14杯（28%），每次≥3杯（21%）。瑞士主要通过结肠镜检查（86%）、法国主要通过粪便检测（93%）对50岁（87%）至75岁（67%）的患者每10年进行一次结直肠癌筛查（瑞士为65%，法国为91%）。前列腺癌筛查通常采用共同决策（82%），对50岁（74%）至75 - 80岁（32% - 34%）的患者每年进行一次筛查（62%）。
结论
这些措施的提供方式存在很大差异，需要加以解决，因为这可能与对当前指南的一些误解、指南采纳的障碍有关，或者更有可能与各项建议之间缺乏一致性有关。
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